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Blood pressure measurement in patients with cardiogenic shock

the effect of norepinephrine

Hromádka, Milana; Tůmová, Pavlínaa; Rokyta, Richarda; Seidlerová, Jitkab,,c

doi: 10.1097/MBP.0000000000000393
Clinical Methods and Pathophysiology

Background: Before arterial cannulation for invasive blood pressure monitoring, clinical decision-making depends on non-invasive blood pressure in critically ill patients. Whether non-invasive blood pressure is comparable to invasive measurement is not clearly elucidated. We address this issue as it relates to the use of norepinephrine in patients with cardiogenic shock.

Methods: We analysed invasive and non-invasive blood pressure in 85 patients admitted to the Coronary-Care Unit for cardiogenic shock. We compared initial blood pressure measurement (just after radial artery cannulation) and blood pressure taken during the first 72 hours after admission. Invasive blood pressure was used as the reference method.

Results: Initial invasive mean and systolic arterial pressures were in a good agreement with oscillometric blood pressure; mean differences were −0.4 ± 8.8 and +6.1 ± 14.4 mmHg with correlation coefficients of 0.76 and 0.74. Doses of norepinephrine were significant negative determinants of invasive/oscillometric blood pressure differences. The invasive/oscillometric mean arterial pressures and SBP differences were +0.1 ± 3.4 and 7.6 ± 1.6 mmHg in patients treated with nothing or a maximum norepinephrine dose of 0.6 µg/kg/min. However, treatment with very high doses of norepinephrine was associated with a steep rise in mean arterial pressures and SBP invasive/oscillometric differences (−9.5 ± 3.3 and −8.5 ± 5.2 mmHg). In a total of 967 sets of blood pressure measurements, invasive/oscillometric differences were relatively stable across blood pressure categories, with the exception of measurements assessed after very high norepinephrine doses.

Conclusions: Non-invasive BP is a sufficient substitute for invasive measurement in cardiogenic shock patients, with the exception of those receiving very high doses of norepinephrine.

aCardiology Department, University Hospital and Faculty of Medicine in Pilsen and Faculty Hospital, Charles University

bInternal Department II, University Hospital and Faculty of Medicine in Pilsen, Charles University

cBiomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic

The work was conducted at University Hospital in Pilsen, Alej Svobody 80, 304 60 Plzen, Pilsen, Czech Republic.

Received 28 November 2018 Accepted 8 May 2019

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Correspondence to Jitka Seidlerová, MD, PhD, Assoc. Prof., Internal Department II, University Hospital and Faculty of Medicine in Pilsen, Charles University, Edvarda Benese 13, 305 99 Pilsen, Czech Republic, Tel: +420 377 402250; fax: +420 377 402374; e-mail:

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