Invasive and Concomitant Noninvasive Intraoperative Blood Pressure Monitoring

Wax, David B.; Lin, Hung‐Mo; Leibowitz, Andrew B.

doi:10.1097/aln.0b013e3182330286

Cited by 141 publications

(76 citation statements)

References 18 publications

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“…As shown in a large retrospective study, brachial measurements underestimate hypertensive blood pressure levels and produce higher values at the lower end of the spectrum 25. As hypertension is common in patients presenting with an AIS,24 this discrepancy might result in an underestimation of smaller drops in blood pressure in patients in whom intraprocedural invasive blood pressure measurements were extracted.…”

Section: Discussionmentioning

confidence: 99%

A decrease in blood pressure is associated with unfavorable outcome in patients undergoing thrombectomy under general anesthesia

Treurniet

Berkhemer

Immink

et al. 2017

J NeuroIntervent Surg

106

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Background Up to two-thirds of patients are either dependent or dead 3 months after thrombectomy for acute ischemic stroke (AIS). Loss of cerebral autoregulation may render patients with AIS vulnerable to decreases in mean arterial pressure (MAP). Objective To determine whether a fall in MAP during intervention under general anesthesia (GA) affects functional outcome. Methods This subgroup analysis included patients from the MR CLEAN trial treated with thrombectomy under GA. The investigated variables were the difference between MAP at baseline and average MAP during GA (ΔMAP) as well as the difference between baseline MAP and the lowest MAP during GA (ΔLMAP). Their association with a shift towards better outcome on the modified Rankin Scale (mRS) after 90 days was determined using ordinal logistic regression with adjustment for prognostic baseline variables. Results Sixty of the 85 patients treated under GA in MR CLEAN had sufficient anesthetic information available for the analysis. A greater ΔMAP was associated with worse outcome (adjusted common OR (acOR) 0.95 per point mm Hg, 95% CI 0.92 to 0.99). An average MAP during GA 10 mm Hg lower than baseline MAP constituted a 1.67 times lower odds of a shift towards good outcome on the mRS. For ΔLMAP this association was not significant (acOR 0.97 per mm Hg, 95% CI 0.94 to 1.00, p=0.09). Conclusions A decrease in MAP during intervention under GA compared with baseline is associated with worse outcome. Trial registration number NTR1804; ISRCTN10888758; post-results. BACKGROUND

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Section: Discussionmentioning

confidence: 99%

A decrease in blood pressure is associated with unfavorable outcome in patients undergoing thrombectomy under general anesthesia

Treurniet

Berkhemer

Immink

et al. 2017

J NeuroIntervent Surg

106

View full text Add to dashboard Cite

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“…This may result in greater risks of erroneous clinical decisions—for example, unnecessary use of inotropic support and blood transfusions in hypotensive patients or, conversely, delayed antihypertensive treatment in hypertensive patients [13, 19, 28]. Unfortunately, the literature is not consistent about the range of accuracy that can be considered acceptable in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Techniques for Blood Pressure Measurement Are Not a Reliable Alternative to Direct Measurement: A Randomized Crossover Trial in ICU

Ribezzo

Spina

Bartolomeo

et al. 2014

The Scientific World Journal

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Introduction. Noninvasive blood pressure (NIBP) monitoring methods are widely used in critically ill patients despite poor evidence of their accuracy. The erroneous interpretations of blood pressure (BP) may lead to clinical errors. Objectives. To test the accuracy and reliability of aneroid (ABP) and oscillometric (OBP) devices compared to the invasive BP (IBP) monitoring in an ICU population. Materials and Methods. Fifty adult patients (200 comparisons) were included in a randomized crossover trial. BP was recorded simultaneously by IBP and either by ABP or by OBP, taking IBP as gold standard. Results. Compared with ABP, IBP systolic values were significantly higher (mean difference ± standard deviation 9.74 ± 13.8; P < 0.0001). Both diastolic (−5.13 ± 7.1; P < 0.0001) and mean (−2.14 ± 7.1; P=0.0033) IBP were instead lower. Compared with OBP, systolic (10.80 ± 14.9; P < 0.0001) and mean (5.36 ± 7.1; P < 0.0001) IBP were higher, while diastolic IBP (−3.62 ± 6.0; P < 0.0001) was lower. Bland-Altman plots showed wide limits of agreement in both NIBP-IBP comparisons. Conclusions. BP measurements with different devices produced significantly different results. Since in critically ill patients the importance of BP readings is often crucial, noninvasive techniques cannot be regarded as reliable alternatives to direct measurements.

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“…illustrated that there was a significant difference between the two monitoring techniques although it did not elucidate the reasons for these discrepancies. [5]…”

Section: Introductionmentioning

confidence: 99%

Accuracy in blood pressure monitoring: The effect of noninvasive blood pressure cuff inflation on intra-arterial blood pressure values

et al. 2017

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Context:Both invasive and noninvasive blood pressure (invasive arterial blood pressure [IABP] and noninvasive BP [NIBP]) monitors are used perioperatively; however, they often produce different values. The reason for this discrepancy is not clear, and it is possible that the act of cuff inflation itself might affect the IABP values, especially with the recurrent cycling of NIBP cuff.Aim:The aim of this study was to determine the effect of ipsilateral NIBP cuff inflation on the contralateral IABP values.Settings and Designs:Prospective, observational study.Materials and Methods:One hundred consecutive patients were studied. The NIBP device was set to cycle every 5 min for a total of 6 times. During each cuff inflation cycle, changes in IABP values from the arterial line in the contralateral arm were recorded. A total of 582 measurements were included for data analysis.Statistical Analysis:Chi-square, paired t-test, analysis of variance.Results:Mean (± standard deviation) changes in systolic BP (SBP), diastolic BP, and mean BP with cuff inflation were 6.7 ± 5.9, 2.6 ± 4.0, and 4.0 ± 3.9 mmHg, respectively. We observed an increase of 0–10 mmHg in SBP in majority (73.4%) of cuff inflations. The changes in IABP did not differ between the patients with or without hypertension or with the baseline SBP.Conclusions:This study showed that there is a transient reactive rise in IABP values with NIBP cuff inflation. This is important information in the perioperative and intensive care settings, where both these measurement techniques are routinely used. The exact mechanism for this effect is not known but may be attributed to the pain and discomfort from cuff inflation.

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Invasive and Concomitant Noninvasive Intraoperative Blood Pressure Monitoring

Cited by 141 publications

References 18 publications

A decrease in blood pressure is associated with unfavorable outcome in patients undergoing thrombectomy under general anesthesia

A decrease in blood pressure is associated with unfavorable outcome in patients undergoing thrombectomy under general anesthesia

Noninvasive Techniques for Blood Pressure Measurement Are Not a Reliable Alternative to Direct Measurement: A Randomized Crossover Trial in ICU

Accuracy in blood pressure monitoring: The effect of noninvasive blood pressure cuff inflation on intra-arterial blood pressure values

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