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

Intensive Care Medicine volume 33, Article number: 1931 (2007) Cite this article

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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References

  1. Kelly R, Hayward C, Avolio A, O'Rourke M (1989) Noninvasive determination of age-related changes in the human arterial pulse. Circulation 80:1652–1659

    PubMed  CAS  Google Scholar 

  2. Dart AM, Kingwell BA (2001) Pulse pressure: a review of mechanisms and clinical relevance. J Am Coll Cardiol 37:975–984

    PubMed  Article  CAS  Google Scholar 

  3. Nichols WW, O'Rourke MF (2005) McDonalds blood flow in arteries: theoretical, experimental and clinical principles, 5th edn. Edward Arnold, London

    Google Scholar 

  4. Pauca AL, O'Rourke MF, Kon ND (2001) Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension 38:932–937

    PubMed  Article  CAS  Google Scholar 

  5. O'Rourke MF, Adji A (2005) An updated clinical primer on large artery mechanics: implications of pulse waveform analysis and arterial tonometry. Curr Opin Cardiol 20:275–281

    PubMed  Article  Google Scholar 

  6. Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL (2001) Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 119:867–873

    PubMed  Article  CAS  Google Scholar 

  7. Lodato RF (1997) Arterial pressure monitoring. In: Tobin MJ (ed) Principles and practice of intensive care monitoring. McGraw Hill, New York, pp 733–749

    Google Scholar 

  8. Pauca AL, Wallenhaupt SL, Kon ND, Tucker WY (1992) Does radial artery pressure accurately reflect aortic pressure? Chest 102:1193–1198

    PubMed  CAS  Google Scholar 

  9. Liu Z, Brin KP, Yin FCP (1986) Estimation of total arterial compliance: an improved method and evaluation of current methods. Am J Physiol 251:H588–H600

    PubMed  CAS  Google Scholar 

  10. Chemla D, Hébert JL, Coirault C, Zamani K, Suard I, Colin P, Lecarpentier Y (1998) Total arterial compliance estimated by stroke volume-to-aortic pulse pressure ratio in humans. Am J Physiol 274:H500–H505

    PubMed  CAS  Google Scholar 

  11. McVeigh GE, Hamilton PK, Morgan DR (2002) Evaluation of mechanical arterial properties: clinical, experimental and therapeutic aspects. Clin Sci (Lond) 102:51–67

    Article  Google Scholar 

  12. Michard F, Chemla D, Richard C, Wysocki M, Pinsky MR, Lecarpentier Y, Teboul JL (1999) Clinical use of respiratory changes in arterial pulse pressure to monitor the hemodynamic effects of PEEP. Am J Respir Crit Care Med 159:935–939

    PubMed  CAS  Google Scholar 

  13. Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138

    PubMed  CAS  Google Scholar 

  14. Convertino VA, Cooke WH, Holcomb JB (2006) Arterial pulse pressure and its association with reduced stroke volume during progressive central hypovolemia. J Trauma 61:629–634

    PubMed  Article  Google Scholar 

  15. Lamia B, Chemla D, Richard C, Teboul JL (2005) Clinical Review. Interpretation of arterial pressure wave in shock-states. Crit Care 9:601–606

    PubMed  Article  Google Scholar 

  16. Hope SA, Tay DB, Meredith IT, Cameron JD (2002) Comparison of generalized and gender-specific transfer functions for the derivation of aortic waveforms. Am J Physiol Heart Circ Physiol 283:H1150–H1155

    PubMed  CAS  Google Scholar 

  17. Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, Hughes AD, Thurston H, O'Rourke MF (2006) Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes. Principal results of the conduit artery function evaluation (CAFE) study. Circulation 113:1213–1225

    PubMed  Article  CAS  Google Scholar 

  18. Huntsman LL, Stewart DK, Barnes SR, Franklin SB, Colocousis JS, Hessel (1983) Noninvasive Doppler determination of cardiac output in man. Clinical validation. Circulation 67:593–602

    PubMed  CAS  Google Scholar 

  19. Poelaert JI (2001) Haemodynamic monitoring. Curr Opin Anaesthesiol 14:27–32

    PubMed  Article  CAS  Google Scholar 

  20. Berkenstadt H, Friedman Z, Preisman S, keidan I, Livingstone D, Perel A (2005) Pulse pressure and stroke volume variations during severe hemorrhage in ventilated dogs. Br J Anaesth 94:721–726

    PubMed  Article  CAS  Google Scholar 

  21. Millasseau SC, SJ Patel, Redwood SR, Ritter JM, Chowienczyk PJ (2003) Pressure wave reflection assessed from the peripheral pulse. Is a transfer function necessary? Hypertension 41:1016–1020

    PubMed  Article  CAS  Google Scholar 

  22. Papaioannou TG, Lekakis JP, Karatzis EN, Papamichael CM, Stamatelopoulos KS, Protogerou AD, Mavrikakis M, Stefanidis C (2006) Transmission of calibration errors (input) by generalized transfer functions to the aortic pressures (output) at different hemodynamic states. Int J Cardiol 110:46–52

    PubMed  Article  Google Scholar 

  23. Bourgeois MJ, Gilbert BK, Donald DE, Wood EH (1974) Characteristics of aortic diastolic pressure decay with application to the continuous monitoring of changes in peripheral vascular resistance. Circ Res 35:56–66

    PubMed  CAS  Google Scholar 

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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.

Author information

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 (2007). https://doi.org/10.1007/s00134-007-0738-4

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

Keywords

  • Pulse pressure
  • Arterial stiffness
  • Stroke volume
  • Arterial tonometry