Direct Arterial Pressure Monitoring: Pattern Recognition in the Management of Circulatory Failure

  • M. Nirmalan
  • M. R. Pinsky
Conference paper

Abstract

Direct arterial blood pressure monitoring is frequently undertaken in operating rooms, critical care units, emergency departments and coronary care units where rapid alterations in hemodynamic status may occur in response to the underlying disease and/or treatment. In addition to providing a beat-to beat measurement of blood pressure, a careful study of the individual components of the arterial pressure waveform will also enable a more comprehensive assessment of several other hemodynamic parameters that may influence treatment [1, 2, 3, 4]. Changes in circulating volume (or ventricular preload), stroke volume (an important determinant of cardiac output), volume responsiveness and peripheral vascular resistance (or afterload) are some of the more important variables that may be inferred from the arterial pressure trace. Understanding the significance of all the components of an arterial pressure waveform is, therefore, an essential skill for hospital doctors involved in the care of acutely ill patients. In this case-based discussion we will present a series of arterial pressure recordings that illustrate some of the clinically important concepts.

Keywords

Turkey Norepinephrine Vasocon Metaraminol Voluven 

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References

  1. 1.
    Pinsky MR (2003) Probing the limits of arterial pulse contour analysis to predict preload responsiveness. Anesth Analg 96: 1245–1247CrossRefPubMedGoogle Scholar
  2. 2.
    Marquez J, McCurry K, Severyn DA, Pinsky MR (2008) Ability of pulse power, esophageal Doppler, and arterial pulse pressure to estimate rapid changes in stroke volume in humans. Crit Care Med 36: 3001–3007CrossRefPubMedGoogle Scholar
  3. 3.
    Michard F, Chemla D, Richard C, et al (1999) Clinical use of respiratory changes in arterial pulse pressure to monitor the hemodynamic effects of PEEP. Am J Respir Crit Care Med 159: 935–939PubMedGoogle Scholar
  4. 4.
    Michard F, Boussat S, Chemla D, et al (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162: 134–138PubMedGoogle Scholar
  5. 5.
    Dark P, Little R, Nirmalan M, Purdy J (2006) Systemic arterial pressure wave reflections during acute hemorrhage. Crit Care Med 34: 1497–1505CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2010

Authors and Affiliations

  • M. Nirmalan
    • 1
  • M. R. Pinsky
    • 2
  1. 1.Critical Care UnitManchester Royal InfirmaryManchesterUK
  2. 2.Department of Critical Care MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA

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