Contribution of arterial stiffness and stroke volume to peripheral pulse pressure in ICU patients: an arterial tonometry study |
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Authors: | Bouchra Lamia Jean-Louis Teboul Xavier Monnet David Osman Julien Maizel Christian Richard Denis Chemla |
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Institution: | (1) Université Paris-Sud 11, Equipe d’Accueil EA4046, 94275 Le Kremlin-Bicêtre, France;(2) Service de Réanimation Médicale, AP-HP, Le Kremlin-Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France;(3) Service de Physiologie-Explorations Fonctionnelles, AP-HP, Le Kremlin-Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France |
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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.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. |
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Keywords: | Pulse pressure Arterial stiffness Stroke volume Arterial tonometry |
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