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Predictors of ineffectual radial arterial pressure monitoring in valvular heart surgery

Authors
 Seong Wook Hong  ;  Jae Kwang Shim  ;  Yong Seon Choi  ;  Duk-Hee Chun  ;  Jong Chan Kim  ;  Bum Su Kim  ;  Young Lan Kwak 
Citation
 Journal of Heart Valve Disease, Vol.18(5) : 546-553, 2009 
Journal Title
 Journal of Heart Valve Disease 
ISSN
 0966-8519 
Issue Date
2009
Abstract
BACKGROUND AND AIM OF THE STUDY: Unexpected sustained underestimation of the central aortic pressure by the radial arterial pressure commonly develops following cardiopulmonary bypass (CPB) in valvular heart surgery (VHS), leading to an inappropriate use of vasopressors. The study aim was to identify clinical predictors leading to a sustained inappropriate difference between the radial and femoral arterial pressure (IDRF) in VHS. METHODS: A total of 200 patients undergoing VHS was studied prospectively. Those patients who developed sustained IDRF (systolic IDRF > or =10 mmHg and/or mean IDRF > or =5 mmHg) from immediately after discontinuation of CPB until the end of the surgery were compared with patients who did not develop any IDRF. RESULTS: Data from seven patients who required second aortic cross-clamping and re-CPB were excluded from the analysis; thus, data from 193 patients were analyzed. In total, 53 patients (27.5%) developed sustained IDRF, whereas 80 patients (41.4%) did not develop any IDRF. In multivariate analysis, female gender, the presence of atrial fibrillation and diuretic use were identified as independent preoperative predictors; longer-duration aortic cross-clamping and use of larger amounts of vasopressin during CPB were identified as independent operative risk factors of the sustained IDRF. CONCLUSION: When an erroneously low radial arterial pressure is suspected following CPB in this subset of patients undergoing VHS, monitoring of the femoral or axillary arterial pressure should be considered to guide hemodynamic management, as there is an increased risk of persistence of this phenomenon.
Full Text
http://www.icr-heart.com/?cid=2129
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Kim, Jong Chan(김종찬)
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Chun, Duk Hee(전덕희)
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
Hong, Seong Wook(홍성욱)
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/104362
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