Department of Nephrology, Ruhr-University of Bochum, University Hospital Marien Hospital Herne, Herne, Germany.
Department of Cardiology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg, Brandenburg, Germany.
Eur J Clin Invest. 2021 Sep;51(9):e13587. doi: 10.1111/eci.13587. Epub 2021 May 22.
Patients in haemodynamic shock are in need for an intensive care treatment. Invasive haemodynamic monitoring is state of the art for these patients. However, evolved, non-invasive blood pressure monitoring devices offer advanced functions like the assessment of central blood pressure and arterial stiffness. We analysed the feasibility of two oscillometric blood pressure devices in patients with shock.
We performed a monocentre prospective study, enrolling 57 patients admitted to the intensive care unit (ICU), due to septic and/or cardiogenic shock. We assessed invasive and non-invasive peripheral and central blood pressure <24 hours and 48 hours after admission on the ICU. Additional haemodynamic parameters such as pulse wave velocity (PWV), augmentation pressure and augmentation index were obtained through Mobil-o-Graph PWA (IEM) and SphygmoCor XCEL (AtCor Medical).
A complete haemodynamic assessment was successful in all patients (48) with the Mobil-o-Graph 24 hours PWA and in 29 patients with the SphygmoCor XCEL (P = .001), when cases of death or device malfunction were excluded. Reasons for failure were severe peripheral artery disease, haemodynamic instability, oedema and agitation. Invasive blood pressure showed a sufficient correlation with both devices; however, large differences between invasive and non-invasive techniques were recorded in Bland-Altmann analysis (P < .05 for all parameters). PWV differed between the two devices.
Non-invasive peripheral blood pressure measurement remains a rescue technique. However, non-invasive assessment of arterial stiffness and central blood pressure is possible in patients with septic or cardiogenic shock. Further studies are required to assess their clinical significance for patients in shock.
血流动力学不稳定的患者需要重症监护治疗。有创血流动力学监测是此类患者的标准治疗方法。然而，先进的非侵入性血压监测设备提供了评估中心血压和动脉僵硬度等高级功能。我们分析了两种振荡血压监测仪在休克患者中的可行性。
我们进行了一项单中心前瞻性研究，共纳入 57 名因感染性和/或心源性休克而入住重症监护病房（ICU）的患者。我们在入住 ICU 后<24 小时和 48 小时评估了有创和非侵入性外周和中心血压。通过 Mobil-o-Graph PWA（IEM）和 SphygmoCor XCEL（AtCor Medical）获得了脉搏波速度（PWV）、增强压和增强指数等其他血流动力学参数。
排除死亡或设备故障病例后，所有患者（48 例）在 Mobil-o-Graph 24 小时 PWA 和 29 例患者在 SphygmoCor XCEL 上成功完成了完整的血流动力学评估（P = 0.001）。失败的原因是严重的外周动脉疾病、血流动力学不稳定、水肿和躁动。有创血压与两种设备均具有良好的相关性；然而，在 Bland-Altman 分析中记录到有创和非侵入性技术之间存在较大差异（所有参数 P < 0.05）。两种设备的 PWV 不同。
非侵入性外周血压测量仍然是一种抢救技术。然而，在感染性或心源性休克患者中可以进行动脉僵硬度和中心血压的非侵入性评估。需要进一步研究来评估它们对休克患者的临床意义。
