Effects of arm elevation on radial artery pressure: a new method to distinguish hypovolemic shock and septic shock from hypotension. Issue 3 (June 2018)

• Record Type: Journal Article
• Authors: Xie, Zhiyi; Zhang, Zhenyu; Xu, Yuan; Zhou, Hua; Wu, Sheng; Wang, Zhong
• Is Part Of: Blood pressure monitoring. Volume 23:Issue 3(2018)
• Publication Date: 2018-06
• Subjects: arm elevation -- hemodynamic -- hypotension -- hypovolemic shock -- invasive blood pressure -- radial artery -- septic shock; Blood pressure -- Measurement -- Periodicals; Blood Pressure Determination -- Periodicals; Blood Pressure Monitoring, Ambulatory -- Periodicals; Blood Pressure Monitors -- Periodicals; Hypertension -- Periodicals; 612.140287
• DOI: 10.1097/MBP.0000000000000318
• Languages: English
• ISSNs: 1359-5237

Abstract

Abstract : Objectives: In this prospective observational study, we investigated the variability in radial artery invasive blood pressure associated with arm elevation in patients with different hemodynamic types. Patients and methods: We carried out a prospective observational study using data from 73 general anesthesia hepatobiliary postoperative adult patients admitted to an ICU over a 1-year period. A standard procedure was used for the arm elevation test. The value of invasive radial arterial pressure was recorded at baseline, and 30 and 60 s after the arm had been raised from 0° to 90°. We compared the blood pressure before versus after arm elevation, and between hemodynamically stable, hypovolemic shock, and septic shock patient groups. Results: In all 73 patients, systolic arterial pressure (SAP) decreased, diastolic arterial pressure (DAP) increased, and pulse pressure (PP) decreased at 30 and 60 s after arm elevation ( P <0.01), but the mean arterial pressure (MAP) was unchanged ( P >0.05). On comparing 30 and 60 s, there was no significant difference in SAP, DAP, PP, or MAP ( P >0.05). In 40 hemodynamically stable patients, SAP and PP decreased, and DAP and MAP increased significantly at 30 and 60 s after arm elevation compared with baseline ( P <0.01). In 16 hypovolemic patients, SAP, DAP, and MAP increased significantly compared with baseline at 30 and 60 s ( P <0.01), but PP was unchanged ( P >0.05). In 17 patients with septic shock, SAP, PP, and MAP decreased significantly versus baseline at 30 and 60 s ( P <0.01), but DAP was unchanged ( P >0.05). Comparison of the absolute value of pressure change of septic shock patients at 30 s after raising the arm showed that SAP, DAP, and MAP changes were significantly lower compared with those in hypovolemic shock and hemodynamically stable patients ( P <0.01). The areas under the receiver operator characteristic curve for predicting septic shock was 0.930 [95% confidence interval (CI): 0.867–0.992, P < 0.001] for change value at 30 s after arm elevation of SAP. The best cut-off point for the SAP change value was −5 mmHg or less, with a sensitivity of 94.12%, a specificity of 80.36%, a positive likelihood ratio of 4.79 (95% CI: 2.8–8.2), and a negative likelihood ratio of 0.073 (95% CI: 0.01–0.5). Conclusion: Our study shows that hypovolemic shock and septic shock patients have significantly different radial artery invasive blood pressure changes in an arm elevation test, which could be applied as a new method to distinguish hypovolemic shock and septic shock from hypotension.