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Meta-Analysis
. 2024 May 24;6(6):e1096.
doi: 10.1097/CCE.0000000000001096. eCollection 2024 Jun 1.

Comparison of Central and Peripheral Arterial Blood Pressure Gradients in Critically Ill Patients: A Systematic Review and Meta-Analysis

Daisuke Hasegawa  1 , Ryota Sato  2 , Abhijit Duggal  3   4 , Mary Schleicher  5 , Kazuki Nishida  6 , Ashish K Khanna  7   8   9 , Siddharth Dugar  3   4
Affiliations
Meta-Analysis

Comparison of Central and Peripheral Arterial Blood Pressure Gradients in Critically Ill Patients: A Systematic Review and Meta-Analysis

Daisuke Hasegawa et al. Crit Care Explor. .

Abstract

Objectives: Measurement of blood pressure taken from different anatomical sites, are often perceived as interchangeable, despite them representing different parts of the systemic circulation. We aimed to perform a systematic review and meta-analysis on blood pressure differences between central and peripheral arterial cannulation in critically ill patients.

Data sources: We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase from inception to December 26, 2023, using Medical Subject Headings (MeSH) terms and keywords.

Study selection: Observation study of adult patients in ICUs and operating rooms who underwent simultaneous central (femoral, axillary, or subclavian artery) and peripheral (radial, brachial, or dorsalis pedis artery) arterial catheter placement in ICUs and operating rooms.

Data extraction: We screened and extracted studies independently and in duplicate. We assessed risk of bias using the revised Quality Assessment for Studies of Diagnostic Accuracy tool.

Data synthesis: Twenty-four studies that enrolled 1598 patients in total were included. Central pressures (mean arterial pressure [MAP] and systolic blood pressure [SBP]) were found to be significantly higher than their peripheral counterparts, with mean gradients of 3.5 and 8.0 mm Hg, respectively. However, there was no statistically significant difference in central or peripheral diastolic blood pressure (DBP). Subgroup analysis further highlighted a higher MAP gradient during the on-cardiopulmonary bypass stage of cardiac surgery, reperfusion stage of liver transplant, and in nonsurgical critically ill patients. SBP or DBP gradient did not demonstrate any subgroup specific changes.

Conclusions: SBP and MAP obtained by central arterial cannulation were higher than peripheral arterial cannulation; however, clinical implication of a difference of 8.0 mm Hg in SBP and 3.5 mm Hg in MAP remains unclear. Our current clinical practices preferring peripheral arterial lines need not change.

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Conflict of interest statement

Dr. Khanna consults for Edwards Lifesciences, Medtronic, Potrero Medical, GE Healthcare, Philips North America, Caretaker Medical, and Retia Medical. He is funded by an National Institutes of Health/National Center for Advancing Translational Sciences KL2 award for assessment of blood pressure and oxygenation in postoperative patients and a Wake Forest Hypertension and Vascular Research award for studying the relationship between serum renin and outcomes in patients with septic shock. Dr. Duggal consults for ALung Technologies and receives funding from National Heart, Lung, and Blood Institute U grant for the Prevention and Early Treatment of Acute Lung Injury (PETAL) network to study prevention and treatment of acute lung injury. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow chart of the identification and selection of studies for inclusion.
Figure 2.
Figure 2.
Forest plots for primary and secondary outcomes. DBP = diastolic blood pressure, MAP = mean arterial pressure, SBP = systolic blood pressure.
Figure 3.
Figure 3.
Funnel plots for the primary outcome.
See this image and copyright information in PMC

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