Arterial site selection for measurement of mean arterial pressure in septic shock patients on high-dose norepinephrine

Bhanuprakash Bhaskar, Mohan Gurjar, Prabhaker Mishra, Afzal Azim, Banani Poddar, Arvind K Baronia, Bhanuprakash Bhaskar, Mohan Gurjar, Prabhaker Mishra, Afzal Azim, Banani Poddar, Arvind K Baronia

Abstract

Background: The guidelines of the Surviving Sepsis Campaign suggest using invasive blood pressure (IBP) measurement in septic shock patients, without specifying for a preferred arterial site for accuracy in relation to the severity of septic shock. The objective of this study was to determine the mean arterial pressure (MAP) gradient between the femoral and radial artery sites in septic shock patients.

Method: This prospective study was carried out at a 20-bed ICU in a university hospital. Simultaneous MAP measurements at femoral and radial arterial sites were obtained in septic shock patients receiving norepinephrine (≥0.1 μg/kg/min), with a pre-planned subgroup analysis for those receiving a high dose of norepinephrine (≥0.3 μg/kg/min).

Results: The median norepinephrine dose across all 80 patients studied, including 59 patients on a high dose, was 0.4 (0.28-0.7) μg/kg/min. Overall, simultaneous measurement of MAP (mmHg) at the femoral and radial arterial sites produced mean (95% CI) MAP values of 81 (79-83) and 78 (76-80), respectively, with a mean difference of 3.3 (2.67-3.93), p < 0.001. In Bland-Altman analysis of MAP measurements, the detected effect sizes were 1.14 and 1.04 for the overall and high-dose cohorts, respectively, which indicates a significant difference between the measurements taken at each of the two arterial sites. The Pearson correlation coefficient indicated a weak but statistically significant correlation between MAP gradient and norepinephrine dose among patients receiving a high dose of norepinephrine (r = 0.289; p = 0.026; 95% CI 0.036-0.508).

Conclusion: In septic shock patients, MAP readings were higher at the femoral site than at the radial site, particularly in those receiving a high dose of norepinephrine.

Clinical trial registration: [ClinicalTrials.gov], identifier [NCT03475667].

Keywords: arteries; femoral-radial arterial pressure gradient; hemodynamic monitoring; invasive blood pressure; mean arterial pressure; norepinephrine; septic shock; vasoconstrictor.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Bhaskar, Gurjar, Mishra, Azim, Poddar and Baronia.

Figures

FIGURE 1
FIGURE 1
Patients included in the study.
FIGURE 2
FIGURE 2
Bland–Altman analysis of differences between femoral and radial arterial pressure among all patients (n = 80), and among those on high-dose norepinephrine (n = 59). Panels (A,B) represent SBP; panels (C,D) represent MAP. The solid line represents bias (the mean difference between simultaneous measurements). Dotted lines show 95% limits of agreement (bias ± 1.96 SD). SBP, systolic blood pressure; MAP, mean arterial pressure.
FIGURE 3
FIGURE 3
Pearson correlation between norepinephrine dose and mean arterial pressure difference between the femoral and radial sites among patients receiving (A) norepinephrine dose <0.3 (0.1–0.29) μg/kg/min; (B) norepinephrine dose ≥0.3 μg/kg/min.

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