Monitoring Arterial Blood Pressure and Cardiac Output using Central or Peripheral Arterial Pressure Waveforms

  • J. Smith
  • L. Camporota
  • R. Beale


Arterial blood pressure and cardiac output are the two most important and frequently measured hemodynamic parameters in critically ill patients as they provide indirect information on global tissue perfusion and oxygen delivery, and can guide fluid management and vasoactive drug use [1, 2]. Inaccurate measurement of these parameters, both in the intensive care unit (ICU) and the operating room (OR), can lead to misdiagnosis and inappropriate treatment, potentially impacting on patient morbidity and mortality. In the ICU, arterial blood pressure is commonly measured invasively via a peripheral artery (e.g., radial) or less frequently via a central artery (e.g., femoral). However, because the arterial blood pressure is not constant throughout the arterial tree — as a consequence of changes in hydrostatic pressure, arterial stiffness, and pressure wave reflection that are dependent on individual characteristics (e.g., age, height, gender), disease state (e.g., sepsis), and the administration of vasoactive drugs — the site of arterial blood pressure measurement may not faithfully reflect organ perfusion pressure.


Mean Arterial Pressure Arterial Blood Pressure Pulse Wave Velocity Radial Artery Vasoactive Drug 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Pinsky MR (2002) Functional hemodynamic monitoring. Intensive Care Med 28: 386–388CrossRefPubMedGoogle Scholar
  2. 2.
    Hofer CK, Ganter MT, Zollinger A (2007) What technique should I use to measure cardiac output? Curr Opin Crit Care 13: 308–317CrossRefPubMedGoogle Scholar
  3. 3.
    Cholley BP, Payen D (2005) Noninvasive techniques for measurements of cardiac output. Curr Opin Crit Care 11: 424–429CrossRefPubMedGoogle Scholar
  4. 4.
    Berton C, Cholley B (2002) Equipment review: new techniques for cardiac output measurement — oesophageal Doppler, Fick principle using carbon dioxide, and pulse contour analysis. Crit Care 6: 216–221CrossRefPubMedGoogle Scholar
  5. 5.
    Della Rocca G, Costa MG (2005) Volumetric monitoring: principles of application. Minerva Anestesiol 71: 303–306PubMedGoogle Scholar
  6. 6.
    Rodig G, Prasser C, Keyl C, Liebold A, Hobbhahn J (1999) Continuous cardiac output measurement: pulse contour analysis vs thermodilution technique in cardiac surgical patients. Br J Anaesth 82: 525–530PubMedGoogle Scholar
  7. 7.
    Tannenbaum GA, Mathews D, Weissman C (1993) Pulse contour cardiac output in surgical intensive care unit patients. J Clin Anesth 5: 471–478CrossRefPubMedGoogle Scholar
  8. 8.
    Weissman C, Ornstein EJ, Young WL (1993) Arterial pulse contour analysis trending of cardiac output: hemodynamic manipulations during cerebral arteriovenous malformation resection. J Clin Monit 9: 347–353CrossRefPubMedGoogle Scholar
  9. 9.
    Gratz I, Kraidin J, Jacobi AG, de Castro NG, Spagna P, Larijani GE (1992) Continuous noninvasive cardiac output as estimated from the pulse contour curve. J Clin Monit 8: 20–27CrossRefPubMedGoogle Scholar
  10. 10.
    Linton NW, Linton RA (2001) Estimation of changes in cardiac output from the arterial blood pressure waveform in the upper limb. Br J Anaesth 86: 486–496CrossRefPubMedGoogle Scholar
  11. 11.
    Jansen JR, Wesseling KH, Settels JJ, Schreuder JJ (1990) Continuous cardiac output monitoring by pulse contour during cardiac surgery. Eur Heart J 11 (Suppl I):26–32PubMedGoogle Scholar
  12. 12.
    Godje O, Hoke K, Goetz AE, et al (2002) Reliability of a new algorithm for continuous cardiac output determination by pulse-contour analysis during hemodynamic instability. Crit Care Med 30: 52–58CrossRefPubMedGoogle Scholar
  13. 13.
    Band DM, Linton RA, O’Brien TK, Jonas MM, Linton NW (1997) The shape of indicator dilution curves used for cardiac output measurement in man. J Physiol 498 (Pt 1): 225–229PubMedGoogle Scholar
  14. 14.
    Linton RA, Band DM, Haire KM (1993) A new method of measuring cardiac output in man using lithium dilution. Br J Anaesth 71: 262–266CrossRefPubMedGoogle Scholar
  15. 15.
    Linton R, Band D, O’Brien T, Jonas M, Leach R (1997) Lithium dilution cardiac output measurement: a comparison with thermodilution. Crit Care Med 25: 1796–1800CrossRefPubMedGoogle Scholar
  16. 16.
    O’Rourke MF, Seward JB (2006) Central arterial pressure and arterial pressure pulse: new views entering the second century after Korotkov. Mayo Clin Proc 81: 1057–1068CrossRefPubMedGoogle Scholar
  17. 17.
    Pauca AL, Wallenhaupt SL, Kon ND, Tucker WY (1992) Does radial artery pressure accurately reflect aortic pressure? Chest 102: 1193–1198CrossRefPubMedGoogle Scholar
  18. 18.
    Hirata K, Kawakami M, O’Rourke MF (2006) Pulse wave analysis and pulse wave velocity: a review of blood pressure interpretation 100 years after Korotkov. Circ J 70: 1231–1239CrossRefPubMedGoogle Scholar
  19. 19.
    Nichols WW, O’Rourke MF (2005) McDonald’s Blood Flow in Arteries, Fifth edn. Hodder Arnold, LondonGoogle Scholar
  20. 20.
    O’Rourke MF, Blazek JV, Morreels CL Jr, Krovetz LJ (1968) Pressure wave transmission along the human aorta. Changes with age and in arterial degenerative disease. Circ Res 23: 567–579PubMedGoogle Scholar
  21. 21.
    Kelly RP, Gibbs HH, O’Rourke MF, et al (1990) Nitroglycerin has more favourable effects on left ventricular afterload than apparent from measurement of pressure in a peripheral artery. Eur Heart J 11: 138–144PubMedGoogle Scholar
  22. 22.
    Slogoff S, Keats AS, Arlund C (1983) On the safety of radial artery cannulation. Anesthesiology 59: 42–47CrossRefPubMedGoogle Scholar
  23. 23.
    Soderstrom CA, Wasserman DH, Dunham CM, Caplan ES, Cowley RA (1982) Superiority of the femoral artery of monitoring. A prospective study. Am J Surg 144: 309–312CrossRefPubMedGoogle Scholar
  24. 24.
    Mignini MA, Piacentini E, Dubin A (2006) Peripheral arterial blood pressure monitoring adequately tracks central arterial blood pressure in critically ill patients: an observational study. Crit Care 10:R43CrossRefPubMedGoogle Scholar
  25. 25.
    Yazigi A, Madi-Jebara S, Haddad F, Hayek G, Jawish D (2002) Accuracy of radial arterial pressure measurement during surgery under controlled hypotension. Acta Anaesthesiol Scand 46: 173–175CrossRefPubMedGoogle Scholar
  26. 26.
    Kanazawa M, Fukuyama H, Kinefuchi Y, Takiguchi M, Suzuki T (2003) Relationship between aortic-to-radial arterial pressure gradient after cardiopulmonary bypass and changes in arterial elasticity. Anesthesiology 99: 48–53CrossRefPubMedGoogle Scholar
  27. 27.
    Baba T, Goto T, Yoshitake A, Shibata Y (1997) Radial artery diameter decreases with increased femoral to radial arterial pressure gradient during cardiopulmonary bypass. Anesth Analg 85: 252–258CrossRefPubMedGoogle Scholar
  28. 28.
    Chauhan S, Saxena N, Mehrotra S, Rao BH, Sahu M (2000) Femoral artery pressures are more reliable than radial artery pressures on initiation of cardiopulmonary bypass. J Cardiothorac Vasc Anesth 14: 274–276CrossRefPubMedGoogle Scholar
  29. 29.
    Manecke GR, Jr., Parimucha M, Stratmann G, et al (2004) Deep hypothermic circulatory arrest and the femoral-to-radial arterial pressure gradient. J Cardiothorac Vasc Anesth 18: 175–179CrossRefPubMedGoogle Scholar
  30. 30.
    Rivers EP, Lozon J, Enriquez E, et al (1993) Simultaneous radial, femoral, and aortic arterial pressures during human cardiopulmonary resuscitation. Crit Care Med 21: 878–883CrossRefPubMedGoogle Scholar
  31. 31.
    Pauca AL, Wallenhaupt SL, Kon ND (1994) Reliability of the radial arterial pressure during anesthesia. Is wrist compression a possible diagnostic test? Chest 105: 69–75CrossRefPubMedGoogle Scholar
  32. 32.
    Dorman T, Breslow MJ, Lipsett PA, et al (1998) Radial artery pressure monitoring underestimates central arterial pressure during vasopressor therapy in critically ill surgical patients. Crit Care Med 26: 1646–1649CrossRefPubMedGoogle Scholar
  33. 33.
    Arnal D, Garutti I, Perez-Pena J, Olmedilla L, Tzenkov IG (2005) Radial to femoral arterial blood pressure differences during liver transplantation. Anaesthesia 60: 766–771CrossRefPubMedGoogle Scholar
  34. 34.
    Gravlee GP, Wong AB, Adkins TG, Case LD, Pauca AL (1989) A comparison of radial, brachial, and aortic pressures after cardiopulmonary by pass. J Cardiothorac Anesth 3: 20–26CrossRefPubMedGoogle Scholar
  35. 35.
    Wheeler AP, Bernard GR, Thompson BT, et al (2006) Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 354: 2213–2224CrossRefPubMedGoogle Scholar
  36. 36.
    Shah MR, Hasselblad V, Stevenson LW, et al (2005) Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 294: 1664–1670CrossRefPubMedGoogle Scholar
  37. 37.
    Hirschl MM, Binder M, Gwechenberger M, et al (1997) Noninvasive assessment of cardiac output in critically ill patients by analysis of the finger blood pressure waveform. Crit Care Med 25: 1909–1914CrossRefPubMedGoogle Scholar
  38. 38.
    de Wilde RB, Breukers RB, van den Berg PC, Jansen JR (2006) Monitoring cardiac output using the femoral and radial arterial pressure waveform. Anaesthesia 61: 743–746CrossRefPubMedGoogle Scholar
  39. 39.
    Orme RM, Pigott DW, Mihm FG (2004) Measurement of cardiac output by transpulmonary arterial thermodilution using a long radial artery catheter. A comparison with intermittent pulmonary artery thermodilution. Anaesthesia 59: 590–594CrossRefPubMedGoogle Scholar
  40. 40.
    Wouters PF, Quaghebeur B, Sergeant P, Van Hemelrijck J, Vandermeersch E (2005) Cardiac output monitoring using a brachial arterial catheter during off-pump coronary artery bypass grafting. J Cardiothorac Vasc Anesth 19: 160–164CrossRefPubMedGoogle Scholar
  41. 41.
    Smith J, Wolff C, Mills E, et al (2007) Comparison between uncalibrated cardiac output using the femoral and radial arterial pressure waveform in critically ill patients. Crit Care 11 (Suppl 2): P296 (abst)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • J. Smith
    • 1
  • L. Camporota
    • 1
  • R. Beale
    • 1
  1. 1.Department of Adult Critical Care Guy’s and St Thomas’ NHS Foundation TrustSt Thomas’ HospitalLondonUK

Personalised recommendations