Skip to main content

Evaluation of the pulse wave arrival time as a marker for blood pressure changes in critically ill infants and children

Abstract

Objective. Pulse arrival time (PAT), which is the interval between the R wave of the electrocardiogram (ECG) and the arrival of the pulse wave peripherally, has been reported to be suitable for use as an indirect measure of blood pressure change. The purpose of this study was to evaluate, in critically ill infants and children, the degree to which 1/PAT covaries with systolic, diastolic, and mean blood pressure, as well as heart rate.Methods. A laboratory device was used to calculate PAT in real time from the ECG and the plethysmographic curve of pulse oximetry used for routine monitoring. Calculated PAT and corresponding blood pressures and heart rate were stored on hard disk. A total of 15 critically ill patients, aged 6 days to 16 years, weighing 3 to 80 kg, were studied.Results. In all patients, one period of 11,000 to 36,000 beats could be evaluated. Mean correlation coefficients were best for systolic blood pressure (r=0.73), followed by mean blood pressure (r=0.68) and diastolic blood pressure (r=0.61), and, finally, heart rate (r=0.52). In 7 patients, the correlation coefficient for systolic blood pressure was >0.9; but, in 4 patients, it was <0.5.Conclusions. We conclude that the correlation between 1/PAT and systolic blood pressure is not strong enough to serve as a marker for blood pressure changes in critically ill infants and children. This may be due to changes of the preejection period, which is part of the PAT.

This is a preview of subscription content, access via your institution.

References

  1. Moens AJ. Die Pulskurve. Leiden: Brill, 1878

    Google Scholar 

  2. Korteweg JC. über die Fortpflanzungsgeschwindigkeit des Schalls in elastischen Röhren. Ann Physik Chem NF 1878;5:525–533

    Article  Google Scholar 

  3. Callaghan FJ, Geddes LA, Babbs CF, Bourland JD. Relationship between pulse-wave velocity and arterial elasticity. Med Biol Eng Comput 1986;24:248–254

    PubMed  Article  CAS  Google Scholar 

  4. Bramwell JC, Downing AC, Hill AV. The effect of blood pressure on the extensibility of the human artery. Heart 1923;10:289–300

    Google Scholar 

  5. Remington JW. The physiology of the aorta and the major arteries. Section 2, Circulation. In: Hamilton WF, Dow P, eds. Handbook of Physiology. Washington: American Physiological Society, 1962:799–819

    Google Scholar 

  6. Steele JM. Interpretation of arterial elasticity from measurements of pulse wave velocity. I. Effects of pressure. Am Heart J 1937;14:452–465

    Article  Google Scholar 

  7. Pruett JD, Bourland JD, Geddes LA. Measurement of pulse-wave velocity using a beat-sampling technique. Ann Biomed Eng 1988;16:341–347

    PubMed  Article  CAS  Google Scholar 

  8. Hickinson SK, McSwiney BA. The effect of variation of blood pressure on pulse wave velocity in the brachial artery in man. Proc Physiol Soc 1924;59:217–220

    Google Scholar 

  9. Nye ER. The effect of blood pressure alteration on the pulse wave velocity in the brachial artery in man. Br Heart J 1964;26:261–265

    PubMed  Article  CAS  Google Scholar 

  10. Gribbin B, Steptoe A, Sleight P. Pulse wave velocity as a measure of blood pressure change. Psychophysiology 1976;13:86–90

    PubMed  Article  CAS  Google Scholar 

  11. Weltman G, Sullivan G, Bredon D. The continuous measurement of arterial pulse wave velocity. Med Electron Biol Eng 1963;2:145–154

    Article  Google Scholar 

  12. Henderson JB, Rodbard S, Morse HT. Effects of anesthesia and related procedures on arterial pressure wave arrival times. Anesth Analg 1972;51:942–952

    PubMed  Article  CAS  Google Scholar 

  13. Steptoe A, Smulyan H, Gribbin B. Pulse wave velocity and blood pressure change: Calibration and applications. Psychophysiology 1976;13:488–493

    PubMed  Article  CAS  Google Scholar 

  14. Obrist PA, Light KC, McCubbin JA, et al. Pulse transit time: Relationship to blood pressure and myocardial performance. Psychophysiology 1979;16:292–301

    PubMed  Article  CAS  Google Scholar 

  15. Carruthers M, Taggart P. Validation of a new inexpensive noninvasive miniaturized blood pressure monitor. J Amb Monitor 1988;1:163–170

    Google Scholar 

  16. Vectron Gesellschaft für Technologie und Systemforschung mbH, Patentoffenlegungsschrift DE 3807672 A1. 1991

  17. Lane JD, Greenstadt L, Shapiro D, Rubinstein E. Pulse transit time and blood pressure: An intensive analysis. Psychophysiology 1983;20:45–49

    PubMed  Article  CAS  Google Scholar 

  18. Allen RA, Schneider JA, Davidson DM, et al. The covariation of blood pressure and pulse transit time in hypertensive patients. Psychophysiology 1981;18:301–306

    PubMed  Article  CAS  Google Scholar 

  19. Newlin DB. Relationships of pulse transmission times to pre-ejection period and blood pressure. Psychophysiology 1981;18:316–321

    PubMed  Article  CAS  Google Scholar 

  20. Ahmed SS, Levinson GE, Schwartz CJ, Ettinger PO. Systolic time intervals as measures of the contractile state of the left ventricular myocardium in man. Circulation 1972;46:559–571

    PubMed  CAS  Google Scholar 

  21. Newlin DB, Levenson RW. Pre-ejection period: Measuring beta-adrenergic influences upon the heart. Psychophysiology 1979;16:546–553

    PubMed  Article  CAS  Google Scholar 

  22. Sawayama T, Ochiai M, Marumoto S, et al. Influence of amyl nitrite inhalation on the systolic time intervals in normal subjects and in patients with ischemic heart disease. Circulation 1969;40:327–335

    PubMed  CAS  Google Scholar 

  23. Dobrin PB, Rovick AA. Influence of vascular smooth muscle on contractile mechanics and elasticity of arteries. Am J Physiol 1969;217:1644–1651

    PubMed  CAS  Google Scholar 

  24. Volgyesi GA, Shulman D. Feasibility study for the development of a new continuous blood pressure monitor for pediatric anesthesia (Abstract). Anesthesiology 1990;69(Suppl 3A):A326

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Dr. Wippermann is a recipient of the Franz Volhard Stipendium of the ‘Deutschen Liga zur Bekämpfung des hohen Blutdrucks,’ which helped to support this study.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wippermann, C.F., Schranz, D. & Huth, R.G. Evaluation of the pulse wave arrival time as a marker for blood pressure changes in critically ill infants and children. J Clin Monitor Comput 11, 324–328 (1995). https://doi.org/10.1007/BF01616991

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01616991

Key words

  • Measurement, blood pressure
  • Monitoring, pulse arrival time