Abstract
Objective:To determine the accuracy of peripheral (radial) arterial access as compared to central (femoral) arterial access for measurement of invasive blood pressure (IBP) in critically ill patients after cardiopulmonary bypass.Methods:Sixty patients (60) who required high inotropic/vasopressor support on weaning from cardio-pulmonary bypass and weaned off in 2nd attempt were included in this study. The duration of this study was from June 2015 to August 2016. Radial and femoral arterial access was achieved in all patients for simultaneous measurement of blood pressure. Arterial pressures were noted after 5, 15 and 30 minutes of weaning from cardiopulmonary bypass for both radial and femoral artery simultaneously.Results:Mean age of study patients was 56.48±11.17 years. 85% patients were male. There was significant difference in systolic blood pressure, diastolic blood pressure and mean arterial pressures between the radial artery and femoral artery cannulation. Mean arterial pressures were significantly high in femoral artery as compared to the radial artery. The mean arterial pressures after five minutes of weaning using central access were 76.28±10.21 mmHg versus 64.15±6.76 mmHg in peripheral arterial access (p-value <0.001). Similarly we also found significant difference in mean arterial pressures after 15 minutes of weaning from cardiopulmonary bypass 78.70±10.12 mmHg in central access versus 72.03±6.76 mmHg using peripheral arterial access (p-value <0.001). The difference in arterial pressures were less marked as compared to the previous differences after 30 minutes of weaning from cardiopulmonary bypass as compared to the earlier readings (p-value 0.001).Conclusion:Peripheral arterial pressures are unreliable in critically ill patients after cardiopulmonary bypass receiving high dose of inotropic drugs. Central arterial access should be used in these patients to get accurate estimates of patients’ blood pressure in early periods after cardiopulmonary bypass.
Highlights
Monitoring of arterial blood pressure is very important for the evaluation of hemodynamic measurements as it gives a mandatory information about cardiovascular performance and tissue perfusion.[1,2] The most common indication for invasive blood pressure (IBP) monitoring is continuous hemodynamic monitoring in critically ill patients, during high risk and major surgery, in patients with sepsis and in patients receiving vasoactive drugs or changes in blood volume or arterial tone and those with arrhythmias.[3,4,5] IBP monitoring is a gold standard as it allows beat by beat measurement of patients’ blood pressure and vasoactive drugs response in these patients
Dorman et al concluded that IBP monitoring using radial artery cannulation underestimates the central arterial pressure and femoral line allowed a significant reduction in infusion of vasoactive drugs in critically ill patients.[13]
There was a significant difference in systolic blood pressure, diastolic blood pressure and mean arterial pressures between the radial artery and femoral artery cannulation after 5, 15 and 30 minutes of weaning from cardio-pulmonary bypass (CPB)
Summary
Monitoring of arterial blood pressure is very important for the evaluation of hemodynamic measurements as it gives a mandatory information about cardiovascular performance and tissue perfusion.[1,2] The most common indication for invasive blood pressure (IBP) monitoring is continuous hemodynamic monitoring in critically ill patients, during high risk and major surgery, in patients with sepsis and in patients receiving vasoactive drugs or changes in blood volume or arterial tone and those with arrhythmias.[3,4,5] IBP monitoring is a gold standard as it allows beat by beat measurement of patients’ blood pressure and vasoactive drugs response in these patients. Arterial blood monitoring should be as accurate as possible. Radial artery cannulation is used in about 92.0% cases and femoral artery cannulation is the 2nd most commonly used artery.[6] some clinicians prefer femoral artery access because of its lower rates of occlusion, thrombosis, and infectious complications.[7] Many studies have compared the accuracy of peripheral blood pressure monitoring and central blood monitoring in cardiac surgery patients.[8,9,10,11,12] These studies were conducted on hemodynamically stable patients and compared the accuracy of radial and femoral arterial access either in pre-cardiopulmonary bypass or during cardiopulmonary bypass phase but not in postcardiopulmonary bypass period. The aim of the present study was to determine the accuracy of peripheral (radial) arterial access as compared to central (femoral) arterial access for measurement of IBP in critically sick patients after cardiopulmonary bypass
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