Non-invasive blood pressure monitoring with an oscillometric brachial cuff: impact of arrhythmia
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Arrhythmia-induced beat-to-beat variability of blood pressure (BP) is deemed to hinder the reliability of non-invasive oscillometric measurements (NIBP) but few data support this belief. We assessed the impact of arrhythmia on a NIBP device never tested for this purpose. We compared, in intensive care unit patients with and without arrhythmia, the agreement between three pairs of NIBP (Infinity™ Delta monitor, Dräger medical systems) and invasive readings. For systolic, diastolic and mean BP, the mean bias between NIBP and invasive measurements was not higher, in 89 patients with arrhythmia, than that observed in 127 patients with regular rhythm (p = 0.93 for mean BP). Averaging three measurements overcame the higher within-subject variability of NIBP measurements during arrhythmia, and yielded similar agreement between the two techniques in patients with arrhythmia and with regular rhythm. The international organization for standardization criteria (mean bias < 5 and SD < 8 mmHg) were satisfied neither during arrhythmia nor during regular rhythm: for mean BP, mean bias of − 8.0 ± 6.5 and − 7.5 ± 6.1 mmHg, respectively. The detection of hypotension (systolic invasive BP < 90 mmHg or mean invasive BP < 65 mmHg) or hypertension (systolic invasive BP > 140 mmHg) by NIBP was similar during arrhythmia and regular rhythm [areas under the receiver operating characteristic curves (AUCROC) of 0.88–0.92, p > 0.13]. The detection of a 10% increase in mean invasive BP after cardiovascular intervention was also associated with similar AUCROCs between the two groups. Provided that triplicates are averaged, the agreement between NIBP measured with the tested device and invasive measurements was not worse during arrhythmia than during regular rhythm.
KeywordsAtrial fibrillation (MeSH) Blood pressure determination (MeSH) Intensive care units (MeSH) Oscillometry Sphygmomanometer
Area under the receiver operating characteristic curve
Intensive care unit
International organization for standardization
Non-invasive monitoring of blood pressure with oscillometric automated brachial cuff
Conception and design: KL, TB. Acquisition of data: KL, TB, MM, SF. Statistical analysis: TB. Drafting and revision of the manuscript: KL, TB, SE, BR.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests. Dräger medical systems (Lübeck, Germany) lent the Infinity Delta monitor to the investigators without being further involved in the study. Hence, the authors were fully independent during data interpretation and manuscript drafting. The authors did not receive any additional support from the company.
This study has been approved by the institutional research ethics committee of Orléans Hospital and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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