+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Critical closing pressure as the arterial downstream pressure with the heart beating and during circulatory arrest



Critical closing pressure as the arterial downstream pressure with the heart beating and during circulatory arrest



Anesthesiology 110(2): 370-379



Calculation of systemic vascular resistance, used for hemodynamic decision-making, is based on central venous pressure taken as the downstream pressure. However, during circulatory arrest, arterial pressure decreases to a plateau higher than central venous pressure, the critical closing pressure (Pcrit). The authors assessed in humans undergoing arrest whether two-compartment and pressure-dependent conductivity models better estimate arterial pressure decay and Pcrit than a single-compartment model, and whether Pcrit corresponds to Pcrit calculated with the heart beating. Aortic pressure decay was fitted to single-compartment, two-compartment, and pressure-dependent conductivity models using specified time intervals during arrest and natural diastole in 10 patients during defibrillator implantation. Although all models closely predicted Pcrit with an arrest of > or = 7s, both two-compartment and pressure-dependent conductivity models better estimated pressure decay than a single-compartment model. However, Pcrit calculated from natural diastolic pressure decay was greater (53 mmHg +/- 15.6) than Pcrit 15 s (26.6 mmHg +/- 7.8, P = 0.001) and 30 s (23.9 mmHg +/- 7.1, P = 0.001) during arrest, and also greater than Pcrit calculated for the same time interval during initial arrest. Thus, during arrest, Pcrit can be closely predicted after > or = 7 s, regardless of the model; two-compartment and pressure-dependent conductivity models provide a better fit than a single-compartment model, and actual Pcrit is much less than Pcrit calculated with the heart beating. Irrespective of uncertainties in whether Pcrit calculated with the heart beating or during arrest is the "true" Pcrit prevailing physiologically, linear vascular resistance is markedly less when substituting Pcrit for central venous pressure as the downstream pressure.

Please choose payment method:






(PDF emailed within 1 workday: $29.90)

Accession: 052385617

Download citation: RISBibTeXText

PMID: 19194163


Related references

Middle cerebral artery flow, the critical closing pressure, and the optimal mean arterial pressure in comatose cardiac arrest survivors-An observational study. Resuscitation 110: 85-89, 2016

Critical closing pressure and arterial resistance have opposing responses to increases in perfusion pressure. FASEB Journal 6(4): A1472, 1992

Cerebral critical closing pressure estimation from Finapres and arterial blood pressure measurements in the aorta. Physiological Measurement 27(12): 1387-1402, 2006

The effect of mean critical closing pressure and total arterial resistance on blood pressure in unanesthetized dogs. Physiologist 16(3): 304, 1973

An experimental study of renal arterial critical closing pressure and effective perfusion pressure detected by Doppler sonography. Zhongguo Chaosheng Yixue Zazhi 13(10): 11-16, 1997

Critical closing pressure in the fetal vessel of the human placenta in vitro. II. Compared effects of a beta adrenergic substance, Salbutamol, on the critical closing pressure and vascular resistance. Reproduccion 3(1-2): 107-112, 1976

The measurement of blood pressure, the critical opening pressure, and the critical closing pressure of digital vessels under various circumstances. Can J Physiol Pharmacol 43(6): 979-993, 1965

Deep hypothermic circulatory arrest and the femoral-to-radial arterial pressure gradient. Journal of Cardiothoracic and Vascular Anesthesia 18(2): 175-179, 2004

Critical closing pressure and arterial resistance in an in vitro model of compartment syndrome. Medicine & Science in Sports & Exercise 26(5 SUPPL ): S162, 1994

Critical hematocrit and oxygen partial pressure in the beating heart of pigs. Microvascular Research 80(3): 389-393, 2011

Brain tissue oxygen pressure, carbon dioxide pressure, and pH during hypothermic circulatory arrest. Surgical Neurology. 46(1): 75-79, 1996

Carotid sinus stimulation influences both arterial resistance and critical closing pressure of the isolated hindlimb vascular bed. Clinical & Investigative Medicine 14(4 SUPPL): A13, 1991

Limitations in estimating critical closing pressure by noninvasive blood pressure measurements. Stroke 35(5): E91-2; Author Reply E91-2, 2004

Critical closing pressure, local perfusion pressure, and the failing skin flap. Annals of Plastic Surgery 8(6): 504-509, 1982

Critical Closing Pressure During Controlled Increase in Intracranial Pressure-Comparison of Three Methods. IEEE Transactions on Bio-Medical Engineering 65(3): 619-624, 2017