Interpretation of blood pressure signal: physiological bases, clinical relevance, and objectives during shock states.

J-F Augusto, J-L Teboul, P Radermacher, P Asfar
Author Information
  1. J-F Augusto: Laboratoire HIFIH, IFR 132, Université d' Angers et service de réanimation médicale et médecine hyperbare, CHU Angers, Angers Cedex 9, France.

Abstract

Achievement of a mean blood pressure (MBP) target is one of the hemodynamic goals to ensure an adequate blood perfusion pressure in critically ill patients. Arterial catheter allows for a continuous and precise monitoring of arterial pressure signal. In addition to giving a precise MBP monitoring, analysis of the blood pressure wave provides information that may help the clinician to interpret hemodynamic status. The interpretation of BP wave requires the understanding of simple principles. In this review, we first discuss the physiological mechanism responsible for arterial pressure generation. We then emphasize the interpretation of the static indexes and the dynamic indexes generated by heart-lung interactions derived from arterial pressure wave. Finally, we focus on MBP value as a therapeutic target in critically ill patients. We discuss the recommended target MBP value by reviewing available data from experimental and clinical studies.

References

  1. N Engl J Med. 2001 Nov 8;345(19):1368-77 [PMID: 11794169]
  2. N Engl J Med. 1995 Oct 19;333(16):1025-32 [PMID: 7675044]
  3. Crit Care Med. 2009 Sep;37(9):2642-7 [PMID: 19602972]
  4. Crit Care Med. 2003 Oct;31(10):2509-13 [PMID: 14530759]
  5. Am J Physiol. 1976 Feb;230(2):298-305 [PMID: 1259008]
  6. Crit Care Clin. 2009 Oct;25(4):781-802, ix [PMID: 19892253]
  7. Blood Press Monit. 2004 Aug;9(4):179-85 [PMID: 15311144]
  8. Intensive Care Med. 2001 Jul;27(7):1231-4 [PMID: 11534574]
  9. Curr Opin Crit Care. 2007 Oct;13(5):549-53 [PMID: 17762234]
  10. Lancet. 2007 Aug 25;370(9588):676-84 [PMID: 17720019]
  11. J Clin Invest. 1962 Feb;41:203-17 [PMID: 13900043]
  12. Intensive Care Med. 2005 Apr;31(4):517-23 [PMID: 15754196]
  13. N Engl J Med. 2008 Feb 28;358(9):877-87 [PMID: 18305265]
  14. Hypertension. 2005 Apr;45(4):652-8 [PMID: 15699456]
  15. Intensive Care Med. 2005 Aug;31(8):1066-71 [PMID: 15973520]
  16. Circ Res. 1955 Nov;3(6):623-32 [PMID: 13270378]
  17. Intensive Care Med. 2007 Jul;33(7):1117-1124 [PMID: 17508201]
  18. Circ Res. 1986 Nov;59(5):483-95 [PMID: 3542277]
  19. Crit Care Med. 2005 Apr;33(4):780-6 [PMID: 15818105]
  20. Crit Care Med. 2009 Mar;37(3):951-6 [PMID: 19237902]
  21. Intensive Care Med. 2007 Sep;33(9):1557-62 [PMID: 17486316]
  22. Crit Care. 2004 Jun;8(3):170-9 [PMID: 15153235]
  23. Crit Care Med. 2004 Jan;32(1):21-30 [PMID: 14707556]
  24. Intensive Care Med. 2005 Apr;31(4):499-500 [PMID: 15742174]
  25. Am J Respir Crit Care Med. 1997 Jun;155(6):1965-71 [PMID: 9196103]
  26. Crit Care Med. 2009 Jun;37(6):1961-6 [PMID: 19384212]
  27. Med Biol Eng Comput. 2009 Feb;47(2):119-29 [PMID: 18626676]
  28. Crit Care Med. 2000 Aug;28(8):2729-32 [PMID: 10966242]
  29. Intensive Care Med. 2003 Apr;29(4):659 [PMID: 12577146]
  30. Anesthesiology. 1998 Dec;89(6):1313-21 [PMID: 9856704]
  31. Crit Care Med. 2008 Oct;36(10):2810-6 [PMID: 18766099]
  32. Crit Care Med. 2008 Jan;36(1):296-327 [PMID: 18158437]
  33. Crit Care. 2000;4(5):282-9 [PMID: 11094507]
  34. Crit Care. 2009;13(3):R92 [PMID: 19534818]
  35. Am J Respir Crit Care Med. 2000 Jul;162(1):134-8 [PMID: 10903232]
  36. Am J Respir Crit Care Med. 1999 Mar;159(3):935-9 [PMID: 10051276]
  37. J Physiol. 1981 Dec;321:21-30 [PMID: 7040635]
  38. Am J Physiol. 1998 Feb;274(2):H500-5 [PMID: 9486253]

MeSH Term

Algorithms
Arteries
Blood Pressure
Blood Pressure Determination
Critical Care
Female
Hemodynamics
Humans
Male
Monitoring, Physiologic
Shock, Septic

Word Cloud

Created with Highcharts 10.0.0pressurebloodMBPtargetarterialwavehemodynamiccriticallyillpatientsprecisemonitoringinterpretationdiscussphysiologicalindexesvalueclinicalAchievementmeanonegoalsensureadequateperfusionArterialcatheterallowscontinuoussignaladditiongivinganalysisprovidesinformationmayhelpclinicianinterpretstatusBPrequiresunderstandingsimpleprinciplesreviewfirstmechanismresponsiblegenerationemphasizestaticdynamicgeneratedheart-lunginteractionsderivedFinallyfocustherapeuticrecommendedreviewingavailabledataexperimentalstudiesInterpretationsignal:basesrelevanceobjectivesshockstates

Similar Articles

Cited By (13)

See all "Cited by" articles