Perioperative Noninvasive Blood Pressure Monitoring

Abstract

The most commonly monitored variable for perioperative hemodynamic management is blood pressure. Several indirect noninvasive blood pressure monitoring techniques have been developed over the last century, including intermittent techniques such as auscultation (Riva-Rocci and Korotkoff) and oscillometry (Marey) and continuous techniques. With the introduction of automated noninvasive blood pressure devices in the 1970s, the oscillometric technique quickly became and remains the standard for automated, intermittent blood pressure measurement. It tends to estimate more extreme high and low blood pressures closer to normal than what invasive measurements indicate. The accuracy of the oscillometric maximum amplitude algorithm for estimating mean arterial pressure is affected by multiple factors, including the cuff size and shape, the shape of the arterial compliance curve and arterial pressure pulse, and pulse pressure itself. Additionally, the technique typically assumes a consistent arterial compliance and arterial pressure pulse, thus changes in arterial compliance and arrhythmias that lead to variation in the pressure pulse can affect accuracy. Volume clamping, based on the Penaz principle, and arterial tonometry provide continuous tracking of the arterial pressure pulse. The ubiquitous use of blood pressure monitoring is in contrast with the lack of evidence for optimal perioperative blood pressure targets.

Intraoperative Blood Pressure Variability Predicts Postoperative Mortality in Non-Cardiac Surgery—A Prospective Observational Cohort Study

“…All patients had multiple blood pressure measurements performed at the time of the surgery by the Primus® integrated anesthesia workstation (Draeger®, Germany) equipped with an automated oscillometric non-invasive BP monitoring (Marey technique) [15]. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were recorded in five-minute intervals during anesthesia (from the first pre-induction measurement until the last measurement during recovery from anesthesia in the operating theatre).…”

Postoperative Hypertension: When Blood Pressure Cuff and Arterial Line Disagree

“…compared to IBP [24]. This has been attributed to stiffened vessels requiring greater cuff pressure to occlude blood flow at low BP and to peripheral amplification of pulse pressure for arterial pressures at high BP (most relevant when measured at the radial artery, as compared to more central measurements) [25]. Therefore, based on these theoretical concerns, it would seem NIBP measurements would tend to more closely reflect central blood pressures at BP extremes.…”

Accuracy of non-invasive and minimally invasive hemodynamic monitoring: where do we stand?

“…It is the absorption of the infrared through the finger that is used to measure the arterial volume, hence the pressure. This cuff pressure adjusts rapidly to clamp the arterial volume throughout the pulse to be able to measure the waveform pressure and pulse contour (18). Cuff pressure is constantly adjusted during the cardiac cycle to keep the volume in the finger constant and these adjustments over time are used to create the blood pressure waveform and analyze the pulse wave (67).…”

“…When comparing the oscillometric noninvasive and invasive arterial blood pressure measurements, it has been established that noninvasive techniques underestimate blood pressure during hypertension and overestimates during hypotension (18). Due to the morbidity and mortality in severely ill patients and the demonstrated drawbacks of inadequate measurement of blood pressure, such as acute kidney injury and ICU mortality, more well developed and reliable techniques would be beneficial for monitoring critically ill patients (19).…”