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Interpretation of blood pressure signal: physiological bases, clinical relevance, and objectives during shock states

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Applied Physiology in Intensive Care Medicine 2

Abstract

Achievement of a mean blood pressure (MBP) target is one of the hemodynamic goals to ensure an adequate blood perfusion pressure in critically ill patients. Arterial catheter allows for a continuous and precise monitoring of arterial pressure signal. In addition to giving a precise MBP monitoring, analysis of the blood pressure wave provides information that may help the clinician to interpret hemodynamic status. The interpretation of BP wave requires the understanding of simple principles. In this review, we first discuss the physiological mechanism responsible for arterial pressure generation. We then emphasize the interpretation of the static indexes and the dynamic indexes generated by heart–lung interactions derived from arterial pressure wave. Finally, we focus on MBP value as a therapeutic target in critically ill patients. We discuss the recommended target MBP value by reviewing available data from experimental and clinical studies.

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Abbreviations

ARDS:

Acute respiratory distress syndrome

BP:

Blood pressure

C:

Compliance

CO:

Cardiac output

DBP:

Diastolic blood pressure

HR:

Heart rate

LV:

Left ventricle

MBP:

Mean blood pressure

PEEP:

Positive end-expiratory pressure

PP:

Pulse pressure

RV:

Right ventricle

SBP:

Systolic blood pressure

SV:

Stroke volume

SVR:

Systemic vascular resistance

RAP:

Right atrial pressure

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Author information

Authors and Affiliations

  1. Laboratoire HIFIH, IFR 132, Universitéd’ Angers et service de réanimation médicale et médecine hyperbare, CHU Angers, rue Larrey, Angers Cedex, France

    J.-F. Augusto

  2. Hôpital de Bicêtre, AP-HP, Service de réanimation médicale, Kremlin-Bicêre, France

    J.-L. Teboul

  3. Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung Universitätsklinik für Anästhesiologie, Universität Ulm, Ulm, Germany

    P. Radermacher

  4. Laboratoire de Bioenergetique Fondamentale et Appliquee, Universite Joseph Fourier, rue de la piscine, Grenoble Cedex, France

    P. Radermacher

  5. Laboratoire HIFIH UPRES EA 3859, Université d’Angers, Angers, France

    P. Asfar

Authors
  1. J.-F. Augusto
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  2. J.-L. Teboul
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  3. P. Radermacher
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  4. P. Asfar
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Editor information

Editors and Affiliations

  1. Dept. of Critical Care Medicine, University of Pittsburgh Medical Center, Scaife Hall 606 3550 Terrace Street, Pittsburgh, PA, 15261, USA

    Michael R. Pinsky MD

  2. Dept. Intensive Care Medicine, Hôpital Henri Mondor, 51 av. Maréchal Lattre de Tassigny, 94010, Créteil, CX, France

    Laurent Brochard MD

  3. Dept. Intensive Care Medicine, Hospital de Sant Pau, Avda. S. Antonio M. Claret 167, 08025, Barcelona, Spain

    Jordi Mancebo MD

  4. General Intensive Care Unit, Università Cattolica des Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy

    Massimo Antonelli

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Augusto, JF., Teboul, JL., Radermacher, P., Asfar, P. (2012). Interpretation of blood pressure signal: physiological bases, clinical relevance, and objectives during shock states. In: Pinsky, M.R., Brochard, L., Mancebo, J., Antonelli, M. (eds) Applied Physiology in Intensive Care Medicine 2. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-28233-1_28

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  • DOI: https://doi.org/10.1007/978-3-642-28233-1_28

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-28232-4

  • Online ISBN: 978-3-642-28233-1

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