The impact of blood pressure cuff location on the accuracy of noninvasive blood pressure measurements in obese patients: an observational study

Abstract

Purpose Obesity presents many challenges to the anesthesiologist, including poorly fitting blood pressure (BP) cuffs due to the conical shape of the upper arm. The aim of this study was to determine the accuracy of noninvasive BP readings, obtained from a noninvasive BP cuff using various cuff locations and wrapping techniques, compared with invasive intra-arterial BP readings. Methods Thirty American Society of Anesthesiologists physical status I-III obese (body mass index [ 30 kgÁm -2 ) individuals undergoing non-cardiac surgery were enrolled in this observational study. Serial oscillometric noninvasive BP (NIBP) measurements were taken in the patients' forearm and upper arm with two different wrapping formations (one following the contour of the upper arm, the other keeping cuff edges parallel). These NIBP measurements were compared with invasive arterial blood pressure (ABP) measurements taken from the ipsilateral radial artery. The precision and bias of the NIBP and ABP measurements were determined using Bland-Altman analysis. Analysis of variance and Welch's t test were used to determine between-group differences in bias.Results There was poor agreement between the ABP measurements and all types of NIBP measurements. Each of our study participants had a least one NIBP parameter (mean arterial pressure, systolic BP, or diastolic BP) that was [ 10 mmHg different than the corresponding ABP parameter. Upper arm BP measurements showed a statistically insignificant trend toward underestimating ABP. For all cuff positions and wrapping techniques, systolic BP offered the best agreement between NIBP and ABP measurements. Conclusions All the forms of NIBP cuff orientation studied had unacceptable precision and bias compared with invasive ABP measurements. When patient and/or surgical conditions necessitate accurate BP monitoring, direct arterial measurement should be considered over NIBP measurements in obese patients.

Techniques for Non-Invasive Monitoring of Arterial Blood Pressure

“…In addition, the same group also examined the cuff position at the forearm of patients. However, oscillometric measurement in these patients in both locations did not allow sufficiently accurate monitoring of BP ( 28 ). This leads to the question, whether BP values resulting from oscillometric measurement with other locations for the cuff than the upper arm can be used for guidance of therapy.…”

“…The analysis revealed clinically relevant inaccuracy of both, auscultatory and oscillometric, techniques ( 27 ), which therefore should not be used to guide therapy in critically ill patients. A similar study compared invasive and oscillometric BP measurement in obese patients undergoing non-cardiac surgery ( 28 ). In addition, the same group also examined the cuff position at the forearm of patients.…”

<p>Validation of two automatic devices, Omron HEM-6232T and HEM-6181, for self-measurement of blood pressure at the wrist according to the ANSI/AAMI/ISO 81060-2:2013 protocol and the European Society of Hypertension International Protocol revision 2010</p>

“…One is the possibility of incorrectly wrapping the cuff and another is the importance of keeping the devise at the level of the heart during BP measurement. Wrapping the cuff perfectly around the wrist leads to an accurate reading 12,13. If the BP monitor is not used correctly, the measurements will be incorrect, leading users to distrust the monitor.…”

The agreement between oscillometric and intra‐arterial technique for blood pressure monitoring in the lower extremities for infants and toddlers undergoing aortic coarctation repair

“…Many clinical trials have been conducted to evaluate the accuracy of blood pressure measured by oscillometric device in comparison with invasive method in different groups of patients with different clinical settings, such as ICU patients, neonates, low birth weight infants, and obese patients . Studies have been also conducted in cardiac patients to verify the accuracy of oscillometric in arm BP measurement .…”