Peripheral pulse pressure holds promise as a readily available bedside surrogate marker for stroke volume in critically ill patients, though its interpretation is confounded by arterial stiffness and vasomotor tone.
Can pulse pressure be reliably used as a surrogate for stroke volume in critically ill patients undergoing shock resuscitation?
This review highlights that while complex physiological factors complicate the relationship between pulse pressure and stroke volume, peripheral pulse pressure can still be a useful bedside tool for identifying low stroke volume during early shock resuscitation.
In critically ill patients, early hemodynamic assessment is essential for guiding shock resuscitation. While cardiac output (CO) is a key indicator of circulatory status, its measurement is often limited by technical and practical constraints. This perspective explores the physiological and clinical relevance of pulse pressure (PP) as a potential surrogate for stroke volume (SV), emphasizing its accessibility at the bedside. The paper discusses how factors such as arterial compliance, vascular tone, and pulse wave amplification influence the PP-SV relationship, often complicating interpretation in acute and complex hemodynamic states. It also examines the effects of vasopressors, vascular decoupling, and catheter site on PP measurements, particularly in septic shock. Despite its limitations, the review highlights how peripheral PP, when carefully interpreted, may aid in identifying low SV and guiding early resuscitation strategies.
Putowski et al. (Thu,) conducted a review in Shock and critical illness. Pulse pressure monitoring was evaluated. Peripheral pulse pressure holds promise as a readily available bedside surrogate marker for stroke volume in critically ill patients, though its interpretation is confounded by arterial stiffness and vasomotor tone.