在使用血管活性药物的重症监护患者中无创检测股动脉至桡动脉的压力梯度
Non-invasive detection of a femoral-to-radial arterial pressure gradient in intensive care patients with vasoactive agents.
作者信息
Jacquet-Lagrèze Matthias, Claveau David, Cousineau Julie, Liu Kun Peng, Guimond Jean-Gilles, Aslanian Pierre, Lamarche Yoan, Albert Martin, Charbonney Emmanuel, Hammoud Ali, Kontar Loay, Denault André
机构信息
Centre Hospitalier Louis Pradel, Département d'Anesthésie Réanimation, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.
Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008, Lyon, France.
出版信息
J Intensive Care. 2021 Nov 27;9(1):71. doi: 10.1186/s40560-021-00585-1.
BACKGROUND
In patient requiring vasopressors, the radial artery pressure may underestimate the true central aortic pressure leading to unnecessary interventions. When using a femoral and a radial arterial line, this femoral-to-radial arterial pressure gradient (FR-APG) can be detected. Our main objective was to assess the accuracy of non-invasive blood pressure (NIBP) measures; specifically, measuring the gradient between the NIBP obtained at the brachial artery and the radial artery pressure and calculating the non-invasive brachial-to-radial arterial pressure gradient (NIBR-APG) to detect an FR-APG. The secondary objective was to assess the prevalence of the FR-APG in a targeted sample of critically ill patients.
METHODS
Adult patients in an intensive care unit requiring vasopressors and instrumented with a femoral and a radial artery line were selected. We recorded invasive radial and femoral arterial pressure, and brachial NIBP. Measurements were repeated each hour for 2 h. A significant FR-APG (our reference standard) was defined by either a mean arterial pressure (MAP) difference of more than 10 mmHg or a systolic arterial pressure (SAP) difference of more than 25 mmHg. The diagnostic accuracy of the NIBR-APG (our index test) to detect a significant FR-APG was estimated and the prevalence of an FR-APG was measured and correlated with the NIBR-APG.
RESULTS
Eighty-one patients aged 68 [IQR 58-75] years and an SAPS2 score of 35 (SD 7) were included from which 228 measurements were obtained. A significant FR-APG occurred in 15 patients with a prevalence of 18.5% [95%CI 10.8-28.7%]. Diabetes was significantly associated with a significant FR-APG. The use of a 11 mmHg difference in MAP between the NIBP at the brachial artery and the MAP of the radial artery led to a specificity of 92% [67; 100], a sensitivity of 100% [95%CI 83; 100] and an AUC ROC of 0.93 [95%CI 0.81-0.99] to detect a significant FR-APG. SAP and MAP FR-APG correlated with SAP (r = 0.36; p < 0.001) and MAP (r = 0.34; p < 0.001) NIBR-APG.
CONCLUSION
NIBR-APG assessment can be used to detect a significant FR-APG which occur in one in every five critically ill patients requiring vasoactive agents.
背景
在需要使用血管升压药的患者中，桡动脉血压可能会低估真正的中心主动脉压，从而导致不必要的干预。当同时使用股动脉和桡动脉置管时，可以检测到股-桡动脉压梯度（FR-APG）。我们的主要目标是评估无创血压（NIBP）测量的准确性；具体而言，测量肱动脉获得的NIBP与桡动脉血压之间的梯度，并计算无创肱-桡动脉压梯度（NIBR-APG）以检测FR-APG。次要目标是评估危重症患者目标样本中FR-APG的患病率。
方法
选择重症监护病房中需要使用血管升压药并同时置有股动脉和桡动脉导管的成年患者。我们记录了有创桡动脉和股动脉血压以及肱动脉NIBP。每小时重复测量一次，共测量2小时。显著的FR-APG（我们的参考标准）定义为平均动脉压（MAP）差值超过10 mmHg或收缩压（SAP）差值超过25 mmHg。估计NIBR-APG（我们的指标测试）检测显著FR-APG的诊断准确性，并测量FR-APG的患病率，并将其与NIBR-APG进行相关性分析。
结果
纳入了81例年龄为68岁[四分位间距58 - 75岁]且序贯器官衰竭评估（SAPS2）评分为35（标准差7）的患者，共获得228次测量数据。15例患者出现显著的FR-APG，患病率为18.5%[95%置信区间10.8 - 28.7%]。糖尿病与显著的FR-APG显著相关。使用肱动脉NIBP与桡动脉MAP之间11 mmHg的差值，检测显著FR-APG的特异性为92%[67；100]，敏感性为100%[95%置信区间83；100]，曲线下面积（AUC）为0.93[95%置信区间0.81 - 0.99]。SAP和MAP的FR-APG与SAP（r = 0.36；p < 0.001）和MAP（r = 0.34；p < 0.001）的NIBR-APG相关。
结论
NIBR-APG评估可用于检测显著的FR-APG，在每五名需要血管活性药物的危重症患者中就有一例出现这种情况。
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