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

Araghi, Ali; Bander, Joseph J.; Guzmán, Jorge

doi:10.1186/cc4896

Cited by 98 publications

(35 citation statements)

References 18 publications

(27 reference statements)

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“…Finally, our observations cannot be generalized to include the patient population excluded from the study. Among these, we acknowledge obese patients for whom NIBP measurements were shown to be inaccurate [ 8 ], patients with arrhythmias, and patients with high doses of vasoconstrictors. Vasoconstrictors can be involved in underdamping/resonance phenomena.…”

Section: Discussionmentioning

confidence: 99%

“…The alternative to IBP monitoring is the non-invasive (NIBP) system (oscillometric technique). However, NIBP measurement is not continuous and, during hemodynamic instability, severe hypotension, in conditions of increased arterial stiffness and in obese patients, this technique is expected to be less accurate than the invasive one [ 2 , 4 - 8 ]. These considerations may be disregarded in case of IBP system calibration errors, altered pulse travelling (arterial dissection or stenosis) and artifacts due to movement or inappropriate dynamic response of the fluid-filled monitoring systems (overdamping and underdamping) [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of invasive arterial pressure monitoring in cardiovascular patients: an observational study

et al. 2014

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IntroductionCritically ill patients and patients undergoing high-risk and major surgery, are instrumented with intra-arterial catheters and invasive blood pressure is considered the “gold standard” for arterial pressure monitoring. Nonetheless, artifacts due to inappropriate dynamic response of the fluid-filled monitoring systems may lead to clinically relevant differences between actual and displayed pressure values. We sought to analyze the incidence and causes of resonance/underdamping phenomena in patients undergoing major vascular and cardiac surgery.MethodsArterial pressures were measured invasively and, according to the fast-flush Gardner’s test, each patient was attributed to one of two groups depending on the presence (R-group) or absence (NR-group) of resonance/underdamping. Invasive pressure values were then compared with the non-invasive ones.ResultsA total of 11,610 pulses and 1,200 non-invasive blood pressure measurements were analyzed in 300 patients. Ninety-two out of 300 (30.7%) underdamping/resonance arterial signals were found. In these cases (R-group) systolic invasive blood pressure (IBP) average overestimation of non-invasive blood pressure (NIBP) was 28.5 (15.9) mmHg (P <0.0001) while in the NR-group the overestimation was 4.1(5.3) mmHg (P <0.0001). The mean IBP-NIBP difference in diastolic pressure in the R-group was −2.2 (10.6) mmHg and, in the NR-group −1.1 (5.8) mmHg. The mean arterial pressure difference was 7.4 (11.2) mmHg in the R-group and 2.3 (6.4) mmHg in the NR-group. A multivariate logistic regression identified five parameters independently associated with underdamping/resonance: polydistrectual arteriopathy (P =0.0023; OR = 2.82), history of arterial hypertension (P =0.0214; OR = 2.09), chronic obstructive pulmonary disease (P =0.198; OR = 2.61), arterial catheter diameter (20 vs. 18 gauge) (P <0.0001; OR = 0.35) and sedation (P =0.0131; OR = 0.5). The ROC curve for the maximal pressure–time ratio, showed an optimum selected cut-off point of 1.67 mmHg/msec with a specificity of 97% (95% CI: 95.13 to 99.47%) and a sensitivity of 77% (95% CI: 67.25 to 85.28%) and an area under the ROC curve by extended trapezoidal rule of 0.88.ConclusionPhysicians should be aware of the possibility that IBP can be inaccurate in a consistent number of patients due to underdamping/resonance phenomena. NIBP measurement may help to confirm/exclude the presence of this artifact avoiding inappropriate treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Accuracy of invasive arterial pressure monitoring in cardiovascular patients: an observational study

et al. 2014

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“…(5) Noninvasive MAP reading using the automatic oscillometric technique with an upper arm inflatable cuff is the most used method postoperatively. (6) This method is the easiest, relatively fast, and cheapest one; but intermittent technique. Thereby, this method is less suitable for monitoring patients with very fast changes in MAP and may be less reliable compared with invasive MAP reading.…”

Section: Introductionmentioning

confidence: 99%

Mean Arterial Blood Pressure Monitoring Among Pediatric Patients after Open Heart Surgery

Ahmed¹,

Elsaman²,

Essa³

2017

IOSR JNHS

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“…There are a variety of methods to measure blood pressure, and they can be divided into non-invasive and invasive measurement according to whether invasive procedures are carried out to the body. Although non-invasive measurement is widely used in clinic, it is not continuous monitoring and is expected to be not accurate in patients with hemodynamic instability, severe hypotension, increased arterial stiffness and obesity [1]- [6]. Invasive blood pressure (IBP) can be measured directly, accurately, and continuously by inserting a cannula in the radial, brachial, femoral, or dorsalis paedis artery and connecting the cannula to a calibrated transducer, which converts blood pressure into an electrical signal.…”

Section: Introductionmentioning

confidence: 99%

A Survey of the Incidence and Consequences of Invasive Blood Pressure Measuring Errors Caused by Arterial Line Occlusion

Zheng¹,

Liu²,

Li³

et al. 2016

OJAnes

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Objective: The objective is to investigate the incidence and consequences of arterial line occlusion during invasive blood pressure monitoring in the form of questionnaire survey. Methods: The questionnaires were randomly distributed to the anesthesiologists who participated the 22 nd annual meeting of Chinese society of anesthesiology. The main contents of this survey included the arterial line managing status, the incidence of arterial line occlusion, the effects of arterial line occlusion on the anesthesiologists' therapy and consequences caused by arterial line occlusion. Results: Totally 294 questionnaires were collected, in which 261 questionnaires were valid. In all respondents, 28.3% expressed that they could not flush arterial line on time, and 95.4% had experienced flushing arterial line only or sometimes or occasionally when the arterial waveform was not normal. Furthermore, 93.9% had experienced partial occlusion of the arterial line, and 79.3% had experienced complete occlusion. According to the serious recall of the respondents, the incidence of partial arterial line occlusion was 17.7% ± 22.0%, and the incidence of complete arterial line occlusion was 3.6% ± 8.1%. For all the respondents, 89.7% had experienced suspecting arterial line occlusion while real hypotension occurred, 65.1% had experienced not treating hypotension timely due to this suspicion, and 31% had experienced serious consequences caused by this suspicion. Conclusion: The incidence of arterial line occlusion is high during invasive blood pressure monitoring, which is a threat to the patients' safety. So, intensive attention should be paid to the arterial line management.

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

Cited by 98 publications

References 18 publications

Accuracy of invasive arterial pressure monitoring in cardiovascular patients: an observational study

Accuracy of invasive arterial pressure monitoring in cardiovascular patients: an observational study

Mean Arterial Blood Pressure Monitoring Among Pediatric Patients after Open Heart Surgery

A Survey of the Incidence and Consequences of Invasive Blood Pressure Measuring Errors Caused by Arterial Line Occlusion

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