Attenuation in invasive blood pressure measurement systems

Poor fidelity invasive arterial blood pressure (IABP) traces are a frequent practical problem. It is common practice to describe any such trace as being 'damped'; the resonance behaviour of IABP measurement systems having been extensively described in the literature. However, as poor quality arterial blood pressure signals are seen even with optimal pressure transduction circuits, this cannot be the sole mechanism. In this commentary the classical lumped-parameter Windkessel model is extended by postulating an additional impedance proximal to the site of IABP measurement. This impedance represents any mechanical obstruction to laminar flow. Equations are presented relating measured and actual arterial blood pressures in terms of the model impedances. The reactive properties of such a partial obstruction may lead to an IABP trace that is superficially similar in appearance to the case of an over-damped measurement system. However, this phenomenon should be termed 'attenuation' rather than 'damping' and is probably more common. The distinction is of practical importance as the behaviour of the measured systolic and diastolic pressures is different -- both are systematically underestimated and the mean arterial pressure is thus not preserved. Furthermore, this error varies inversely with the peripheral vascular resistance of the tissues distal to the measurement point, therefore apparently magnifying the effect of vasodilatation on blood pressure or derived quantities.