Blood pressure monitoring during arrhythmia: agreement between automated brachial cuff and intra-arterial measurements

Lakhal, Karim; Ehrmann, Stéphan; Martin, Maëlle; Faiz, Sofian; Réminiac, François; Cinotti, Raphaël; Capdevila, Xavier; Asehnoune, Karim; Blanlœil, Y.; Rozec, Bertrand; Boulain, Thierry

doi:10.1093/bja/aev304

Cited by 130 publications

(28 citation statements)

References 30 publications

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“…The reliability of non-invasive intermittent BP measurement in patients with arrhythmia has been questioned ( 31 ). Two studies have shown recently that there is no relevant difference between oscillometric measurement in patients with or without arrhythmia ( 32 , 33 ).…”

Section: Are the Techniques Reliable?mentioning

confidence: 99%

Techniques for Non-Invasive Monitoring of Arterial Blood Pressure

2018

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Since both, hypotension and hypertension, can potentially impair the function of vital organs such as heart, brain, or kidneys, monitoring of arterial blood pressure (BP) is a mainstay of hemodynamic monitoring in acutely or critically ill patients. Arterial BP can either be obtained invasively via an arterial catheter or non-invasively. Non-invasive BP measurement provides either intermittent or continuous readings. Most commonly, an occluding upper arm cuff is used for intermittent non-invasive monitoring. BP values are then obtained either manually (by auscultation of Korotkoff sounds or palpation) or automatically (e.g., by oscillometry). For continuous non-invasive BP monitoring, the volume clamp method or arterial applanation tonometry can be used. Both techniques enable the arterial waveform and BP values to be obtained continuously. This article describes the different techniques for non-invasive BP measurement, their advantages and limitations, and their clinical applicability.

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Section: Are the Techniques Reliable?mentioning

confidence: 99%

Techniques for Non-Invasive Monitoring of Arterial Blood Pressure

2018

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“…One example is a recent study of 135 patients with arrhythmia (including 88% of the patients with AF) and an intra-arterial line, in which measurement of arterial BP with an oscillometric device fulfilled the ISO criteria for mean and diastolic BP. Systolic BP was accurate, but not precise for both patients with arrhythmia or regular rhythm (mean bias −1.6 mmHg; SD 10.4 mmHg) [ 27 ]. It is important to stress, however, that no oscillometric device is the same in term of device technology and computational algorithm, and separate validation in AF is thus required for each system.…”

Section: Discussionmentioning

confidence: 99%

Comparing volume-clamp method and intra-arterial blood pressure measurements in patients with atrial fibrillation admitted to the intensive or medium care unit

Berkelmans

Kuipers

Westerhof

et al. 2017

J Clin Monit Comput

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International guidelines highlight the importance of blood pressure (BP) in patients with atrial fibrillation (AF). However, BP measurement in AF is complicated by beat-to-beat fluctuation. Automated BP measurement devices are not validated for patients with AF and no consensus exists on how to measure BP in AF manually. Beat-to-beat BP measurement using the volume-clamp method (VCM) could represent a non-invasive method to accurately assess BP, but has not been validated in AF. 31 admitted patients with sustained AF and 10 control patients with sinus rhythm underwent simultaneous intra-arterial and non-invasive BP measurement using a VCM monitor (Nexfin®, BMEYE, Amsterdam, The Netherlands). Patients with compromised peripheral perfusion, high doses of vasopressor drugs or peripheral edema were excluded. Differences in systolic, diastolic and mean BP of 5 (standard deviation; SD 8) mmHg (accuracy and precision) between both methods were considered acceptable. Additionally, the magnitude of beat-to-beat fluctuations in systolic BP of both methods was compared. In AF, the differences between noninvasive and invasive BP were −4 (SD 12), +1 (SD 7) and 0 (SD 8) mmHg for systolic, diastolic and mean BP respectively. Absolute differences in beat-to-beat BP fluctuations were 1.5 (IQR 0.8–3.8) mmHg. Accuracy of VCM in AF was similar to sinus rhythm. In conclusion, in patients with AF, accurate and precise measurement of non-invasive beat-to-beat BP measurement using the VCM is possible, the one exception being the precision of systolic BP. Beat-to-beat variability can be accurately reproduced.Electronic supplementary materialThe online version of this article (doi:10.1007/s10877-017-0044-9) contains supplementary material, which is available to authorized users.

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“…Such misleading predictions were few for lactate, pH, and Pa CO2 , but to what extent the patients can tolerate the induced inappropriate therapeutic decisions in such circumstances remains to be explored. Although clinically useful prediction of arterial pH and lactate were suggested in singlecentre studies, [7][8][9][10] further works are needed to assess the safety of our predictive models before one can use them with reasonable confidence. Prediction of Sa O2 was more problematic because of the expected poor correlation between Sp O2 and Sa O2 .…”

Section: Discussionmentioning

confidence: 99%

“…3 Arterial catheters are recommended for close blood pressure monitoring of patients in shock 4 and to allow repeated blood gas and lactate concentration measurements, while avoiding repeated vascular punctures. However, recent data are accumulating that suggest non-invasive blood pressure monitoring by oscillometry might allow reliable blood pressure measurements [5][6][7] and that central venous lactate might accurately reflect arterial lactate concentration. 8 9 In addition, a number of singlecentre, small-sized studies have suggested that central or peripheral venous blood gas might reflect arterial blood gas values.…”

mentioning

confidence: 99%

Predicting arterial blood gas and lactate from central venous blood analysis in critically ill patients: a multicentre, prospective, diagnostic accuracy study

Boulain

Garot

Vignon

et al. 2016

British Journal of Anaesthesia

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Blood pressure monitoring during arrhythmia: agreement between automated brachial cuff and intra-arterial measurements

Abstract: Contrary to widespread belief, arrhythmia did not cause flawed automated brachial cuff measurements.

Cited by 130 publications

References 30 publications

Techniques for Non-Invasive Monitoring of Arterial Blood Pressure

Techniques for Non-Invasive Monitoring of Arterial Blood Pressure

Comparing volume-clamp method and intra-arterial blood pressure measurements in patients with atrial fibrillation admitted to the intensive or medium care unit

Predicting arterial blood gas and lactate from central venous blood analysis in critically ill patients: a multicentre, prospective, diagnostic accuracy study

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