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Journal of Clinical Monitoring and Computing

, Volume 32, Issue 4, pp 707–715 | Cite as

Non-invasive blood pressure monitoring with an oscillometric brachial cuff: impact of arrhythmia

  • Karim LakhalEmail author
  • Maëlle Martin
  • Stephan Ehrmann
  • Sofian Faiz
  • Bertrand Rozec
  • Thierry Boulain
Original Research

Abstract

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.

Keywords

Atrial fibrillation (MeSH) Blood pressure determination (MeSH) Intensive care units (MeSH) Oscillometry Sphygmomanometer 

Abbreviations

AUCROC

Area under the receiver operating characteristic curve

BP

Blood pressure

ICU

Intensive care unit

ISO

International organization for standardization

NIBP

Non-invasive monitoring of blood pressure with oscillometric automated brachial cuff

SD

Standard deviation

Notes

Author Contributions

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.

Human rights

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.

Ethical approval

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.

References

  1. 1.
    Chatterjee A, DePriest K, Blair R, Bowton D, Chin R. Results of a survey of blood pressure monitoring by intensivists in critically ill patients: a preliminary study. Crit Care Med. 2010;38:2335–8. doi: 10.1097/CCM.0b013e3181fa057f.CrossRefPubMedGoogle Scholar
  2. 2.
    O’Brien E, Asmar R, Beilin L, et al. European society of hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertension. 2003;21:821–48. doi: 10.1097/01.hjh.0000059016.82022.ca.CrossRefGoogle Scholar
  3. 3.
    National Institute for Health and Clinical Excellence: Guidance. Hypertension: the clinical management of primary hypertension in adults: update of clinical guidelines 18 and 34. London: National Institute for Health and Clinical Excellence; 2011.Google Scholar
  4. 4.
    Pickering TG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on high blood pressure research. Circulation. 2005;111:697–716. doi: 10.1161/01.CIR.0000154900.76284.F6.CrossRefPubMedGoogle Scholar
  5. 5.
    Kollias A, Stergiou GS. Automated measurement of office, home and ambulatory blood pressure in atrial fibrillation. Clin Exp Pharmacol Physiol. 2014;41:9–15. doi: 10.1111/1440-1681.12103.CrossRefPubMedGoogle Scholar
  6. 6.
    O’Brien E, Atkins N, Stergiou G, et al. European society of hypertension international protocol revision 2010 for the validation of blood pressure measuring devices in adults. Blood Press Monit. 2010;15:23–38. doi: 10.1097/MBP.0b013e3283360e98.CrossRefPubMedGoogle Scholar
  7. 7.
    International Organization for Standardization (ISO) (2013) Non-invasive sphygmomanometers—Part 2: clinical investigation of automated measurement type. ISO 81060-2:2013.Google Scholar
  8. 8.
    Stergiou GS, Kollias A, Destounis A, Tzamouranis D. Automated blood pressure measurement in atrial fibrillation: a systematic review and meta-analysis. J Hypertension. 2012;30:2074–82. doi: 10.1097/HJH.0b013e32835850d7.CrossRefGoogle Scholar
  9. 9.
    Pagonas N, Schmidt S, Eysel J, et al. (2013) Impact of atrial fibrillation on the accuracy of oscillometric blood pressure monitoring. Hypertension 62: 579–84. doi: 10.1161/HYPERTENSIONAHA.113.01426.CrossRefPubMedGoogle Scholar
  10. 10.
    Lakhal K, Ehrmann S, Martin M, et al. Blood pressure monitoring during arrhythmia: agreement between automated brachial cuff and intra-arterial measurements. Brit J Anaesth. 2015;115:540–9. doi: 10.1093/bja/aev304.CrossRefPubMedGoogle Scholar
  11. 11.
    Lakhal K, Martin M, Faiz S, et al. The CNAP finger cuff for noninvasive beat-to-beat monitoring of arterial blood pressure: an evaluation in intensive care unit patients and a comparison with 2 intermittent devices. Anesth Analg. 2016;123:1126–35. doi: 10.1213/ANE.0000000000001324.CrossRefPubMedGoogle Scholar
  12. 12.
    Lakhal K, Macq C, Ehrmann S, Boulain T, Capdevila X. Noninvasive monitoring of blood pressure in the critically ill: reliability according to the cuff site (arm, thigh, or ankle). Crit Care Med. 2012;40(4):1207–13.CrossRefGoogle Scholar
  13. 13.
    Lakhal K, Martin M, Faiz S, et al. The CNAP finger cuff for noninvasive beat-to-beat monitoring of arterial blood pressure: an evaluation in intensive care unit patients and a comparison with 2 intermittent devices. Anesth Analg. 2016;123(5):1126–35.CrossRefGoogle Scholar
  14. 14.
    Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.CrossRefGoogle Scholar
  15. 15.
    Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of intensive care medicine. Intensive Care Med. 2014;40:1795–815. doi: 10.1007/s00134-014-3525-z.CrossRefGoogle Scholar
  16. 16.
    Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304–77.CrossRefGoogle Scholar
  17. 17.
    Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of hypertension (ESH) and of the European Society of cardiology (ESC). Eur Heart J. 2013;34:2159–219. doi: 10.3109/08037051.2014.868629.CrossRefGoogle Scholar
  18. 18.
    Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36.CrossRefGoogle Scholar
  19. 19.
    Alpert BS, Quinn DE, Friedman BA. A review of the latest guidelines for NIBP device validation. Blood Press Monit. 2013;18:297–302. doi: 10.1097/MBP.0000000000000007.CrossRefPubMedGoogle Scholar
  20. 20.
    Fortin J, Lerche K, Flot-Zinger D, O’Brien T. Is the standard supplied by the association for the advancement of medical instrumentation the measure of all things for noninvasive continuous hemodynamic devices? Anesthesiology. 2015;122:208–9. doi: 10.1097/ALN.0000000000000485.CrossRefPubMedGoogle Scholar
  21. 21.
    Robin X, Turck N, Hainard A, et al. pROC: an open-source package for R and S + to analyze and compare ROC curves. BMC Bioinform. 2011;12:77. doi: 10.1186/1471-2105-12-77.CrossRefGoogle Scholar
  22. 22.
    Annane D, Sebille V, Duboc D, et al. (2008) Incidence and prognosis of sustained arrhythmias in critically ill patients. Am J Resp Crit Care Med 178: 20 – 5. doi: 10.1164/rccm.200701-031OC.
  23. 23.
    Lip GY, Kakar P, Watson T. Atrial fibrillation—the growing epidemic. Heart. 2007;93:542–3. doi: 10.1136/hrt.2006.110791.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Sykes D, Dewar R, Mohanaruban K, et al. Measuring blood pressure in the elderly: does atrial fibrillation increase observer variability? BMJ. 1990;300:162–3.CrossRefGoogle Scholar
  25. 25.
    Stergiou GS, Kollias A, Karpettas N. (2013) Does atrial fibrillation affect the automated oscillometric blood pressure measurement? Hypertension. doi: 10.1161/HYPERTENSIONAHA.113.02211.
  26. 26.
    Antonelli M, Levy M, Andrews PJ, et al. Hemodynamic monitoring in shock and implications for management. International Consensus Conference, Paris, France, 27–28 April 2006. Intensive Care Med. 2007;33:575–90. doi: 10.1007/s00134-007-0531-4.CrossRefPubMedGoogle Scholar
  27. 27.
    Araghi A, Bander JJ, Guzman JA. Arterial blood pressure monitoring in overweight critically ill patients: invasive or noninvasive? Crit Care (London England) 2006. 2006;10:R64. doi: 10.1186/cc4896.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • Karim Lakhal
    • 1
    Email author
  • Maëlle Martin
    • 1
  • Stephan Ehrmann
    • 2
    • 3
  • Sofian Faiz
    • 4
  • Bertrand Rozec
    • 1
  • Thierry Boulain
    • 4
  1. 1.Réanimation Chirurgicale Polyvalente, Service d’anesthésie-Réanimation, Hôpital LaënnecCentre Hospitalier UniversitaireNantesFrance
  2. 2.Médecine Intensive RéanimationCHRU de ToursToursFrance
  3. 3.INSERM, Centre d’Étude des Pathologies Respiratoires, UMR, 1100, Aérosolthérapie et Biomédicaments à Visée Respiratoire, Faculté de MédecineUniversité François RabelaisToursFrance
  4. 4.Service de Réanimation Médicale, Hôpital La SourceCentre Hospitalier RégionalOrléansFrance

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