Non-invasive oscillometric versus invasive arterial blood pressure measurements in critically ill patients: A post hoc analysis of a prospective observational study

Thomas Kaufmann; Eline G M Cox; Renske Wiersema; Bart Hiemstra; Ruben J Eck; Geert Koster; Thomas W L Scheeren; Frederik Keus; Bernd Saugel; Iwan C C van der Horst; SICS Study Group

doi:10.1016/j.jcrc.2020.02.013

Non-invasive oscillometric versus invasive arterial blood pressure measurements in critically ill patients: A post hoc analysis of a prospective observational study

J Crit Care. 2020 Jun:57:118-123. doi: 10.1016/j.jcrc.2020.02.013. Epub 2020 Feb 22.

Authors

Affiliations

¹ Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Electronic address: [email protected].
² Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
³ Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁴ Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁵ Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁶ Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Outcomes Research Consortium, Cleveland, OH, USA.
⁷ Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Intensive Care, Maastricht University Medical Center+, Maastricht University, the Netherlands.

PMID: 32109843
DOI: 10.1016/j.jcrc.2020.02.013

Abstract

Purpose: The aim was to compare non-invasive blood pressure measurements with invasive blood pressure measurements in critically ill patients.

Methods: Non-invasive blood pressure was measured via automated brachial cuff oscillometry, and simultaneously the radial arterial catheter-derived measurement was recorded as part of a prospective observational study. Measurements of systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP) were compared using Bland-Altman and error grid analyses.

Results: Paired measurements of blood pressure were available for 736 patients. Observed mean difference (±SD, 95% limits of agreement) between oscillometrically and invasively measured blood pressure was 0.8 mmHg (±15.7 mmHg, -30.2 to 31.7 mmHg) for SAP, -2.9 mmHg (±11.0 mmHg, -24.5 to 18.6 mmHg) for DAP, and -1.0 mmHg (±10.2 mmHg, -21.0 to 18.9 mmHg) for MAP. Error grid analysis showed that the proportions of measurements in risk zones A to E were 78.3%, 20.7%, 1.0%, 0%, and 0.1% for MAP.

Conclusion: Non-invasive blood pressure measurements using brachial cuff oscillometry showed large limits of agreement compared to invasive measurements in critically ill patients. Error grid analysis showed that measurement differences between oscillometry and the arterial catheter would potentially have triggered at least low-risk treatment decisions in one in five patients.

Keywords: Arterial pressure; Intensive care; Norepinephrine; Oscillometry; Vascular access devices; Vasoactive medication.

Publication types

Observational Study

MeSH terms

Adult
Aged
Arterial Pressure
Blood Pressure Determination / methods*
Blood Pressure*
Catheterization, Peripheral
Critical Illness*
Female
Humans
Male
Middle Aged
Oscillometry / methods*
Prospective Studies
Radial Artery
Reproducibility of Results
Risk