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Contribution of arterial stiffness and stroke volume to peripheral pulse pressure in ICU patients: an arterial tonometry study

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Abstract

Objective

Peripheral arterial pulse pressure is increasingly used to assess hemodynamic status. Our aim was to test the respective influence of arterial stiffness, stroke volume, peripheral resistance, and various hemodynamic and demographic variables on peripheral pulse pressure in critically ill patients.

Design

Prospective study.

Setting

Medical intensive care unit of a university hospital.

Interventions

None.

Patients

67 sinus rhythm patients (mean age 57 ± 17 years) of whom 17 received vasoactive agents.

Measurements and results

The stroke volume was calculated by Doppler echocardiography. Radial pressures were calibrated from systolic and diastolic brachial cuff pressures. Central aortic pressure was estimated by radial applanation tonometry. The arterial compliance was estimated from the aortic pressure curve using the area method and the arterial stiffness was calculated as 1/compliance. The influences of age, body surface area, arterial stiffness, stroke volume, peripheral resistance, and time intervals on peripheral pulse pressure were tested using univariate and multivariate analyses. The mean arterial pressure ranged from 42 to 113 mmHg. Peripheral pulse pressure (59 ± 17 mmHg) was higher than aortic pulse pressure (40 ± 14 mmHg, p < 0.001). In patients aged ≥ 60 years whose mean arterial pressure was ≥ 80 mmHg, peripheral pulse pressure was related to arterial stiffness (r 2 = 0.41) and to stroke volume (multiple r 2 = 0.90). A similar but weaker relationship was observed in the overall population (multiple r 2 = 0.52).

Conclusions

In critically ill patients, and especially in aged subjects with hemodynamic stability, peripheral pulse pressure mainly reflected the combined influences of arterial stiffness and stroke volume.

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Acknowledgements

Part of this study was presented at the American Thoracic Society International Conference, San Diego, in May 2006, and therefore appears as an abstract (Proceedings of the American Thoracic Society 2006; 2: A 296). The authors thank Mr. P. Janczukiewicz for use of laboratory facilities.

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Authors and Affiliations

  1. Université Paris-Sud 11, Equipe d’Accueil EA4046, 94275, Le Kremlin-Bicêtre, France

    Bouchra Lamia, Jean-Louis Teboul, Xavier Monnet, David Osman, Julien Maizel, Christian Richard & Denis Chemla

  2. Service de Réanimation Médicale, AP-HP, Le Kremlin-Bicêtre, 78 rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France

    Bouchra Lamia, Jean-Louis Teboul, Xavier Monnet, David Osman, Julien Maizel & Christian Richard

  3. Service de Physiologie-Explorations Fonctionnelles, AP-HP, Le Kremlin-Bicêtre, 78 rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France

    Denis Chemla

Authors
  1. Bouchra Lamia
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  2. Jean-Louis Teboul
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  3. Xavier Monnet
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  4. David Osman
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  5. Julien Maizel
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  6. Christian Richard
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  7. Denis Chemla
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Corresponding author

Correspondence to Denis Chemla.

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Lamia, B., Teboul, JL., Monnet, X. et al. Contribution of arterial stiffness and stroke volume to peripheral pulse pressure in ICU patients: an arterial tonometry study. Intensive Care Med 33, 1931–1937 (2007). https://doi.org/10.1007/s00134-007-0738-4

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  • DOI: https://doi.org/10.1007/s00134-007-0738-4

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