- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Part 5.1 Physiology
- Part 5.2 Cardiovascular monitoring
- Chapter 129 ECG monitoring in the ICU
- Chapter 130 Arterial and venous cannulation in the ICU
- Chapter 131 Blood pressure monitoring in the ICU
- Chapter 132 Central venous pressure monitoring in the ICU
- Chapter 133 Pulmonary artery catheterization in the ICU
- Chapter 134 Mixed and central venous oxygen saturation monitoring in the ICU
- Chapter 135 Right ventricular function in the ICU
- Chapter 136 Cardiac output assessment in the ICU
- Chapter 137 Oxygen transport in the critically ill
- Chapter 138 Tissue perfusion monitoring in the ICU
- Chapter 139 Lactate monitoring in the ICU
- Chapter 140 Measurement of extravascular lung water in the ICU
- Chapter 141 Doppler echocardiography in the ICU
- Chapter 142 Monitoring the microcirculation in the ICU
- Chapter 143 Imaging the cardiovascular system in the ICU
- Part 5.3 Acute chest pain and coronary syndromes
- Part 5.4 Aortic dissection
- Part 5.5 The hypotensive patient
- Part 5.6 Cardiac failure
- Part 5.7 Tachyarrhythmias
- Part 5.8 Bradyarrhythmias
- Part 5.9 Valvular problems
- Part 5.10 Endocarditis
- Part 5.11 Severe hypertension
- Part 5.12 Severe capillary leak
- Part 5.13 Pericardial tamponade
- Part 5.14 Pulmonary hypertension
- Part 5.15 Pulmonary embolus
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 608) Blood pressure monitoring in the ICU
- Chapter:
- (p. 608) Blood pressure monitoring in the ICU
- Author(s):
Stefano Romagnoli
and Giovanni Zagli
- DOI:
- 10.1093/med/9780199600830.003.0131
Two major systems are available for measuring blood pressure (BP)—the indirect cuff method and direct arterial cannulation. In critically-ill patients admitted to the intensive care unit, the invasive blood pressure is the ‘gold standard’ as a tight control of BP values, and its change over time is important for choosing therapies and drugs titration. Since artefacts due to the inappropriate dynamic responses of the fluid-filled monitoring systems may lead to clinically relevant differences between actual and displayed pressure values, before considering the BP value shown as reliable, the critical care giver should carefully evaluate the presence/absence of artefacts (over- or under-damping/resonance). After the arterial pressure waveform quality has been verified, the observation of each component of the arterial wave (systolic upstroke, peak, systolic decline, small pulse of reflected pressure waves, dicrotic notch) may provide a number of useful haemodynamic information. In fact, changes in the arterial pulse contour are due the interaction between the heart beat and the whole vascular properties. Vasoconstriction, vasodilatation, shock states (cardiogenic, hypovolaemic, distributive, obstructive), valve diseases (aortic stenosis, aortic regurgitation), ventricular dysfunction, cardiac tamponade are associated with particular arterial waveform characteristics that may suggest to the physician underlying condition that could be necessary to investigate properly. Finally, the effects of positive-pressure mechanical ventilation on heart–lung interaction, may suggest the existence of an absolute or relative hypovolaemia by means of the so-called dynamic indices of fluid responsiveness.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Part 5.1 Physiology
- Part 5.2 Cardiovascular monitoring
- Chapter 129 ECG monitoring in the ICU
- Chapter 130 Arterial and venous cannulation in the ICU
- Chapter 131 Blood pressure monitoring in the ICU
- Chapter 132 Central venous pressure monitoring in the ICU
- Chapter 133 Pulmonary artery catheterization in the ICU
- Chapter 134 Mixed and central venous oxygen saturation monitoring in the ICU
- Chapter 135 Right ventricular function in the ICU
- Chapter 136 Cardiac output assessment in the ICU
- Chapter 137 Oxygen transport in the critically ill
- Chapter 138 Tissue perfusion monitoring in the ICU
- Chapter 139 Lactate monitoring in the ICU
- Chapter 140 Measurement of extravascular lung water in the ICU
- Chapter 141 Doppler echocardiography in the ICU
- Chapter 142 Monitoring the microcirculation in the ICU
- Chapter 143 Imaging the cardiovascular system in the ICU
- Part 5.3 Acute chest pain and coronary syndromes
- Part 5.4 Aortic dissection
- Part 5.5 The hypotensive patient
- Part 5.6 Cardiac failure
- Part 5.7 Tachyarrhythmias
- Part 5.8 Bradyarrhythmias
- Part 5.9 Valvular problems
- Part 5.10 Endocarditis
- Part 5.11 Severe hypertension
- Part 5.12 Severe capillary leak
- Part 5.13 Pericardial tamponade
- Part 5.14 Pulmonary hypertension
- Part 5.15 Pulmonary embolus
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care