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Radial Artery Pulse Pressure Variation Correlates With Brachial Artery Peak Velocity Variation in Ventilated Subjects When Measured by Internal Medicine Residents Using Hand-Carried Ultrasound Devices^*

^* From the Department of Cardiology (Drs. Brennan, Blair, Hampole, Goonewardena, Vasaiwala, Shah, and Spencer), The University of Chicago Hospitals, Chicago, IL; and the Carver College of Medicine (Dr. Schmidt), University of Iowa, Iowa City, IA.

Correspondence to: J. Matthew Brennan, MD, Division of Cardiovascular Diseases, Duke University Medical Center, 2300-2399 Erwin Rd, Durham, NC 27710; e-mail: j.matthew.brennan.98{at}alum.dartmouth.org

Abstract

Background: Rapid prediction of the effect of volume expansion is crucial in unstable patients receiving mechanical ventilation. Both radial artery pulse pressure variation (PP) and change of aortic blood flow peak velocity are accurate predictors but may be impractical point-of-care tools.

Purpose: We sought to determine whether respiratory changes in the brachial artery blood flow velocity (Vpeak-BA) as measured by internal medicine residents using a hand-carried ultrasound (HCU) device could provide an accurate corollary to PP in patients receiving mechanical ventilation.

Methods: Thirty patients passively receiving volume-control ventilation with preexisting radial artery catheters were enrolled. The brachial artery Doppler signal was recorded and analyzed by blinded internal medicine residents using a HCU device. Simultaneous radial artery pulse wave and central venous pressure recordings (when available) were analyzed by a blinded critical care physician.

Results: A Doppler signal was obtained in all 30 subjects. The Vpeak-BA correlated well with PP (r = 0.84) with excellent agreement (weighted , 0.82) and limited intraobserver variability (2.8 ± 2.8%) [mean ± SD]. A Vpeak-BA cutoff of 16% was highly predictive of PP 13% (sensitivity, 91%; specificity, 95%). A poor correlation existed between the CVP and both Vpeak-BA (r = – 0.21) and PP (r = – 0.16).

Conclusions: The HCU Doppler assessment of the Vpeak-BA as performed by internal medicine residents is a rapid, noninvasive bedside correlate to PP, and a Vpeak-BA cutoff of 16% may prove useful as a point-of-care tool for the prediction of volume responsiveness in patients receiving mechanical ventilation.

Key Words: hand-carried ultrasound • mechanical ventilation • pulse pressure variation

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Is Brachial Artery Peak Velocity Variation Ready for Prime Time?

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Chest 2007 131: 1279-1281. [Full Text] [PDF]

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