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The effect of variable arterial transducer level on the accuracy of pulse contour waveform-derived measurements in critically ill patients

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Abstract

We know that a 10 cm departure from the reference level of pressure transducer position is equal to a 7.5 mmHg change of invasive hemodynamic pressure monitoring in a fluid-filled system. However, the relationship between the site level of a variable arterial pressure transducer and the pulse contour-derived parameters has yet to be established in critically ill patients. Moreover, the related quantitative analysis has never been investigated. Forty-two critically ill patients requiring PiCCO-Plus cardiac output monitoring were prospectively studied. The phlebostatic axis was defined as the zero reference level; the arterial pressure transducer was then vertically adjusted to different positions (+5, +10, +15, +20, −20, −15, −10, −5 cm) of departure from the zero reference site. The pulse contour waveform-derived parameters were recorded at each position. Elevation of the pressure transducer caused significantly positive changes in the continuous cardiac index (+CCI), stroke volume index (+SVI), and stroke volume variation (+SVV), and negative changes in the rate of left ventricular pressure rise during systole (−dP/dtmax), the systemic vascular resistance index (−SVRI), and vice versa. At the 5 cm position, the SVRI changes reached statistical significance with error. At the 10 cm position, the changes in CCI and dP/dtmax reached statistical significance with error, while the change in SVV reached statistical significance at 15 cm. The change rate of CCI was more than 5 % at the 15 cm position and approximately 10 % at the 20 cm position. On average, for every centimeter change of the transducer, there was a corresponding 0.014 L/min/m2 CCI change and 0.36 % change rate, a 1.41 mmHg/s dP/dtmax change and 0.13 % change rate, and a 25 dyne/s/cm5 SVRI change and 1.2 % change rate. The variation of arterial transducer position can result in inaccurate measurement of pulse contour waveform-derived parameters, especially when the transducer’s vertical distance is more than 10 cm from the phlebostatic axis. These findings have clinical implications for continuous hemodynamic monitoring.

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Acknowledgments

This work was supported by the special fund for health-scientific research in the public interest program (Grant Number 201202011, the Ministry of Health of P. R. China). The authors thank for Jing Zhang for her contribution in the review of the manuscript of spelling and grammar. There are no financial disclosure for any of the authors.

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Authors and Affiliations

  1. Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China

    Huai-wu He, Da-wei Liu, Yun Long & Xiao-ting Wang

  2. Department of Critical Care Medicine, Zi-Bo Central Hospital, Medical College of Shangdong University, Jinan, China

    Mei-ling Zhao

  3. Department of Critical Care Medicine, Bei-Hai People Hosptial, Beihai, GuangXi Province, China

    Xiao-li Lai

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  1. Huai-wu He
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  2. Da-wei Liu
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Correspondence to Da-wei Liu.

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Supplemental Figure 1

Corresponding transducer positions and estimated marginal means of CCI change, CCI change rate. CCI continuous cardiac index (L/min/m2) (TIFF 101 kb)

Supplemental Figure 2

Corresponding transducer positions and estimated marginal means of dP/dtmax change, dP/dtmax change rate. dP/dtmax the rate of left ventricular pressure rise during systole(mmHg/s) (TIFF 105 kb)

Supplemental Figure 3

Corresponding transducer positions and estimated marginal means of SVRI change and SVRI change rate. SVRI systemic vascular resistance index (dyne/sec/cm5) (TIFF 102 kb)

Supplementary material 4 (DOCX 19 kb)

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He, Hw., Liu, Dw., Long, Y. et al. The effect of variable arterial transducer level on the accuracy of pulse contour waveform-derived measurements in critically ill patients. J Clin Monit Comput 30, 569–575 (2016). https://doi.org/10.1007/s10877-015-9756-x

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  • DOI: https://doi.org/10.1007/s10877-015-9756-x

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