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Lowe JB, Yoo MJ, Patrick JO, Bridwell RE. Facilitated Intubation: Time to Re-examine an Old Technique With Its Associated Risks Mitigated by New Technology. Cureus 2023; 15:e43364. [PMID: 37701008 PMCID: PMC10494483 DOI: 10.7759/cureus.43364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Facilitated intubation (FI) refers to intubation performed using a sedative or anesthetic drug as an induction agent, without the use of a paralytic (neuromuscular blocking agent). In comparison, rapid sequence intubation (RSI) employs both an induction agent and a paralytic drug. RSI has been seen to outperform FI in terms of first-pass success when performing direct laryngoscopy and was quickly adopted as the gold standard in all situations. Recently, ketamine-only intubation has been used in situations where there is distorted anatomy or apnea intolerance (physically and physiologically difficult airways) resulting in an increased risk of a can't intubate/can't oxygenate scenario or significant hypoxemia. Frequent and recurring national ketamine shortages have resulted in renewed interest in whether or not other forms of FI are feasible in an era where other factors that mitigate complictions in achieving first-pass success (video laryngoscopy, bougie use, semi-Fowler positioning) are commonly used. We present a case series with outcomes for profoundly hypoxic patients with coronavirus disease 2019 (COVID-19) (physiologically difficult airways) undergoing FI during a time of national ketamine shortage, using modern techniques and technology to maximize first-pass success and minimize peri-intubation complication. METHODS We included patients with COVID-19 pneumonia with pre-intubation oxygen saturations of less than 80% (significant hypoxemia) requiring intubation who presented to a tertiary care center in southern United States between August 25, 2021, and October 22, 2021. In this specific cohort, patients underwent endotracheal intubation with midazolam for induction without the use of paralytic agents. We used video-assisted laryngoscopy to increase the success of the first-pass attempt as well as placing the patients in a semi-Fowler position (head of bed elevation 30-45°) and bilevel positive pressure pre-oxygenation to minimize peri-intubation complications. RESULTS Our case series included 29 consecutive patients that met the inclusion criteria. The mean ± standard deviation (SD) age of the patients was 49.5±15.0 years. The mean±SD pre-intubation oxygenation of our cohort was 73.1±5.9%. All 29 intubations were successful on the first-pass attempt. Only one patient (3.4%) required a rescue paralytic to facilitate oral opening. Of note, 27/29 (93%) of the patients did not receive any immunizations (including partial) for COVID-19. There were no incidents of peri-intubation arrest (cardiac arrest within 30 minutes of induction) or aspiration. CONCLUSIONS In 29 physiologically difficult patients with acute respiratory failure, in whom the physician determined that RSI posed a higher than normal risk, FI assisted by VL, semi-Fowler positioning, and bilevel positive pressure pre-oxygenation resulted in excellent successful first-pass intubation rates without any incidences of peri-intubation arrest or aspiration. While this cohort was small, our study reveals that FI with midazolam does not likely pose a higher risk than ketamine-only intubation and warrants further study.
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Affiliation(s)
- Joshua B Lowe
- Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Michael J Yoo
- Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - John O Patrick
- Emergency Medicine, Royal Air Force (RAF) Lakenhealth Medical Center, RAF Lakenheath, GBR
| | - Rachel E Bridwell
- Emergency Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, USA
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Jones MA, Whitaker KM, Paley JL, Thrower A, Stoner L, Barone Gibbs B. Brachial-femoral pulse wave velocity in 2-4-year-old children: a feasibility study. Blood Press Monit 2023; 28:11-16. [PMID: 36606476 PMCID: PMC9830551 DOI: 10.1097/mbp.0000000000000622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) progression occurs across the lifespan. However, available measures of CVD risk in young children are limited. Carotid-femoral pulse wave velocity (cfPWV) is a gold-standard, noninvasive measure of CVD risk that has been studied in children ages 6-18 years. Yet, cfPWV has been measured to a lesser extent in younger children, a population whose temperament or attention span may pose unique challenges. Brachial-femoral PWV (bfPWV) may be feasible, more acceptable, and could provide similar CVD risk assessment to cfPWV in younger children. This study aimed to determine the feasibility of bfPWV measurement in children ages 2-4 years including assessment of comparability of bfPWV to cfPWV normative data. METHODS In 10 children (mean 2.9 ± 0.5 years), oscillometric cuffs were placed on the upper thigh and upper arm. Following a 5-min rest, cuffs were inflated to a subdiastolic pressure three times, and waveforms were captured. Procedures were repeated after a 15-min rest. Measured values were compared to age-predicted cfPWV extrapolated from published normative data in children 6-18 years of age. RESULTS We successfully obtained at least one acceptable quality bfPWV scan in all participants. Among the subset with a repeated measurement ( n = 5), mean (SD) difference between measurements was 0.013 (0.28) m/s. Mean bfPWV was slightly higher than age-predicted cfPWV (observed: 4.55 m/s; predicted: 3.99 m/s; P = 0.012) with larger residuals among younger children and those not reclined in a chair during measurement. CONCLUSION bfPWV appears to be feasible tool for noninvasive CVD risk assessment in children ages 2-4 years.
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Affiliation(s)
- Melissa A Jones
- Department of Human Movement Science, Oakland University, Rochester, Michigan, Departments of
| | - Kara M Whitaker
- Health and Human Physiology
- Epidemiology, The University of Iowa, Iowa City, Iowa
| | - Joshua L Paley
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alexis Thrower
- Department of Human Performance-Exercise Physiology, West Virginia University, Morgantown, West Virginia
| | - Lee Stoner
- Department of Exercise and Sports Science, University of North Carolina-Chapel Hill
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Bethany Barone Gibbs
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia, USA
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Overall and repeated measures agreement between brachial-femoral and carotid-femoral measures of pulse wave velocity in young and healthy individuals. Blood Press Monit 2022; 27:334-340. [PMID: 35866509 DOI: 10.1097/mbp.0000000000000614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Carotid-femoral pulse-wave velocity (cfPWV) is the gold standard measure of arterial stiffness and independently predicts cardiovascular disease. However, obtaining cfPWV requires technical precision and can be difficult in some populations. Brachial-femoral PWV (bfPWV) is a simpler alternative, but there is limited research comparing the two measures. For physiological studies, it is important to know how well the measures agree at rest, and to what extent changes in the measures correspond after perturbation. OBJECTIVE To assess the overall and repeated measures agreement between cfPWV and bfPWV. METHODS cfPWV and bfPWV were measured in the supine and seated positions, both before and after a 3-h bout of prolonged sitting. The intraclass correlation coefficient (ICC) for overall agreement was calculated using the random variance components from linear mixed-model regression. Repeated measures agreement (change in cfPWV vs. change in bfPWV) was calculated using repeated measures correlation. RESULTS Complete data from 18 subjects (22.6 ± 3.1 years old, 33% female) were included in the analysis. There was strong (ICC ≥ 0.70) overall agreement (ICC, 0.75; 95% CI, 0.60-0.85) and very strong (ICC ≥ 0.90) repeated measures agreement (ICC, 0.90; 95% CI, 0.84-0.94) between cfPWV and bfPWV. DISCUSSION The current findings indicate strong overall agreement and very strong repeated measures agreement between bfPWV and cfPWV. bfPWV is a user-friendly alternative method that agrees with cfPWV-based assessments of central arterial stiffness.
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Ntineri A, Kollias A, Zeniodi ME, Vazeou A, Soldatou A, Stergiou GS. Insight into the 24-hour ambulatory central blood pressure in adolescents and young adults. J Clin Hypertens (Greenwich) 2020; 22:1789-1796. [PMID: 32812687 DOI: 10.1111/jch.13999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/02/2020] [Accepted: 05/07/2020] [Indexed: 11/28/2022]
Abstract
This study attempted to investigate the behavior of 24-hour central ambulatory blood pressure (ABP) in adolescents and young adults. Adolescents and young adults (age 10-25 years) referred for elevated blood pressure (BP) and healthy volunteers had simultaneous 24-hour peripheral (brachial) and central (aortic) ABP monitoring using the same automated upper-arm cuff device (Mobil-O-Graph 24h PWA). Central BP was calculated by the device using two different calibration methods (C1SBP using peripheral systolic (pSBP)/diastolic BP and C2SBP using mean arterial/diastolic BP). A total of 136 participants (age 17.9 ± 4.7 years, 54% adolescents, 77% males, 25% volunteers, 34% with elevated peripheral ABP) were analyzed. Twenty-four-hour pSBP was higher than C1SBP, with this difference being more pronounced during daytime than nighttime (16.3 ± 4.5 and 10.5 ± 3.2 mm Hg, respectively, P < .001). Younger age, higher body height, and male gender were associated with greater systolic ABP amplification (pSBP-C1SBP difference). C1SBP followed the variation pattern of pSBP, yet with smaller nighttime dip (8.4 ± 6.0% vs 11.9 ± 4.6%, P < .001), whereas C2SBP increased (2.4 ± 7.2%) during nighttime sleep (P < .001 for comparison with pSBP change). Older age remained independent determinant of larger nighttime BP fall for pSBP and C1SBP, whereas male gender predicted a larger nighttime C2SBP rise. These data suggest that the calibration method of the BP monitor considerably influences the diurnal variation in central BP, showing a lesser nocturnal dip than pSBP or even nocturnal BP rise, which are determined by the individual's age and gender.
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Affiliation(s)
- Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Maria Elena Zeniodi
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Andriani Vazeou
- First Department of Pediatrics, Panagiotis and Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Panagiotis and Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
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Increased aortic augmentation index is associated with reduced exercise capacity after heart transplantation. J Hypertens 2020; 38:1777-1785. [PMID: 32649621 DOI: 10.1097/hjh.0000000000002455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Exercise capacity is often reduced after heart transplantation. We aimed to investigate the association between aortic stiffness and exercise capacity after heart transplantation. METHODS We retrospectively analyzed the data of patients who underwent a cardiopulmonary exercise test and central hemodynamic measurements over 1 year following heart transplantation, from Janary 2011 to June 2018. RESULTS A total of 54 patients (mean age, 49 years; 72% men) were analyzed. The median peak oxygen uptake level was 21.1 ml/kg per min at a median time of 13 months after heart transplantation. In univariate linear regression, recipient age, pulmonary arterial pressure, pulmonary capillary wedge pressure, hemoglobin level, estimated glomerular filtration rate, aortic augmentation index, and pulse wave velocity were significant predictors for peak oxygen uptake level. After adjustment for other confounding variables, heart rate-corrected aortic augmentation index was a significant predictor for peak oxygen uptake (β = -0.141, 95% confidence interval, -0.263 to -0.058, P = 0.003). CONCLUSION In the present study, increased aortic augmentation index was associated with reduced exercise capacity after heart transplantation. Therefore, this simple measurement of aortic stiffness should be periodically used for the evaluation of exercise capacity after heart transplantation.
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Serinel Y, Hoyos C, Qasem A, Yee BJ, Grunstein RR, Wong KH, Phillips CL. Diurnal changes in central blood pressure and pulse pressure amplification in patients with obstructive sleep apnoea. Int J Cardiol Hypertens 2019; 1:100002. [PMID: 33447736 PMCID: PMC7803064 DOI: 10.1016/j.ijchy.2019.100002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/27/2019] [Indexed: 01/20/2023] Open
Abstract
STUDY OBJECTIVES Recent evidence suggests that compared to peripheral blood pressure (BP), central BP may be more strongly associated with target organ damage and cardiovascular morbidity and mortality. Technological advances now allow the ambulatory measurement of peripheral and central BP over 24 h. For the first time, we set out to characterise the diurnal profile of central BP and pulse pressure amplification (PPA) in patients with obstructive sleep apnoea (OSA). METHODS In this observational study, patients with moderate to severe OSA underwent 24 h central and peripheral BP testing before and after at least 4 weeks of CPAP therapy. Concurrent actigraphy was performed to confirm sleep and wake times. RESULTS 36 patients were screened, 31 had successful testing (mean (SD) age 45 ± 10 years, AHI 58 ± 27 events/hr, Office BP 136/89 ± 10.7/9.5 mmHg, 32% on anti-hypertensives, 77% dippers), 21 completed testing post CPAP. Central systolic and diastolic BP followed the same nocturnal dipping profile as peripheral BP, however the peripheral pulse pressure (PP) narrowed in sleep (-3.2 mmHg, p < 0.001), whereas the central PP remained unchanged (0.124 mmHg, NS), causing a significant reduction in PPA overnight (-10.7%, p < 0.001). The magnitude of dip in central systolic pressure was less than peripheral systolic pressure (by 2.3 mmHg, p < 0.001). After treatment with CPAP, the PPA reduction overnight was attenuated (by -3.3%, p = 0.004). CONCLUSIONS In moderate to severe OSA, central BP and PPA reduce overnight during sleep. Further randomised controlled studies are needed to quantify the differential effects of CPAP and anti-hypertensives on central versus peripheral BP.
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Affiliation(s)
- Yasmina Serinel
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Nepean Hospital, Derby St, Penrith NSW 2750, Australia
| | - Camilla Hoyos
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Ahmad Qasem
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, 2 Technology Place, NSW 2109 Australia
| | - Brendon J. Yee
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Rd, Newtown NSW 2050, Australia
| | - Ronald R. Grunstein
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Rd, Newtown NSW 2050, Australia
| | - Keith H. Wong
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Rd, Newtown NSW 2050, Australia
| | - Craig L. Phillips
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), NHMRC Neurosleep Centre Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Reserve Rd, St Leonards, Sydney, NSW 2065, Australia
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Papaioannou TG, Fasoulis R, Gialafos E, Tousoulis D. Methodological and computational insights on the assessment of arterial baroreflex sensitivity. Exp Physiol 2019; 104:779-780. [PMID: 31034118 DOI: 10.1113/ep087298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 01/23/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Theodore G Papaioannou
- Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Romanos Fasoulis
- Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Gialafos
- First Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Liang X, Su S, Hao G, Snieder H, Treiber F, Kapuku G, Wang X. Determinants of pulse wave velocity trajectories from youth to young adulthood: the Georgia Stress and Heart Study. J Hypertens 2019; 37:563-571. [PMID: 30234784 PMCID: PMC6355367 DOI: 10.1097/hjh.0000000000001933] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Increased arterial stiffness measured by pulse wave velocity (PWV) has been shown to be an important parameter of cardiovascular risk. Longitudinal development of PWV from youth to early adulthood and its possible sociodemographic, anthropometric, hemodynamic and behavioral moderators will be illustrated. METHODS Individual growth curves of carotid-distal PWV across age were created for 559 African American and European American men and women with a maximum of five assessments over an average of 7-year follow-up (mean age at participants' first assessment, 22.3 ± 3.4). RESULTS African Americans and men had significantly higher PWV than did European Americans and women (Ps < 0.01), respectively. A three-way interaction (P < 0.001) between age, sex and ethnicity was observed with African American men displaying a larger rate of increase in PWV with age than the other three ethnic and sex groups. The ethnicity and sex effects on PWV persisted when controlling for other moderators. Waist circumference was the strongest anthropometric predictor but its effect on PWV was only significant in women. Mean arterial pressure was the strongest hemodynamic predictor, marital status of parents was the strongest socioeconomic predictor and marijuana use was the strongest behavioral predictor of PWV. The best-fitting full model explained in total 59.4% of the between-subject variance in PWV with ethnicity, sex and age explaining 25.6%. CONCLUSION We observed significant ethnic and sex differences in longitudinal trajectories of PWV in youth and young adults. In addition, individual differences in PWV growth can largely be explained by mean arterial pressure, waist, marital status of parents and marijuana use.
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Affiliation(s)
- Xiaohua Liang
- Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China,
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA,
| | - Shaoyong Su
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA,
| | - Guang Hao
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA,
| | - Harold Snieder
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Frank Treiber
- College of Nursing, Medical University of South Carolina, Charleston, USA
| | - Gaston Kapuku
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA,
| | - Xiaoling Wang
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA,
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Mitchelmore A, Stoner L, Lambrick D, Jobson S, Faulkner J. Reliability of oscillometric central blood pressure and central systolic loading in individuals over 50 years: Effects of posture and fasting. Atherosclerosis 2018; 269:79-85. [PMID: 29339276 DOI: 10.1016/j.atherosclerosis.2017.12.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/08/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS The between-day reliability of oscillometric pulse wave analysis has been demonstrated in a young, healthy population but not in an older sample. This study examined the between-day reliability of the SphygmoCor XCEL in individuals over 50 years. As blood pressure is measured in a range of postures and fasting states (supine/seated, fasted/non-fasted), this study also investigated the effect of these variables on central blood pressure and central systolic loading. METHODS Fifty-one adults (m = 21; age 57 ± 6.4 y) were tested on three mornings in supine and seated conditions and in fasted and non-fasted states. Data was analysed as a whole and for normotensive (n = 25) and hypertensive participants (n = 26). RESULTS SphygmoCor XCEL demonstrated strong reliability in the whole sample for central systolic and diastolic blood pressures, augmentation index (AIx) and AIx75 (ICC = 0.77-0.95). Significant interaction effects were observed in central diastolic blood pressure, central pulse pressure, augmentation index (AIx) and AIx75 (p < 0.05; ηp2 = 0.10-0.23). Fasting state had a greater influence on central pressures in a seated than supine posture, but a greater effect on central systolic loading measures in a supine posture. CONCLUSIONS The SphygmoCor XCEL is a reliable tool to assess central haemodynamic variables in an older population. It would be pertinent for clinicians and researchers to record central measures in a supine posture to minimise the effects of food consumption. Conversely, the assessment of central systolic loading should occur in a seated condition to minimise the influence of varying fasting states.
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Affiliation(s)
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, NC, USA
| | | | - Simon Jobson
- Department of Sport & Exercise, University of Winchester, UK
| | - James Faulkner
- Department of Sport & Exercise, University of Winchester, UK
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Mechanisms of pulse pressure amplification dipping pattern during sleep time: the SAFAR study. ACTA ACUST UNITED AC 2017; 12:117-127. [PMID: 29287945 DOI: 10.1016/j.jash.2017.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/07/2017] [Accepted: 12/10/2017] [Indexed: 11/20/2022]
Abstract
The difference in pulse pressure (PP) between peripheral arteries and the aorta, called pulse pressure amplification (PPamp), is a well-described physiological phenomenon independently associated with cardiovascular events. Recent studies suggest that it exhibits circadian variability. Our aim was to detect the factors associated with the circadian variability of PPamp. In 497 consecutive subjects (aged 54 years, 56.7% male, 79.7% hypertensives), we assessed the circadian pattern of peripheral and central arterial hemodynamics by 24-hour evaluation of brachial and aortic blood pressure (BP), augmentation index (AI), and pulse wave velocity (PWV) using a validated oscillometric device (Mobil-O-Graph). All parameters exhibited a circadian variation. Sleep dipping (decrease) pattern was observed for PPamp, brachial and aortic systolic BP, mean BP, and PWV, whereas a rising pattern (higher sleep than wake values) was observed for brachial PP, aortic PP, and AI. The factors independently associated with the less sleep dipping in PPamp were older age, lower height, the use of antihypertensive medication, and sleep decrease in arterial stiffness (PWV), whereas female gender, the presence of hypertension, sleep increase of pressure wave reflections (AI), sleep decrease in heart rate, and mean BP were associated with a greater sleep-dipping in PPamp. These data provide further pathophysiological understanding of the mechanisms leading to PPamp dipping. Several implications regarding the clinical use of the aortic and brachial BP, especially during sleep time, are raised that should be addressed in future research.
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Pucci G, Battista F, Anastasio F, Sanesi L, Gavish B, Butlin M, Avolio A, Schillaci G. Effects of gravity-induced upper-limb blood pressure changes on wave transmission and arterial radial waveform. J Hypertens 2016; 34:1091-8. [DOI: 10.1097/hjh.0000000000000931] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Krzesiński P, Stańczyk A, Gielerak G, Piotrowicz K, Banak M, Wójcik A. The diagnostic value of supine blood pressure in hypertension. Arch Med Sci 2016; 12:310-8. [PMID: 27186174 PMCID: PMC4848361 DOI: 10.5114/aoms.2016.59256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 11/22/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Correct blood pressure (BP) measurement is crucial in the diagnosis of arterial hypertension (AH), and controversy exists whether supine BP should be treated as equal to sitting BP. The aim of this study was to evaluate the relation of supine BP to sitting BP and ambulatory BP with regard to identification of diagnostic cut-offs for hypertension. MATERIAL AND METHODS This study included 280 patients with AH (mean age: 44.3 ±10.6 years). The following measurements of BP were performed and analyzed: 1) sitting office blood pressure measurement (OSBP and ODBP); 2) supine BP (supSBP and supDBP), measured automatically (5 times with a 2-minute interval) during evaluation by the Niccomo device (Medis, Germany); 3) 24-hour ambulatory blood pressure (ABP) monitoring. RESULTS The mean supSBP and supDBP were found to be lower than OSBP and ODBP (130.9 ±14.2 vs. 136.6 ±15.5 mm Hg and 84.8 ±9.4 vs. 87.8 ±10.2 mm Hg, respectively; p < 0.000001). The correlations between ABP and supBP/OBP were moderate and strong (correlation coefficients in range 0.55-0.76). The ROC analysis revealed that mean supBP ≥ 130/80 mm Hg was more precise than OBP ≥ 140/90 mm Hg in diagnosing hypertension (AUC: 0.820 vs. 0.550; sensitivity 80.7% vs. 57.4%; specificity 83.2% vs. 52.7%; p < 0.0001) and the additive value derived mostly from its higher predictive power of identifying patients with increased night-time BP. CONCLUSIONS In young and middle-aged hypertensive patients the blood pressure during a 10-minute supine rest was lower than in the sitting position. The supine blood pressure ≥ 130/80 mm Hg was found to be a specific and sensitive threshold for hypertension.
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Affiliation(s)
- Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Adam Stańczyk
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Grzegorz Gielerak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Katarzyna Piotrowicz
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Małgorzata Banak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Agnieszka Wójcik
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
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Sirevaag EJ, Casaccia S, Richter EA, O'Sullivan JA, Scalise L, Rohrbaugh JW. Cardiorespiratory interactions: Noncontact assessment using laser Doppler vibrometry. Psychophysiology 2016; 53:847-67. [PMID: 26970208 DOI: 10.1111/psyp.12638] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/17/2016] [Indexed: 01/02/2023]
Abstract
The application of a noncontact physiological recording technique, based on the method of laser Doppler vibrometry (LDV), is described. The effectiveness of the LDV method as a physiological recording modality lies in the ability to detect very small movements of the skin, associated with internal mechanophysiological activities. The method is validated for a range of cardiovascular variables, extracted from the contour of the carotid pulse waveform as a function of phase of the respiration cycle. Data were obtained from 32 young healthy participants, while resting and breathing spontaneously. Individual beats were assigned to four segments, corresponding with inspiration and expiration peaks and transitional periods. Measures relating to cardiac and vascular dynamics are shown to agree with the pattern of effects seen in the substantial body of literature based on human and animal experiments, and with selected signals recorded simultaneously with conventional sensors. These effects include changes in heart rate, systolic time intervals, and stroke volume. There was also some evidence for vascular adjustments over the respiration cycle. The effectiveness of custom algorithmic approaches for extracting the key signal features was confirmed. The advantages of the LDV method are discussed in terms of the metrological properties and utility in psychophysiological research. Although used here within a suite of conventional sensors and electrodes, the LDV method can be used on a stand-alone, noncontact basis, with no requirement for skin preparation, and can be used in harsh environments including the MR scanner.
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Affiliation(s)
- Erik J Sirevaag
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sara Casaccia
- Preston M. Green Department of Electrical and Systems Engineering, School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Industrial Engineering and Mathematical Science, Università Politecnica delle Marche, Ancona, Italy
| | - Edward A Richter
- Preston M. Green Department of Electrical and Systems Engineering, School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joseph A O'Sullivan
- Preston M. Green Department of Electrical and Systems Engineering, School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Lorenzo Scalise
- Department of Industrial Engineering and Mathematical Science, Università Politecnica delle Marche, Ancona, Italy
| | - John W Rohrbaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Papaioannou TG, Karageorgopoulou T, Stefanadis C, Tousoulis D. Validation of Devices and Methods for Noninvasive Estimation of Central Aortic Blood Pressure in Children. Hypertension 2015; 66:e7. [DOI: 10.1161/hypertensionaha.115.05666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Theodore G. Papaioannou
- Biomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theofani Karageorgopoulou
- Biomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christodoulos Stefanadis
- Biomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- Biomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Evaluation of 24-Hour Arterial Stiffness Indices and Central Hemodynamics in Healthy Normotensive Subjects versus Treated or Untreated Hypertensive Patients: A Feasibility Study. Int J Hypertens 2015; 2015:601812. [PMID: 25692032 PMCID: PMC4321851 DOI: 10.1155/2015/601812] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 12/22/2014] [Accepted: 12/30/2014] [Indexed: 01/13/2023] Open
Abstract
Objective. Central blood pressure (BP) and vascular indices estimated noninvasively over the 24 hours were compared between normotensive volunteers and hypertensive patients by a pulse wave analysis of ambulatory blood pressure recordings. Methods. Digitalized waveforms obtained during each brachial oscillometric BP measurement were stored in the device memory and analyzed by the validated Vasotens technology. Averages for the 24 hours and for the awake and asleep subperiods were computed. Results. 142 normotensives and 661 hypertensives were evaluated. 24-hour central BP, pulse wave velocity (PWV), and augmentation index (AI) were significantly higher in the hypertensive group than in the normotensive group (119.3 versus 105.6 mmHg for systolic BP, 75.6 versus 72.3 mmHg for diastolic BP, 10.3 versus 10.0 m/sec for aortic PWV, −9.7 versus −40.7% for peripheral AI, and 24.7 versus 11.0% for aortic AI), whereas reflected wave transit time (RWTT) was significantly lower in hypertensive patients (126.6 versus 139.0 ms). After adjusting for confounding factors a statistically significant between-group difference was still observed for central BP, RWTT, and peripheral AI. All estimates displayed a typical circadian rhythm. Conclusions. Noninvasive assessment of 24-hour arterial stiffness and central hemodynamics in daily life dynamic conditions may help in assessing the arterial function impairment in hypertensive patients.
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Robertson AD, Edgell H, Hughson RL. Assessing cerebrovascular autoregulation from critical closing pressure and resistance area product during upright posture in aging and hypertension. Am J Physiol Heart Circ Physiol 2014; 307:H124-33. [PMID: 24858843 DOI: 10.1152/ajpheart.00086.2014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Static cerebral autoregulation (sCA) is believed to be resistant to aging and hypertensive pathology. However, methods to characterize autoregulation commonly rely on beat-by-beat mean hemodynamic measures and do not consider within-beat pulse wave characteristics that are impacted by arterial stiffening. We examined the role of critical closing pressure (CrCP) and resistance area product (RAP), two measures derived from the pulse wave, across supine lying, sitting, and standing postures in young adults, normotensive older adults, and older adults with controlled and uncontrolled hypertension (N = 80). Traditional measures of sCA, using both intracranial and extracranial methods, indicated similar efficiency across all groups, but within-beat measures suggested different mechanisms of regulation. At rest, RAP was increased in hypertension compared with young adults (P < 0.001), but CrCP was similar. In contrast, the drop in CrCP was the primary regulator of change in cerebrovascular resistance upon adopting an upright posture. Both CrCP and RAP demonstrated group-by-posture interaction effects (P < 0.05), with older hypertensive adults exhibiting a rise in RAP that was absent in other groups. The posture-related swings in CrCP and RAP were related to changes in both the pulsatile and mean components of arterial pressure, independent of age, cardiac output, and carbon dioxide. Group-by-posture differences in pulse pressure were mediated in part by an attenuated heart rate response in older hypertensive adults (P = 0.002). Examination of pulsatile measures in young, elderly, and hypertensive adults identified unique differences in how cerebral blood flow is regulated in upright posture.
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Affiliation(s)
- Andrew D Robertson
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - Heather Edgell
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - Richard L Hughson
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
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