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Updated: Jan 16, 2026
Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
Ultrasound-measured brachial artery reactive hyperemia in critically ill patients: an observational study
Casey R Storms1, Tristan Bice1, Jimmy Zhang1
1Division of Pulmonary & Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY, 14642-4861, USA.
Background:
Ultrasound-measured brachial artery reactive hyperemia (RH) is independently predictive of hospital mortality in critically ill patients with sepsis. Its association with mortality is uncertain in critically ill patients in general.
Methods:
This was a combined case-control and prospective cohort study. Ultrasound was used to measure brachial artery reactive hyperemia in 150 critically ill patients at a single academic medical center and in 44 control subjects without acute illness. Measurements were compared in cases versus controls, septic vs. non-septic critically ill patients, and hospital survivors vs. non-survivors. Follow-up measurements were obtained 3-5 days later in a sub-sample of patients.
Results:
RH was calculated as the percent change in pre- vs. post-ischemic brachial artery velocity-time integral measured by Doppler ultrasound. RH was impaired in critically ill compared to control subjects (194 [179-210] vs. 369 [314-433]%, p < 0.001; results expressed as mean [95% confidence interval]) but similar in septic compared to non-septic patients (196 [177-217] vs. 199 [170-233], p = 0.88). RH was significantly lower in hospital non-survivors compared to survivors (144 [120-173] vs. 204 [187-222], p = 0.003). Multivariable analysis showed that the difference between survivors and non-survivors was not confounded by age or comorbidities (odds ratio for hospital death = 0.26 per log unit rise in RH, 95% confidence interval = 0.08-0.83, p = 0.02). The magnitude of RH improved over 3-5 days in hospital survivors (n = 63, 204 [180-232] vs. 239 [208-275], p = 0.02), but did not change in non-survivors (n = 11, 133 [107-165] vs. 128 [75-220].
Conclusions:
Reactive hyperemia of the brachial artery is impaired in undifferentiated critically ill patients, lower in non-survivors compared to survivors, and independently associated with hospital mortality. Brachial artery reactive hyperemia improves significantly over time in survivors but not in non-survivors.
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01:21Sites for measruring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:23Assessment of blood pressure in brachial artery(two-step method)
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:19Assessing Blood pressure using a doppler ultrasound
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.