Factors influencing the accuracy of oscillometric blood pressure measurement in critically ill patients

Bur, Andreas; Herkner, Harald; Vlcek, Marianne; Woisetschläger, Christian; Derhaschnig, Ulla; Karth, Georg Delle; Laggner, Anton N.; Hirschl, Michael M.

doi:10.1097/01.ccm.0000053650.12025.1a

Cited by 109 publications

(73 citation statements)

References 21 publications

(29 reference statements)

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“…Although our study focused on overweight critically ill patients, these findings are in agreement with those of previously reported trials conducted in different patient populations [6,14,15]. Because the oscillometric method is not standardized, measuring algorithms differ from manufacturer to manufacturer and even from device to device [10,16].…”

Section: Overall Biassupporting

confidence: 81%

“…Furthermore, inotropic support did not contribute to the inaccuracy of the measurements in a larger group of patients [14], and although the points below the lower limits of agreement corresponded to patients receiving vasopressor support, these few observations are not likely to be responsible for the overall negative bias observed in our study.…”

Section: Overall Biasmentioning

confidence: 51%

“…Because the oscillometric method is not standardized, measuring algorithms differ from manufacturer to manufacturer and even from device to device [10,16]. The variability in these empirically derived algorithms has been blamed for the lack of agreement between methods, and although the use of a new standardized algorithm decreased the negative bias, oscillometric measurements continued to underestimate IABP readings [14]. Inappropriateness of cuff sizes in relation to arm circumference is also responsible for underestimation or overestimation of direct blood pressure readings [4,10].…”

Section: Overall Biasmentioning

confidence: 99%

“…It is unlikely that this was a factor in our study because the most common mismatch for obese patients is a smaller than needed blood pressure cuff, yielding an overestimated NIBP reading. Moreover, the intentional use of a smaller than recommended cuff size has been postulated to decrease the negative biases attributed to oscillometric readings [14]. Arrhythmias, another factor that is Values are expressed as mean ± standard error.…”

Section: Overall Biasmentioning

confidence: 99%

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Arterial blood pressure monitoring in overweight critically ill patients: invasive or non-invasive?

Bander

Guzmán

Araghi

2004

Chest

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Introduction Blood pressure measurements frequently guide management in critical care. Direct readings, commonly from a major artery, are considered to be the gold standard. Because arterial cannulation is associated with risks, alternative noninvasive blood pressure (NIBP) measurements are routinely used. However, the accuracy of NIBP determinations in overweight patients in the outpatient setting is variable, and little is known about critically ill patients. This prospective, observational study was performed to compare direct intraarterial blood pressure (IABP) with NIBP measurements obtained using auscultatory and oscillometric methods in overweight patients admitted to our medical intensive care unit.

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Section: Overall Biassupporting

confidence: 81%

Section: Overall Biasmentioning

confidence: 51%

Section: Overall Biasmentioning

confidence: 99%

Section: Overall Biasmentioning

confidence: 99%

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Arterial blood pressure monitoring in overweight critically ill patients: invasive or non-invasive?

Bander

Guzmán

Araghi

2004

Chest

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“…Non-invasive blood pressure (NIBP) measurement using a limb cuff, usually around the upper arm, and an oscillometric technique is fast, repeatable and noninvasive. However, concerns exist as to the accuracy of the obtained measurements [6][7][8][9], when compared with IABP measurements, particularly in unstable or haemodynamically abnormal patients [10][11][12].…”

mentioning

confidence: 99%

Comparison of non‐invasive and invasive blood pressure in aeromedical care

McMahon¹,

Hogg²,

Corfield³

et al. 2012

Anaesthesia

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SummaryBlood pressure measurement is an essential physiological measurement for all critically ill patients. Previous work has shown that non-invasive blood pressure is not an accurate reflection of invasive blood pressure measurement. In a transport environment, the effects of motion and vibration may make non-invasive blood pressure less accurate. Consecutive critically ill patients transported by a dedicated aeromedical retrieval and critical care transfer service with simultaneous invasive and non-invasive blood pressure measurements were analysed. Two sets of measurements were recorded, first in a hospital environment before departure (pre-flight) and a second during aeromedical transport (inflight). A total of 56 complete sets of data were analysed. Bland-Altman plots showed limits of agreement (precision) for pre-flight systolic blood pressure were )37.3 mmHg to 30.0 mmHg, and for pre-flight mean arterial pressure )20.5 mmHg to 25.0 mmHg. The limits of agreement for in-flight systolic blood pressure were )40.6 mmHg to 33.1 mmHg, while those for in-flight mean blood pressure in-flight were )23.6 mmHg to 24.6 mmHg. The bias for the four conditions ranged from 0.5 to )3.8 mmHg. There were no significant differences in values between pre-flight and in-flight blood pressure measurements for all categories of blood pressure measurement. Thus, our data show that noninvasive blood pressure is not a precise reflection of invasive intra-arterial blood pressure. Mean blood pressure measured non-invasively may be a better marker of invasive blood pressure than systolic blood pressure. Our data show no evidence of non-invasive blood pressures being less accurate in an aeromedical transport environment.

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Association Between Arterial Catheter Use and Hospital Mortality in Intensive Care Units

et al. 2014

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IMPORTANCE Arterial catheters are used frequently in intensive care units (ICUs). Clinical effectiveness and adverse events associated with the use of the catheters have not been formally evaluated in clinical studies. OBJECTIVE To determine whether an association exists between arterial catheter use and hospital mortality in ICU patients. DESIGN, SETTING, AND PARTICIPANTS Propensity-matched cohort analysis of data in the Project IMPACT database, from 2001 to 2008. A total of 139 ICUs in the United States were included. Participants were ICU patients 18 years or older. EXPOSURE Arterial catheter use. MAIN OUTCOMES AND MEASURES Our main outcome was hospital mortality. We assessed a primary cohort of medical patients requiring mechanical ventilation and 9 secondary cohorts. We used propensity score-matched pairs as the primary analytic strategy. Sensitivity analyses included 4 alternative methods of comparison in the primary cohort: multivariate modeling without propensity adjustment, mixed-effects multivariate logistic regression without propensity adjustment, multivariate modeling with propensity adjustment, and stratification based on propensity quintiles. RESULTS Our primary cohort consisted of 60 975 patients; 24 126 of these patients (39.6%) had an arterial catheter in place during their ICU stay, and analyses were based on 13 603 propensity score-matched pairs. We found no association between arterial catheter use and hospital mortality in medical patients requiring mechanical ventilation in the primary analysis (odds ratio [OR], 0.98; 95% CI, 0.93-1.03; P = .40) or the 4 sensitivity analyses (P Ն .58 for all). In 8 of 9 secondary cohorts we were unable to detect an association between arterial catheter use and hospital mortality. In the cohort of patients receiving vasopressors, arterial catheter use was associated with an increased odds of death (OR, 1.08; 95% CI, 1.02-1.14; P = .008). CONCLUSIONS AND RELEVANCE In this propensity-matched cohort analysis, arterial catheters were not associated with improvements in hospital mortality in medical ICU patients requiring mechanical ventilation. Given the costs and potential harms associated with invasive catheters, randomized clinical trials are needed to further evaluate the usefulness of these frequently used devices.

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Factors influencing the accuracy of oscillometric blood pressure measurement in critically ill patients

Cited by 109 publications

References 21 publications

Arterial blood pressure monitoring in overweight critically ill patients: invasive or non-invasive?

Arterial blood pressure monitoring in overweight critically ill patients: invasive or non-invasive?

Comparison of non‐invasive and invasive blood pressure in aeromedical care

Association Between Arterial Catheter Use and Hospital Mortality in Intensive Care Units

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