Oscillometric and intra‐arterial blood pressure in children post‐kidney transplantation: Is invasive blood pressure measurement always needed?

Abstract

Abbreviations: BMI, body mass index; BP, blood pressure; IBP, invasive blood pressure; MAP, mean arterial pressure; NIBP, non-invasive blood pressure; PICU, pediatric intensive care unit; PRES, posterior reversible encephalopathy syndrome; R, correlation coefficients; SD, standard deviation; SEM, standard error of the mean. AbstractObjective: Blood pressure (BP) monitoring in children immediately after kidney transplantation is ideally performed with an arterial line. Accurate measurement of BP is necessary for optimal management. However, during the first days postoperative, the arterial line is removed and BP measurement is switched to a non-invasive device. The aim of this study was to determine the accuracy and reliability of the automated oscillometric device compared to invasive arterial BP (IBP) monitoring in patients after renal transplantation in pediatric intensive care unit (PICU). Method:We analyzed all simultaneously measured BPs in children with a kidney transplant in the Amalia Children'. BP measurements were performed according to the hospital protocol. Agreement between invasive and non-invasive methods was assessed using Bland-Altman plots.Results: A total of 29 patients were included in this retrospective study. The majority of children were male (59%), and median age was 11 years (range 1-17 years). Totally, 80 BP measurements were recorded during the first days post-kidney transplantation. The correlation coefficients (R) of systolic, diastolic, and MAP of non-invasive (NIBP) and IBP measurements were 0.84, 0.76, and 0.77, respectively (P < 0.01).Overall, the average MAP (7.5 ± 1.2 mm Hg; P < 0.05) NIBP values were lower compared to IBP. In hypertensive patients, MAP (10.4 ± 10.0 mm Hg; P < 0.05) BP values were significantly lower using the NIBP device. Clinically relevant difference of >10 mm Hg was found in 51% (41/80) of measurements and mainly observed in hypertensive measurements.Conclusions: IBP measurement is considered the golden standard for monitoring BP in patients immediately after kidney transplantation. NIBP values showed a good agreement with invasive reading, but the variability of NIBP mainly in hypertensive patients is high as it is the number of clinically relevant differences to IBP. We conclude that IBP remains the golden standard to monitor BP in children directly postoperatively.

Comparison of intraoperative blood pressure values measured by noninvasive versus invasive methods during normotension, hypertension, and hypotension

“…Similar observations were made for the mean arterial pressures of during hypertension in our study. This result was different from the results obtained by Wax et al ,[ 14 ] Marouane et al ,[ 15 ] and Zhang et al ,[ 17 ] where the mean pressures were higher with the invasive method than the noninvasive modality. The probable reasons for the different conclusions have been discussed already.…”

“…In other studies by Zhang et al . [ 17 ] and Marouane et al ,[ 15 ] the diastolic pressures were found to be comparable. The reason for the conflicting results could be that Zhang et al .…”

“…[ 14 ] and Marouane et al . [ 15 ] reported higher SBP with invasive intra-arterial technique when compared to the oscillometric cuff method. The possible reason for this difference in results could be that firstly, they were retrospective studies and secondly, the measurements were made using a different oscillometer and the size of the NIBP cuff was not documented.…”

Hypertension in pediatric kidney transplantation

“…Invasive intra‐arterial BP measurement is used only in the immediate posttransplant period and remains the gold standard to monitor BP in children directly postoperatively 26 …”