October 2018 Journal Club

Hi Everyone
Have a look at this month’s paper here


It’s food for thought…..

“Hi everyone
Hope you all enjoyed the paper!
I appreciate that this isn’t a very “academic” topic but it’s something that has always interested me, namely how reliable / robust are the numbers that we aspire to normalise?
To be honest I’m not sure that even now I really understand what blood pressure is, yes I know MAP = CO x SVR¬† but the fact that it seems to vary depending on where you measure it suggests that it’s not the universal constant that we are led to believe……
This paper is a nice, simple and straightforward demonstration of this. It shows a clear difference in MAP between radial and femoral arteries that in higher doses of Noradrenaline reaches clinically significant values (5-10mmHg of MAP).
Personally speaking switching to femoral arterial pressure monitoring has made a clinical difference in certain cases that I’ve been involved in over the years. What I mean by that is in some situations of refractory shock you suddenly find that you’ve been over vasoconstricting the patient and therefore contributing to the vicious cycle of hypoperfusion rather than breaking it.
So in terms of what you might want to take away from this paper? Maybe it might just plant a seed of doubt in your minds so that when you next have a septic patient with rapidly escalating vasopressor requirements and a radial arterial line you at least could consider that the value you are chasing is like many things in life; relative…….
Let me know what you think



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