Effect of peripheral edema on cuff-based/oscillometric blood pressure measurements accuracy

Abstract

Introduction: Blood pressure (BP) measurement is essential for epidemiological studies and clinical decisions. It seems that tissue characteristics can affect BP results and we try to find edema effect on BP results taken by different methods. Methods: BP of 55 children before open heart surgery were measured and compared according to three methods: Arterial as standard and reference, oscillometric and auscultatory methods. Peripheral edema as a tissue characteristic was defined in higher than +2 as marked edema and in equal or lower than +2 as no edema. Statistical analyses: data was expressed as Mean and 95% of confidence interval (CI 95%). Comparison of two groups was performed by T independent test and of more than two groups by ANOVA test. Mann–Whitney U and paired T-test were used for serially comparisons of changes. P less than 0.05 was considered significant. Results: Fifty five children aged 29.4±3.9 months were divided into two groups: 10 children with peripheral edema beyond +2 and 45 cases without edema. Oscillometric method overestimated systolic BP and the Mean (CI 95%) difference of oscillometric to arterial was 4.8 (8/-1, P=0.02) in edematous and 4.2 (7/1, p=0.004) in non edematous. Oscillometric method underestimated diastolic BP as -9 (-1.8/-16.5, P=0.03) in edematous group and 2.6 (-0.7/+5, P= 0.2) in non edematous compared to arterial method. Conclusion: Oscillometric device standards cannot cover all specific clinical conditions. It underestimates diastolic BP significantly in edematous children, which was 9.2 mmHg in average beyond the acceptable standards.

Comparison of Blood Pressure Measurements by Currently Available Multiparameter Monitors and Mercury Column Sphygmomanometer in Patients Admitted in Pediatric Intensive Care Unit

“…In a study on children (age, 29.4 ± 3.9 months, n = 55), MPMs and auscultatory methods were shown to underestimate SBP and DBP compared to IABP methods in presence of limb edema. 13 Lower NIBP values in edematous limbs in our study supports this observation, and suggest clinicians to be cautious as edema is common among sepsis patients in LMICs. 25 – 27 Though MPM measurements were not affected by inotropes in adults, 11 they seem to overestimate readings among children with high VIS >40.…”

“… 15 Intra-arterial blood pressure readings are reportedly similar to auscultatory NIBP readings among critically ill children (age, 29.4 + 3.9 months). 13 In our study, overestimation of SBP, DBP, and MAP by MPMs, irrespective of age, gender, and critical care characteristics are in agreement. In contrast, Wong et al, reported underestimation (by about 4–5 mm Hg) by two AODs (Welch-Allyn® Vital Sign monitor and Dinamap Procare-120®) compared to MCS in outpatient setting (age, 5–15 years).…”

“… 5 A study among critically ill children revealed overestimation of SBP (by 2–4 mm Hg) and underestimation of DBP (by 2–7 mm Hg) by an AOD (Datex-Ohmeda, USA) compared to auscultatory method. 13 In another study from PICU, MPM was shown to overestimate intra-arterial blood pressure (IABP) with wide variation (SBP, −3.6 + 12.85 mm Hg; DBP, −4.7 + 9.3 mm Hg; MAP, −3.12 + 9.30 mm Hg). 14 A retrospective analysis of big data provided similar findings.…”

Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns

“…The increased body weight during pregnancy, neonatal birthweight, gestational age, maximum SBP and diastolic BP (DBP), level of albumin and urine protein in 24 h, duration of hypertension, the severity of HDP, and the level of edema were also recorded. Edema was classified in standard grade by a physician as follows:[ 21 ] (1 = A normal foot and leg contour with a barely perceptible pit; 2 = Fairly normal lower extremity contours with a moderately deep pit; 3 = Obvious foot and leg swelling with a deep pit; 4 = Severe foot and leg swelling that distorts the normal contours with a deep pit).…”