Risk factors for a central-to-peripheral arterial blood pressure gradient in adults: a systematic review

Accurate hemodynamic monitoring is essential for personalized care in surgical and intensive care unit (ICU) settings, and radial artery catheters are the gold standard. Nevertheless, central-to-peripheral arterial blood pressure gradients (CPAPGs) have been reported in up to 77% of patients, potentially leading to misinformed clinical decisions. Identifying patients at risk of CPAPGs is crucial to adapt monitoring strategies. We aimed to identify the risk factors contributing to CPAPGs and assess their level of consensus in a systematic review of the literature.

For this systematic review, we searched MEDLINE/PubMed®, Embase, and Cochrane databases (CENTRAL and Database of Systematic Reviews) from inception to 15 July 2024. Studies on adult patients with simultaneous radial and central arterial pressure monitoring were included. We extracted and analyzed risk factors and assessed the consistency of the literature for each.

From 741 retrieved articles, we included 55 studies (N = 5,598) evaluating the presence of CPAPGs during cardiopulmonary bypass, hepatic transplant, ICU stay, and other settings. Overall, 90 unique potential risk factors were evaluated, with 36 showing a statistically significant association with CPAPGs. Complex procedures and smaller radial artery diameter were the most consistent predictors, with both showing significant association with CPAPGs in the 3 studies evaluating them. Vasopressor usage showed statistical significance in half the studies evaluating it, and demographic factors, potentially associated with smaller radial artery diameter, such as older age, shorter stature, and female sex, were also statistically significant risk factors in some studies.

The present systematic review identified numerous risk factors for CPAPGs. In patients with multiple contributing factors, clinicians should consider using more central arterial cannulation to minimize the risk of inaccurate pressure measurements.

PROSPERO ( CRD42024561474 ); first submitted 10 July 2024.