Correlation between invasive and noninvasive blood pressure measurements in severely burned children

Cambiaso‐Daniel, Janos; Rontoyanni, Victoria G.; Foncerrada, Guillermo; Nguyen, Anthony; Čapek, Karel; Wurzer, Paul; Lee, Jong O.; Hundeshagen, Gabriel; Voigt, Charles D.; Branski, Ludwik K.; Finnerty, Celeste C.; Herndon, David N.

doi:10.1016/j.burns.2018.03.001

Cited by 10 publications

(11 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly, Joffe et al 30 found a poor degree of correlation in blood pressure readings obtained via IAL versus those obtained via NIBP in critically ill children. The findings of the present study on patients undergoing LE FEE reconstruction along with our previous findings in patients undergoing flap-based breast reconstruction extend the findings of Cambiaso-Daniel et al 29 and Joffe et al 30 to the adult population and suggest that IAL should be used in instances where highly accurate hemodynamic measurements are essential for patient safety and/or surgical success.…”

Section: Discussionsupporting

confidence: 89%

Intraoperative Invasive Blood Pressure Monitoring in Flap-Based Lower Extremity Reconstruction

et al. 2022

View full text Add to dashboard Cite

Background Despite the lack of clear indications for the use of intra-arterial lines (IALs) for intraoperative hemodynamic monitoring, they are often used in a variety of settings. In this retrospective review of patients undergoing free tissue transfer (FTT) for lower extremity (LE) reconstruction, we sought to (1) identify patient factors associated with IAL placement, (2) compare hemodynamic measurements obtained via IAL versus noninvasive blood pressure (NIBP) monitoring, and (3) investigate whether method of hemodynamic monitoring affected intraoperative administration of blood pressure–altering medications. Methods Patients undergoing LE FTT from January 2017 through June 2020 were retrospectively reviewed. Patients were pair matched based on flap donor site, sex, and body mass index to identify patient factors associated with IAL placement. Methods previously described by Bland and Altman (Lancet. 1986;327:307–310) were used to investigate agreement between IAL and NIBP measurements. Results Sixty-eight patients were included with 34 patients in the IAL group and 34 in the NIBP group. Older patients (P = 0.03) and those with a higher Charlson Comorbidity Index (P = 0.05) were significantly more likely to have an IAL placed. Agreement analysis demonstrated that mean arterial pressures calculated from IAL readings were as much as 31 points lower or 28 points higher than those from NIBP. Bias calculations with this extent of difference suggest poor correlation between IAL readings and NIBP (R 2 = 0.3027). There was no significant difference between groups in rate of administration of blood-pressure altering medications. Conclusions Surgeons should consider the risks and benefits of IAL placement on a case-by-case basis, particularly for patients who are young and healthy. Our findings highlight the need for clearer guidance regarding the use of IAL in patients undergoing LE FTT.

show abstract

Section: Discussionsupporting

confidence: 89%

Intraoperative Invasive Blood Pressure Monitoring in Flap-Based Lower Extremity Reconstruction

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Similar findings have been reported in the literature by Cambiaso-Daniel et al and Joffe et al; however, these studies were limited to pediatric patients. 16 , 17 These findings suggest that intra-arterial blood pressure monitoring should be used in the place of NIBP in cases where accuracy of measurements is paramount.…”

Section: Discussionmentioning

confidence: 98%

“…The complications associated with intra-arterial catheterization are rare, but exist nonetheless. As few as <1.0% of patients will experience major complications with ABP monitoring, 7 , 8 , 16 but the incidence of minor complications with radial artery catheterization, such as temporary occlusion of the artery, has been cited to be as high as 35%. 8 , 18 Despite its known complications, invasive blood pressure monitoring is indicated in certain procedures and with certain patient populations in which the benefits to use outweigh these risks.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Invasive Blood Pressure Monitoring in Flap-Based Breast Reconstruction: Does It Change Outcomes?

Dekker

Noe

Bekeny

et al. 2021

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background: Despite the lack of guidelines regarding the use of intra-arterial lines in postmastectomy breast reconstruction (PMBR), they continue to be used in this setting. In this study of patients undergoing PMBR, we aimed to (1) identify factors associated with intra-arterial line placement, (2) analyze the correlation between intra-arterial monitoring and noninvasive blood pressure (NIBP) monitoring, and (3) investigate whether hemodynamic management differs significantly between patients undergoing intra-arterial blood pressure monitoring versus NIBP. Methods: All patients undergoing flap-based PMBR between 2017 and 2019 were retrospectively reviewed. Patients were pair-matched based on flap donor site, BMI, and age to identify factors associated with intra-arterial line placement. Methods described by Bland and Altman 1 were utilized to determine agreement between intra-arterial line measurements and NIBP. Results: Thirty-two patients were included with 16 patients in the intra-arterial line group and 16 in the NIBP group. None of the factors studied were significantly related to the likelihood of intra-arterial line placement. Agreement analysis demonstrated that mean arterial pressures calculated from intra-arterial line readings were as much as 23 points lower or 12 points higher than those from NIBP. Bias calculations with this extent of difference suggest poor correlation between intra-arterial line readings and NIBP. There was no difference between groups in rate of administration of blood-pressure altering medications (hypertensive: n = 3, 18.8%, P = 1.000; hypotensive: n = 7, 3.8%, P = 1.000). Conclusion: Our findings highlight the need for more definitive guidance regarding the use of intra-arterial monitoring in patients undergoing PMBR.

show abstract

“…This can probably be explained by the inaccuracy of BP measurements rather than a real limitation of PAAT. In critically ill children, blood pressure measured by cuff does not correlate well with invasively measured blood pressure and cannot replace it when knowing that accurate blood pressure is crucial for minute-to-minute management [42,43]. Similarly, in premature infants, especially at the lower systemic blood pressure range, noninvasive blood pressure measurements do not correlate well with invasive measurements and tend to significantly over-estimate BP, falsely reassuring the providing team [44].…”

Section: Discussionmentioning

confidence: 99%

Utility of Pulmonary Artery Acceleration Time to Estimate Systolic Pulmonary Artery Pressure in Neonates and Young Infants

et al. 2019

View full text Add to dashboard Cite

Transthoracic echocardiogram (TTE) is commonly used to screen for pulmonary hypertension (PHTN) in neonates and young infants. However, in the absence of sufficient tricuspid regurgitation (TR), a ventricular septal defect (VSD), or a patent ductus arteriosus (PDA), the estimation of systolic pulmonary artery pressure (SPAP) becomes challenging. Pulmonary artery acceleration time (PAAT) is an alternate parameter that is easy to obtain in almost all patients and does not require the presence of tricuspid valvar regurgitation or an anatomical cardiac defect. We sought to examine the correlation of PAAT with estimated SPAP by TTE and create an equation to estimate the SPAP using PAAT. We performed a retrospective review of TTEs performed on neonates and young infants (4 months of age or younger) at our institution between April 2017 and December 2018, along with the corresponding medical records. We included TTEs that provided estimation for SPAP and at least one PAAT measurement. During the study period, 138 TTEs performed on 82 patients met the inclusion criteria. Strong correlation was delineated between PAAT and SPAP estimated by the maximum velocity of tricuspid valve regurgitation Doppler, correlation coefficient (r) = − 0.83. Moderate correlation was detected between PAAT and SPAP estimated by PDA Doppler, r = − 0.66. Utilizing the following equation "SPAP = 82.6 − 0.58 × PAAT + RA mean pressure", PAAT can be used to estimate SPAP in neonates and young infants. PAAT can be used as an alternative to TR jet to assess SPAP when the latter is absent or insufficient. Further studies are needed to verify the accuracy of this equation.

show abstract

Correlation between invasive and noninvasive blood pressure measurements in severely burned children

Abstract: Cuff measurements vary widely from those of intra-arterial lines, which have a low complication rate. Intra-arterial lines are advisable when tight control of the hemodynamic response is essential.

Cited by 10 publications

References 20 publications

Intraoperative Invasive Blood Pressure Monitoring in Flap-Based Lower Extremity Reconstruction

Intraoperative Invasive Blood Pressure Monitoring in Flap-Based Lower Extremity Reconstruction

Intraoperative Invasive Blood Pressure Monitoring in Flap-Based Breast Reconstruction: Does It Change Outcomes?

Utility of Pulmonary Artery Acceleration Time to Estimate Systolic Pulmonary Artery Pressure in Neonates and Young Infants

Contact Info

Product

Resources

About