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Radial artery pulse pressure variation correlates with brachial artery peak velocity variation in ventilated subjects when measured by internal medicine residents using hand-carried ultrasound devices.
- Source :
-
Chest [Chest] 2007 May; Vol. 131 (5), pp. 1301-7. - Publication Year :
- 2007
-
Abstract
- Background: Rapid prediction of the effect of volume expansion is crucial in unstable patients receiving mechanical ventilation. Both radial artery pulse pressure variation (DeltaPP) and change of aortic blood flow peak velocity are accurate predictors but may be impractical point-of-care tools.<br />Purposes: We sought to determine whether respiratory changes in the brachial artery blood flow velocity (DeltaVpeak-BA) as measured by internal medicine residents using a hand-carried ultrasound (HCU) device could provide an accurate corollary to DeltaPP in patients receiving mechanical ventilation.<br />Methods: Thirty patients passively receiving volume-control ventilation with preexisting radial artery catheters were enrolled. The brachial artery Doppler signal was recorded and analyzed by blinded internal medicine residents using a HCU device. Simultaneous radial artery pulse wave and central venous pressure recordings (when available) were analyzed by a blinded critical care physician.<br />Results: A Doppler signal was obtained in all 30 subjects. The DeltaVpeak-BA correlated well with DeltaPP (r = 0.84) with excellent agreement (weighted kappa, 0.82) and limited intraobserver variability (2.8 +/- 2.8%) [mean +/- SD]. A DeltaVpeak-BA cutoff of 16% was highly predictive of DeltaPP > or = 13% (sensitivity, 91%; specificity, 95%). A poor correlation existed between the CVP and both DeltaVpeak-BA (r = - 0.21) and DeltaPP (r = - 0.16).<br />Conclusions: The HCU Doppler assessment of the DeltaVpeak-BA as performed by internal medicine residents is a rapid, noninvasive bedside correlate to DeltaPP, and a DeltaVpeak-BA cutoff of 16% may prove useful as a point-of-care tool for the prediction of volume responsiveness in patients receiving mechanical ventilation.
- Subjects :
- Aged
Blood Flow Velocity physiology
Brachial Artery physiology
Cardiac Output physiology
Female
Humans
Internship and Residency
Male
Middle Aged
Observer Variation
Positive-Pressure Respiration
Radial Artery physiology
Regional Blood Flow physiology
Respiratory Mechanics
Ultrasonography, Doppler instrumentation
Ventricular Function, Left physiology
Blood Pressure physiology
Brachial Artery diagnostic imaging
Point-of-Care Systems statistics & numerical data
Radial Artery diagnostic imaging
Respiration, Artificial adverse effects
Stroke Volume physiology
Subjects
Details
- Language :
- English
- ISSN :
- 0012-3692
- Volume :
- 131
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Chest
- Publication Type :
- Academic Journal
- Accession number :
- 17494781
- Full Text :
- https://doi.org/10.1378/chest.06-1768