scholarly journals Non-invasive detection of a femoral-to-radial arterial pressure gradient in intensive care patients with vasoactive agents

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Matthias Jacquet-Lagrèze ◽  
David Claveau ◽  
Julie Cousineau ◽  
Kun Peng Liu ◽  
Jean-Gilles Guimond ◽  
...  
Keyword(s):  
Intensive Care ◽  
Arterial Pressure ◽  
Pressure Gradient ◽  
Critically Ill ◽  
Radial Artery ◽  
Brachial Artery ◽  
Critically Ill Patients ◽  
Vasoactive Agents ◽  
Non Invasive ◽  
Radial Artery Pressure

Abstract Background In patient requiring vasopressors, the radial artery pressure may underestimate the true central aortic pressure leading to unnecessary interventions. When using a femoral and a radial arterial line, this femoral-to-radial arterial pressure gradient (FR-APG) can be detected. Our main objective was to assess the accuracy of non-invasive blood pressure (NIBP) measures; specifically, measuring the gradient between the NIBP obtained at the brachial artery and the radial artery pressure and calculating the non-invasive brachial-to-radial arterial pressure gradient (NIBR-APG) to detect an FR-APG. The secondary objective was to assess the prevalence of the FR-APG in a targeted sample of critically ill patients. Methods Adult patients in an intensive care unit requiring vasopressors and instrumented with a femoral and a radial artery line were selected. We recorded invasive radial and femoral arterial pressure, and brachial NIBP. Measurements were repeated each hour for 2 h. A significant FR-APG (our reference standard) was defined by either a mean arterial pressure (MAP) difference of more than 10 mmHg or a systolic arterial pressure (SAP) difference of more than 25 mmHg. The diagnostic accuracy of the NIBR-APG (our index test) to detect a significant FR-APG was estimated and the prevalence of an FR-APG was measured and correlated with the NIBR-APG. Results Eighty-one patients aged 68 [IQR 58–75] years and an SAPS2 score of 35 (SD 7) were included from which 228 measurements were obtained. A significant FR-APG occurred in 15 patients with a prevalence of 18.5% [95%CI 10.8–28.7%]. Diabetes was significantly associated with a significant FR-APG. The use of a 11 mmHg difference in MAP between the NIBP at the brachial artery and the MAP of the radial artery led to a specificity of 92% [67; 100], a sensitivity of 100% [95%CI 83; 100] and an AUC ROC of 0.93 [95%CI 0.81–0.99] to detect a significant FR-APG. SAP and MAP FR-APG correlated with SAP (r2 = 0.36; p < 0.001) and MAP (r2 = 0.34; p < 0.001) NIBR-APG. Conclusion NIBR-APG assessment can be used to detect a significant FR-APG which occur in one in every five critically ill patients requiring vasoactive agents.

Relationship between Aortic-to-radial Arterial Pressure Gradient after Cardiopulmonary Bypass and Changes in Arterial Elasticity

2003 ◽  
Vol 99 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Masahiro Kanazawa ◽  
Haruo Fukuyama ◽  
Yoshio Kinefuchi ◽  
Mamoru Takiguchi ◽  
Toshiyasu Suzuki
Keyword(s):  
Cardiopulmonary Bypass ◽  
Arterial Pressure ◽  
Pressure Gradient ◽  
Radial Artery ◽  
Aortic Pressure ◽  
Propagation Time ◽  
Arterial Elasticity ◽  
Pressure Distributions ◽  
Before And After ◽  
Radial Artery Pressure

Background An aortic-to-radial arterial pressure gradient may develop during and after cardiopulmonary bypass (CPB). The mechanisms of this pressure gradient remain controversial. To clarify the cause of the pressure gradient after CPB, the authors investigated the relationship between the pressure gradient and changes in the pulse wave velocity (PWV) before and after CPB. Methods The pressure gradient from the aorta to the radial artery and a change in PWV were measured with a wire (0.37 mm in diameter) tipped with a miniature pressure transducer in 12 patients undergoing cardiac surgery. The pressure distributions and waveforms were measured and recorded with electrocardiograph. The PWV was calculated by measuring the propagation time between the R wave of the electrocardiograph and the rising point of the arterial pressure waveform at 10-cm intervals. Results After CPB, 7 of 12 patients demonstrated a marked pressure gradient. In these patients, the pressure distribution showed a gradual decrease toward the periphery without a precipitous step-down in pressure at any one specific anatomic location. The PWV decreased as the intraarterial pressure decreased from the aorta to the radial artery, and the relative arterial elasticity decreased linearly toward the periphery. Conclusions The results showed that the decrease in PWV implies a decrease in arterial elasticity, and the decrease in the arterial elasticity correlated with the decrease in intraarterial pressure. These findings demonstrated that a radial artery pressure lower than the aortic pressure after CPB may be due to the decrease in arterial elasticity.

scholarly journals Impact of non-invasive respiratory support in severe patients with COVID-19

ANALES RANM ◽  
2020 ◽  
Vol 137 (137(02)) ◽  
pp. 154-160
Author(s):  
Ester Zamarrón ◽  
Carlos Carpio ◽  
Ana Santiago ◽  
Sergio Alcolea ◽  
Juan Carlos Figueira ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Respiratory Therapy ◽  
Respiratory Support ◽  
Intensive Care Patients ◽  
Non Invasive ◽  
Discharged Patients ◽  
Respiratory Treatment ◽  
The Impact

Objectives: to assess the impact of non-invasive respiratory therapies in critically ill patients diagnosed with COVID-19. Methods: retrospective cohort study of COVID-19 hospitalized patients who required non-invasive respiratory support. The impact of these treatments was evaluated in three groups of patients: pre-intensive care patients, discharged patients from critical care unit (CCU) and non-CCU admitted patients. The impact was assessed 30 days after completing respiratory therapy and was categorized as hospital discharge, transfer to a rehabilitation center, admission to the UCC and deceased. Results: a total of 80 patients were included (average age: 65.9 ± 11.9; men = 45 [56.3%]). 29 (36.3%) patients received BIPAP, 35 (43.8%) CPAP and 27 (33.4%) high-oxygen nasal cannula. Regarding the groups for the indication of respiratory treatment, 37 (46.3%) patients corresponded to the pre-intensive care patients, 24 (30%) were discharged patients from the CCU and 19 (23.8%) to the non-CCU admitted group. In the pre-intensive care, admission to a CCU was avoided in 19 (52.8%) patients and, on the other hand, 14 (38.9%) patients finally were admitted in a CCU. In the group of discharged patients from the UCC 19 (82.6%) patients showed a favorable course of disease. Only 3 (13%) patients were admitted in a UCC or died. Finally, in the group of non-CCU admitted, 6 (31.3%) improved after the use of respiratory therapy and 13 (68.4%) were deceased. Conclusions: respiratory therapies have a favorable impact on critically ill patients affected by COVID-19, both in patients with an indication for admission in the CCU, in those who are discharged from the CCUs and in those who do not have criteria for admission in these units.

scholarly journals Craniocerebral hypothermia as a therapeutic treatment option for thermal balance disturbances in post-comatose patients

2020 ◽  
Vol 2 (1) ◽  
pp. 11-19
Author(s):  
O. A. Shevelev ◽  
Sh. Kh. Saidov ◽  
M. V. Petrova ◽  
M. A. Chubarova ◽  
E. Sh. Usmanov
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Treatment Algorithm ◽  
Traumatic Injuries ◽  
Non Invasive ◽  
Medical Institutions ◽  
Disability Rate ◽  
Level Of Consciousness ◽  
Chronically Critically Ill

Background. Functional outcome in patients after cardiovascular, cerebral or traumatic injuries often remains unfavorable, what needs long rehabilitation and care. Aims. Optimization of chronically critically ill patients treatment using selective craniocerebral hypothermia added to a standard intensive care. Methods. Use of craniocerebral therapeutic hypothermia device ATG-01 has greater clinical efficacy in mortality rate, CRS-R rate and modified Rankin scale rate, as well as decrease in disability rate. Treatment algorithm with the use of craniocerebral hypothermia device ATG-01 has greater efficacy in cost- effectiveness analysis. Results. Methods of multipositional SHF- radiothermometry and thermomonitoring, as well as non-invasive craniocerebral hypothermia used in chronically critically ill patients for the first time. Results of our research have showed high efficacy of these methods and let us optimistically estimate the perspective to involve CCH in rehabilitation interventions of such patients. Conclusion. Our results can be used in Intensive Care Units of different medical institutions that provide healthcare to patients with brain damage and common central nervous system diseases that outcome to low level of consciousness.

scholarly journals Bedside echocardiography in critically ill patients

2015 ◽  
Vol 13 (4) ◽  
pp. 644-646 ◽  
Author(s):  
Eduardo Casaroto ◽  
Tatiana Mohovic ◽  
Lilian Moreira Pinto ◽  
Tais Rodrigues de Lara
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Basic Training ◽  
Common Procedure ◽  
Left Ventricle Function ◽  
Non Invasive ◽  
Bedside Echocardiography ◽  
Cardiovascular Assessment ◽  
Ventricle Function

ABSTRACT The echocardiography has become a vital tool in the diagnosis of critically ill patients. The use of echocardiography by intensivists has been increasing since the 1990’s. This tool has become a common procedure for the cardiovascular assessment of critically ill patients, especially because it is non-invasive and can be applied in fast and guided manner at the bedside. Physicians with basic training in echocardiography, both from intensive care unit or emergency department, can assess the left ventricle function properly with good accuracy compared with assessment made by cardiologists. The change of treatment approach based on echocardiographic findings is commonly seen after examination of unstable patient. This brief review focuses on growing importance of echocardiography as an useful tool for management of critically ill patients in the intensive care setting along with the cardiac output assessment using this resource.

Sign in / Sign up

Export Citation Format

Share Document