Modalities of Invasive Arterial Pressure Monitoring in Critically Ill Patients. Issue 39 (September 2015)

• Record Type: Journal Article
• Authors: Jacq, Gwenaëlle; Gritti, Karine; Carré, Cécile; Fleury, Nadège; Lang, Annie; Courau-Courtois, Josette; Bedos, Jean-Pierre; Legriel, Stephane; Volpicelli., Giovanni
• Is Part Of: Medicine. Volume 94:Issue 39(2015)
• Publication Date: 2015-09
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000001557
• Languages: English
• ISSNs: 0025-7974

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <p>Few studies assessed modalities of invasive arterial pressure monitoring (IAPM). We evaluated effects on measured values of various combinations of transducer level, catheter access site, and patient position.</p> <p>Prospective observational study in consecutive adults admitted to a French intensive care unit in 2009 to 2011 and fulfilling our inclusion criteria. Four combinations (B–E) of transducer level, catheter access site, and patient position were compared with a reference combination (A) (A: patient supine with all catheters in the same plane and a single transducer level (M) for zero point reference (Z) aligned on the phlebostatic axis; B: 45° head-of-bed elevation with M and Z aligned on the phlebostatic axis; C: 45° head-of-bed elevation with M aligned on the catheter access site and Z on the phlebostatic axis; D: 45° head-of-bed elevation with M and Z aligned on the catheter access site; and E: 45° head-of-bed elevation with M aligned on the phlebostatic axis and Z on the catheter access site).</p> <p>We included 103 patients, 68 men and 35 women, with a median age of 69 years (interquartile range [IQR], 56–78); at inclusion, 91 (88.3%) received mechanical ventilation, 45 (43.7%) catecholamines, and 66 (64.1%) sedation. The IAPM access site was femoral in 49 (47.6%) and radial in 54 (52.4%) patients, with 62 of 103 (60.2%) catheters on the right side. Measured absolute mean arterial pressure values were significantly higher with 3 study combinations (C–E) than with the reference combination (A). After adjustment, the differences versus A (median, 83 [IQR, 74–92] mm Hg) remained significant for D (median, 91 [IQR, 85–100] mm Hg, <italic>P</italic> < 0.001) and E (median, 88 [IQR, 77–99] mm Hg, <italic>P</italic> < 0.001). The difference versus A was not significant for B (median, 85 [IQR, 76–94] mm Hg, <italic>P</italic> = 0.21) or C (median, 90 [IQR, 84–100] mm Hg, <italic>P</italic> = 0.006).</p> <p>Several modalities used for zeroing and/or transducer leveling during IAPM may result in statistically and clinically significant overestimation of measured mean arterial pressure values. For patients in the 45° head-of-bed elevation position, aligning the Z on the phlebostatic axis provides values that are not significantly different from those obtained using the reference supine modality.</p> </sec> </abstract>