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Critical Care (London, England) Apr 2020Arterial blood pressure (BP) is a fundamental cardiovascular variable, is routinely measured in perioperative and intensive care medicine, and has a significant impact... (Review)
Review
Arterial blood pressure (BP) is a fundamental cardiovascular variable, is routinely measured in perioperative and intensive care medicine, and has a significant impact on patient management. The clinical reference method for BP monitoring in high-risk surgical patients and critically ill patients is continuous invasive BP measurement using an arterial catheter. A key prerequisite for correct invasive BP monitoring using an arterial catheter is an in-depth understanding of the measurement principle, of BP waveform quality criteria, and of common pitfalls that can falsify BP readings. Here, we describe how to place an arterial catheter, correctly measure BP, and identify and solve common pitfalls. We focus on 5 important steps, namely (1) how to choose the catheter insertion site, (2) how to choose the type of arterial catheter, (3) how to place the arterial catheter, (4) how to level and zero the transducer, and (5) how to check the quality of the BP waveform.
Topics: Arterial Pressure; Blood Pressure Determination; Critical Illness; Guidelines as Topic; Humans; Intensive Care Units; Monitoring, Physiologic; Patient Positioning; Ultrasonography, Interventional; Vascular Access Devices
PubMed: 32331527
DOI: 10.1186/s13054-020-02859-w -
Revista Espanola de Anestesiologia Y... Feb 2020
Topics: Arterial Pressure; Blood Pressure; Blood Pressure Determination; Brain; Cerebrovascular Circulation; Homeostasis; Humans; Hypotension; Intraoperative Complications; Preoperative Care; Reference Values
PubMed: 31952812
DOI: 10.1016/j.redar.2019.11.006 -
American Journal of Human Biology : the... Jan 2018Human biologists have been examining arterial blood pressure since they began studying the effects of the environment and culture on the health of diverse populations.... (Review)
Review
Human biologists have been examining arterial blood pressure since they began studying the effects of the environment and culture on the health of diverse populations. The Korotkoff auscultatory technique with a trained observer and aneroid sphygmomanometer is the method of choice for blood pressure measurement in many bioanthropological field contexts. Korotkoff sounds (the first and fifth phases) are the preferred determinants of systolic and diastolic pressure, even in infants, children, pregnant women, and the elderly. Training of observers, positioning of individuals, and selection of cuff size are all essential for obtaining standardized measurements. Automatic electronic devices are increasingly being used for blood pressure measurement in human biological studies. The automatic monitors often use the oscillometric method for measuring pressure, but must be validated before use. The emergence of automatic ambulatory blood pressure monitors has opened another avenue of research on blood pressure in human biology, where allostasis and circadian responses to environmental change and real life behavioral challenges can be defined and evaluated, largely because there is now the ability to make multiple measurements over time and in varying contexts. Stand-alone automatic monitors can also be substituted for manual auscultated readings in field contexts, although in studies where participants measure their own pressure, education about how the devices work and protocol specifics are necessary. Finally, computer-driven plethysmographic devices that measure pressure in the finger are available to evaluate short-term reactivity to specific challenges.
Topics: Arterial Pressure; Auscultation; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Humans; Oscillometry
PubMed: 28940503
DOI: 10.1002/ajhb.23063 -
Anesthesia and Analgesia Aug 2018Intraoperative hypotension is associated with postoperative mortality. Early detection of hypotension by continuous hemodynamic monitoring might prompt timely therapy,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Intraoperative hypotension is associated with postoperative mortality. Early detection of hypotension by continuous hemodynamic monitoring might prompt timely therapy, thereby reducing intraoperative hypotension. We tested the hypothesis that continuous noninvasive blood pressure monitoring reduces intraoperative hypotension.
METHODS
Patients ≥45 years old with American Society of Anesthesiologists physical status III or IV having moderate-to-high-risk noncardiac surgery with general anesthesia were included. All participating patients had continuous noninvasive hemodynamic monitoring using a finger cuff (ClearSight, Edwards Lifesciences, Irvine, CA) and a standard oscillometric cuff. In half the patients, randomly assigned, clinicians were blinded to the continuous values, whereas the others (unblinded) had access to continuous blood pressure readings. Continuous pressures in both groups were used for analysis. Time-weighted average for mean arterial pressure <65 mm Hg was compared using 2-sample Wilcoxon rank-sum tests and Hodges Lehmann estimation of location shift with corresponding asymptotic 95% CI.
RESULTS
Among 320 randomized patients, 316 were included in the intention-to-treat analysis. With 158 patients in each group, those assigned to continuous blood pressure monitoring had significantly lower time-weighted average mean arterial pressure <65 mm Hg, 0.05 [0.00, 0.22] mm Hg, versus intermittent blood pressure monitoring, 0.11 [0.00, 0.54] mm Hg (P = .039, significance criteria P < .048).
CONCLUSIONS
Continuous noninvasive hemodynamic monitoring nearly halved the amount of intraoperative hypotension. Hypotension reduction with continuous monitoring, while statistically significant, is currently of uncertain clinical importance.
Topics: Aged; Anesthesia, General; Anesthesiology; Arterial Pressure; Blood Pressure; Blood Pressure Determination; Female; Hemodynamics; Humans; Hypotension; Male; Middle Aged; Monitoring, Intraoperative; Monitoring, Physiologic; Oscillometry; Reproducibility of Results; Surgical Procedures, Operative; Treatment Outcome
PubMed: 29916861
DOI: 10.1213/ANE.0000000000003482 -
Physiological Research Nov 2023The development of methods for measuring blood pressure (BP) in newborns and small children has a rich history. Methods for BP measuring in adults had to be adapted to... (Review)
Review
The development of methods for measuring blood pressure (BP) in newborns and small children has a rich history. Methods for BP measuring in adults had to be adapted to this age group. For measuring BP in direct invasive way, a suitable approach had to be found to access the arterial circulation through the umbilical and later radialis artery. Currently, results obtained from direct invasive BP measurement are considered the "gold standard". The development of non-invasive methods for BP measuring in newborns and children began with the use of von Basch's sphygmomanometer (1880). In 1899, Gustav Gärtner constructed the device, which was the basis for the flush method. After the discovery of the palpation and auscultation methods, these methods were also used for BP measurement in newborns and children, however, the BP values obtained in these ways were typically underestimated using excessively wide cuffs. From the auscultation method, methods utilizing ultrasound and infrasound to detect arterial wall movement and blood flow were later developed. The oscillometric method for BP measurement was introduced by E. J. Marey so early as in 1876. In 1912, P. Balard used the oscillometric technique to measure blood pressure in a large group of newborns. Through different types of oscillometers using various methods for detecting vascular oscillations (such as xylol method, impedance and volume plethysmography, etc.), the development has continued to assessment of vascular oscillations by modern sensor technology and software. For continuous non-invasive blood pressure measurement, the volume-clamp method, first described by Jan Peňáz in 1968, was developed. After modification for use in newborns, application of the cuff to the wrist instead of the finger, it is primarily used in clinical physiological studies to evaluate beat-to-beat BP and heart rate pressure variability, such as in the determination of the baroreflex sensitivity.
Topics: Adult; Child; Humans; Infant, Newborn; Infant; Blood Pressure; Blood Pressure Determination; Arterial Pressure; Arteries; Fingers
PubMed: 38015754
DOI: 10.33549/physiolres.935173 -
Current Opinion in Critical Care Jun 2020To discuss recent findings relevant to optimizing blood pressure targets in adult, postcardiac arrest (PCA) patients and whether to tailor these based on specific... (Review)
Review
PURPOSE OF REVIEW
To discuss recent findings relevant to optimizing blood pressure targets in adult, postcardiac arrest (PCA) patients and whether to tailor these based on specific patient, cardiac arrest or treatment characteristics.
RECENT FINDINGS
Observational data suggest that mean arterial pressure (MAP) below 65-75 mmHg in PCA patients is associated with worse outcome. A higher MAP could be beneficial in patients with chronic hypertension who more frequently have a right shift of the cerebral autoregulation curve. Two recent randomized pilot trials compared lower and higher MAP targets during PCA care and found no significant effect on biomarkers of neurological injury. The haemodynamic interventions in those studies did not use any cerebral perfusion endpoints beyond a static MAP targets during ICU stay. Individualized, dynamic MAP targets based on assessments of cerebral perfusion and tailored to the specifics of the patient, cardiac arrest circumstances and treatment responses may be more conducive to improved outcomes. Pilot data suggest that near infrared spectroscopy monitoring may be used to determine the cerebral autoregulatory capacity and an optimal MAP, but this approach is yet to be tested in clinical trials.
SUMMARY
Current evidence suggests targeting a MAP of at least 65-75 mmHg in PCA patients. Future studies should focus on whether certain patient groups could benefit from higher and dynamic MAP targets.
Topics: Adult; Arterial Pressure; Blood Pressure; Blood Pressure Determination; Cerebrovascular Circulation; Critical Care; Heart Arrest; Humans
PubMed: 32304388
DOI: 10.1097/MCC.0000000000000722 -
Sensors (Basel, Switzerland) May 2022Accurate estimation of blood pressure (BP) waveforms is critical for ensuring the safety and proper care of patients in intensive care units (ICUs) and for... (Review)
Review
Accurate estimation of blood pressure (BP) waveforms is critical for ensuring the safety and proper care of patients in intensive care units (ICUs) and for intraoperative hemodynamic monitoring. Normal cuff-based BP measurements can only provide systolic blood pressure (SBP) and diastolic blood pressure (DBP). Alternatively, the BP waveform can be used to estimate a variety of other physiological parameters and provides additional information about the patient's health. As a result, various techniques are being proposed for accurately estimating the BP waveforms. The purpose of this review is to summarize the current state of knowledge regarding the BP waveform, three methodologies (pressure-based, ultrasound-based, and deep-learning-based) used in noninvasive BP waveform estimation research and the feasibility of employing these strategies at home as well as in ICUs. Additionally, this article will discuss the physical concepts underlying both invasive and noninvasive BP waveform measurements. We will review historical BP waveform measurements, standard clinical procedures, and more recent innovations in noninvasive BP waveform monitoring. Although the technique has not been validated, it is expected that precise, noninvasive BP waveform estimation will be available in the near future due to its enormous potential.
Topics: Arterial Pressure; Blood Pressure; Blood Pressure Determination; Humans
PubMed: 35632360
DOI: 10.3390/s22103953 -
Heart Failure Reviews Jan 2021Accurate mean blood pressure determination is essential to prevent adverse events in patients with continuous-flow left ventricular assist devices (CFLVAD). We sought to... (Review)
Review
Accurate mean blood pressure determination is essential to prevent adverse events in patients with continuous-flow left ventricular assist devices (CFLVAD). We sought to evaluate the accuracy of noninvasive methods of blood pressure measurement compared with invasive intra-arterial recordings in patients with CFLVAD. Systematic electronic search was performed on four online databases (PubMed, Scopus, Embase, and Web of Knowledge) for the terms "Blood Pressure" AND ("Heart-Assist Devices" OR "Left ventricular Assist Devices"). Only studies that compared an intra-arterial and noninvasive blood pressure measurement were included. Electronic search of scientific literature identified 5968 articles. After deduplication, screening of titles and abstracts, full-text review, and excluding incorrect populations and comparator, a total of 12 studies with 502 participants were included, of those 402 participants who had intra-arterial blood pressure measurement. Doppler mean arterial blood pressure showed a very high correlation with mean intra-arterial blood pressure (r = 0.97, r = 0.87) in low pulsatility situations. When the pulsatility was not evaluated, the correlation was high moderate (r = 0.63, r = 0.741). In low pulsatility situations, the correlation was moderate to high moderate (r = 0.42 to r = 0.65). Oscillometer automatic blood pressure cuff showed a moderate to very high correlation with intra-arterial mean arterial blood pressure (r = 0.42, r = 0.86) but also could be low in the context of low pulsatility associated with inconsistent success in noninvasive measurement (r = 0.25). Studies correlating intra-arterial with noninvasive techniques were performed in the context of routine clinical care using fluid-filled catheters. The degree of correlation between both methods is at least moderate.
Topics: Arterial Pressure; Blood Pressure; Blood Pressure Determination; Heart-Assist Devices; Humans; Ultrasonography, Doppler
PubMed: 32696152
DOI: 10.1007/s10741-020-10006-4 -
The Canadian Veterinary Journal = La... Apr 2020Arterial blood pressure is a common parameter evaluated in conscious and anesthetized veterinary species. Non-invasive blood pressure measurement techniques, such as... (Review)
Review
Arterial blood pressure is a common parameter evaluated in conscious and anesthetized veterinary species. Non-invasive blood pressure measurement techniques, such as Doppler ultrasonic flow detector and oscillometry, are attractive in certain animals due to their availability and ease of use. The greatest limitation to non-invasive blood pressure monitoring can be its inaccuracy, particularly in hypotensive or hypertensive patients and in certain species. Part 1 of this 2-part review summarizes the current techniques available to non-invasively measure arterial blood pressure in animals and discusses validation of non-invasive devices. Part 2 summarizes the veterinary literature that evaluates the use of non-invasive blood pressure measurement techniques in conscious and anesthetized species and develops general conclusions for proper use and interpretation of data from non-invasive blood pressure devices.
Topics: Animals; Arterial Pressure; Blood Pressure; Blood Pressure Determination; Hypotension; Oscillometry
PubMed: 32255821
DOI: No ID Found -
Intensive Care Medicine Oct 2022
Review
Topics: Arterial Pressure; Blood Pressure; Blood Pressure Determination; Hemodynamic Monitoring; Humans; Monitoring, Physiologic
PubMed: 35802139
DOI: 10.1007/s00134-022-06798-8