The impact of underdamping on the maximum rate of the radial pressure rise during systole (dP/dtMAX)

Anesthesiology and Perioperative Science Pub Date : 2023-09-22 DOI:10.1007/s44254-023-00033-3

Frederic Michard, Lorenzo Foti, Gianluca Villa, Zaccaria Ricci, Stefano Romagnoli

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Abstract

Purpose

In patients with a radial arterial catheter, underdamping of the pressure signal is common and responsible for an overestimation of systolic arterial pressure (SAP). The maximum rate of the arterial pressure rise during systole (dP/dt_MAX) has been proposed to assess left ventricular systolic function. The impact of underdamping on dP/dt_MAX is likely but has never been quantified.

Methods

We analyzed data from 70 critically ill patients monitored with a radial catheter in whom underdamping of the arterial pressure waveform was confirmed by the Gardner’s method. Invasive SAP and dP/dt_MAX were recorded at baseline and after the correction of underdamping with a resonance filter.

Results

With resonance filtering, SAP decreased from 159 ± 25 to 139 ± 22 mmHg (p < 0.001) and dP/dt_MAX from 2.0 ± 0.6 to 1.1 ± 0.3 mmHg/ms (p < 0.001). The underdamping-induced overestimation of SAP (delta-SAP) ranged from 6 to 41 mmHg (mean 21 ± 9 mmHg or + 15%) and the overestimation of dP/dt_MAX (delta-dP/dt_MAX) ranged from 0.2 to 2.0 mmHg/ms (mean 0.9 ± 0.4 mmHg/ms or + 84%). A significant linear relationship (p < 0.001, r = 0.6) was observed between delta-SAP and delta-dP/dt_MAX such that the higher was delta-SAP, the higher was delta-dP/dt_MAX.

Conclusions

Radial arterial pressure underdamping has a major impact on dP/dt_MAX. In case of underdamping, the overestimation of dP/dt_MAX is > fivefold higher than SAP overestimation. Therefore, caution should be exercised before using radial dP/dt_MAX as a marker of left ventricular systolic function.

Trial registration

Registered at ClinicalTrials.gov on December 22, 2021 (NCT05166993).

Graphical Abstract

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欠阻尼对收缩期径向压力最大上升率（dP/dtMAX）的影响

目的在使用桡动脉导管的患者中，压力信号阻尼不足很常见，这也是导致高估收缩期动脉压（SAP）的原因。有人提出用收缩期动脉压上升的最大速率（dP/dtMAX）来评估左心室收缩功能。我们分析了使用桡动脉导管监测的 70 名重症患者的数据，加德纳方法证实了这些患者的动脉压波形存在欠阻尼。结果经共振滤波后，SAP 从 159 ± 25 mmHg 降至 139 ± 22 mmHg（p < 0.001），dP/dtMAX 从 2.0 ± 0.6 mmHg/ms 降至 1.1 ± 0.3 mmHg/ms（p < 0.001）。湿润不足引起的 SAP 高估（delta-SAP）范围为 6 至 41 mmHg（平均 21 ± 9 mmHg 或 + 15%），dP/dtMAX 高估（delta-dP/dtMAX）范围为 0.2 至 2.0 mmHg/ms（平均 0.9 ± 0.4 mmHg/ms 或 + 84%）。在 delta-SAP 和 delta-dP/dtMAX 之间观察到明显的线性关系（p < 0.001，r = 0.6），即 delta-SAP 越高，delta-dP/dtMAX 越高。在阻尼不足的情况下，dP/dtMAX 的高估值是 SAP 高估值的五倍。因此，在使用桡动脉dP/dtMAX作为左心室收缩功能的标志物之前应慎重。试验注册于2021年12月22日在ClinicalTrials.gov网站注册（NCT05166993）。图文摘要

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Anesthesiology and Perioperative Science

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