Accuracy and precision of oscillometric noninvasive blood pressure measurement in critically ill patients: systematic review and meta-analysis.

Mean arterial pressure (MAP) is a key haemodynamic variable monitored in critically ill patients. The advantages of oscillometric noninvasive blood pressure (NIBP) measurement are its easy and fast methodology; however, the accuracy and the precision of this measurement in critically ill patients is constantly debated. We performed a systematic review and meta-analysis of observational studies comparing oscillometric NIBP methods with invasive arterial pressure (IAP) measurements. We included studies of adult critically ill patients, which evaluated MAP in the same patient by both NIBP and IAP at any site. We included only studies comparing simultaneous measurements of arterial pressure by NIBP and IAP, reporting their results using mean difference and SD of agreement. The main outcome was to define the bias of the MAP measured by NIBP over the IAP measurement. The quality of the studies was analysed by the QUADAS 2 tool. Seven studies and 1593 patients were included in the main analysis. The oscillometric NIBP method had a mean value of -1.50 mmHg when compared with IAP (95% CI: -3.34 to 0.35; I2 = 96% for random effects model, P < 0.01). The limits of agreement for MAP varied between -14.6 mmHg and +40.3 mmHg. NIBP had an adequate accuracy regarding MAP measurements by oscillometry. Limits of agreement may thus narrow the clinical applicability in scenarios in which there is a need for a more precise management of blood pressure.

Effects of cuff size and position on the agreement between arterial blood pressure measured by Doppler ultrasound and through a dorsal pedal artery catheter in anesthetized cats.

OBJECTIVE: To compare the effects of cuff size/position on the agreement between arterial blood pressure measured by Doppler ultrasound (ABPDoppler) and dorsal pedal artery catheter measurements of systolic (SAPinvasive) and mean arterial pressure (MAPinvasive) in anesthetized cats. STUDY DESIGN: Prospective study. ANIMALS: A total of eight cats (3.0-3.8 kg) for neutering. METHODS: During isoflurane anesthesia, before surgery, changes in end-tidal isoflurane concentrations and/or administration of dopamine were performed to achieve SAPinvasive within 60-150 mmHg. Cuff sizes 1, 2 and 3 (bladder width: 20, 25 and 35 mm, respectively) were placed on distal third of the antebrachium, above the tarsus and below the tarsus for ABPDoppler measurements. Agreement between ABPDoppler and SAPinvasive or between ABPDoppler and MAPinvasive was compared with reference standards for noninvasive blood pressure devices used in humans and small animals. RESULTS: Mean bias and precision (±standard deviation) between ABPDoppler and SAPinvasive met veterinary standards (≤10 ± 15 mmHg), but not human standards (≤5 ± 8 mmHg), with cuffs 1 and 2 placed on the thoracic limb (7.4 ± 13.9 and -5.8 ± 9.5 mmHg, respectively), and with cuff 2 placed proximal to the tarsus (7.2 ± 12.4 mmHg). Cuff width-to-limb circumference ratios resulting in acceptable agreement between ABPDoppler and SAPinvasive were 0.31 ± 0.04 (cuff 1) and 0.42 ± 0.05 (cuff 2) on the thoracic limb, and 0.43 ± 0.05 (cuff 2) above the tarsus. ABPDoppler showed no acceptable agreement with MAPinvasive by any reference standard. CONCLUSIONS AND CLINICAL RELEVANCE: The agreement between ABPDoppler and SAPinvasive can be optimized by placing the occlusive cuff on the distal third of the antebrachium and above the tarsus. In these locations, cuff width should approach 40% of limb circumference to provide clinically acceptable estimations of SAPinvasive. Doppler ultrasound cannot be used to estimate MAPinvasive in cats.

Measurement of blood pressure by digital palpation of the peripheral pulse in anesthetized dogs / Mensuração da pressão arterial por palpação digital do pulso periférico em cães anestesiados

The present study aimed to determine the accuracy of measurement of blood pressure (BP) by digital palpation of peripheral pulse (indirect method) in anesthetized dogs. Indirect determination of BP was performed using a sphygmomanometer and a cuff placed proximal to carpus and BP was defined as the value recorded by sphygmomanometer at the time that digital palpation of the pulse in metacarpal artery returned after occlusion and subsequent gradual cuff deflation. Blood pressure was measured simultaneously by invasive (direct) method. Data were compared by Bland Altman analysis to verify the agreement between methods. A total of 131, 65 and 56 observations were performed in 31 dogs during normotension, hypotension and hypertension, respectively. During hypotension, normotension and hypertension, values of bias for systolic arterial pressure (SAP) between methods were respectively - 2, 8 and 12 mmHg, demonstrating underestimation of SAP by the indirect method during normotension and hypertension. Percentages of differences between methods for SAP that were 10 e 20 mmHg were: hypotension, 49 and 88%; normotension, 47 and 79%; hypertension, 25 and 52%. For determination of SAP in dogs, indirect method reported here have lower agreement with the invasive method compared with Doppler and similar to many oscillometric monitors reported in the literature, but do not meet the requirements established by the ACVIM. Use of digital palpation of peripheral pulse for monitoring blood pressure during anesthesia in dogs requires further studies to more accurately determine the accuracy of this method(AU) 

Com o presente estudo, buscou-se determinar a acurácia da aferição da pressão arterial (PA) pela palpação digital do pulso periférico (método indireto) em cães anestesiados. A determinação indireta da PA foi realizada com auxílio de manguito e esfigmomanômetro posicionados proximais ao carpo e o valor da PA foi considerado aquele registrado pelo esfigmomanômetro no momento em que a palpação do pulso retornava na artéria metacarpiana após a oclusão e subsequente desinsuflação gradual do manguito. A PA foi mensurada simultaneamente pelo método invasivo (direto). Os dados foram comparados pela análise de Bland Altman para verificar a concordância entre os métodos. Foram realizadas 131, 65 e 56 observações em 31 cães, respectivamente em normotensão, hipotensão e hipertensão. Durante a normotensão, hipotensão e hipertensão, os valores do viés para a pressão arterial sistólica (PAS) entre os métodos foram respectivamente 8, -2 e 12 mmHg, demonstrando subestimação desta variável pelo método indireto na normotensão e hipertensão. Para a PAS, as diferenças entre os métodos que constituíram 10 e 20 mmHg foram respectivamente: hipotensão, 49 e 88%; normotensão, 47 e 79%; hipertensão, 25 e 52%. Quando utilizado para a determinação da PAS em cães, o método de palpação digital do pulso periférico apresenta concordância inferior com o método invasivo em relação ao Doppler e similar em relação à PAS mensurada por diversos monitores oscilométricos relatados na literatura, mas não cumpre as exigências estabelecidas pelo CAMIV. O uso do método de palpação do pulso periférico para a monitoração da pressão arterial em cães durante a anestesia requer outros estudos para determinar com maior precisão a acurácia desse método(AU)

Measurement of blood pressure by digital palpation of the peripheral pulse in anesthetized dogs / Mensuração da pressão arterial por palpação digital do pulso periférico em cães anestesiados

The present study aimed to determine the accuracy of measurement of blood pressure (BP) by digital palpation of peripheral pulse (indirect method) in anesthetized dogs. Indirect determination of BP was performed using a sphygmomanometer and a cuff placed proximal to carpus and BP was defined as the value recorded by sphygmomanometer at the time that digital palpation of the pulse in metacarpal artery returned after occlusion and subsequent gradual cuff deflation. Blood pressure was measured simultaneously by invasive (direct) method. Data were compared by Bland Altman analysis to verify the agreement between methods. A total of 131, 65 and 56 observations were performed in 31 dogs during normotension, hypotension and hypertension, respectively. During hypotension, normotension and hypertension, values of bias for systolic arterial pressure (SAP) between methods were respectively - 2, 8 and 12 mmHg, demonstrating underestimation of SAP by the indirect method during normotension and hypertension. Percentages of differences between methods for SAP that were 10 e 20 mmHg were: hypotension, 49 and 88%; normotension, 47 and 79%; hypertension, 25 and 52%. For determination of SAP in dogs, indirect method reported here have lower agreement with the invasive method compared with Doppler and similar to many oscillometric monitors reported in the literature, but do not meet the requirements established by the ACVIM. Use of digital palpation of peripheral pulse for monitoring blood pressure during anesthesia in dogs requires further studies to more accurately determine the accuracy of this method

Com o presente estudo, buscou-se determinar a acurácia da aferição da pressão arterial (PA) pela palpação digital do pulso periférico (método indireto) em cães anestesiados. A determinação indireta da PA foi realizada com auxílio de manguito e esfigmomanômetro posicionados proximais ao carpo e o valor da PA foi considerado aquele registrado pelo esfigmomanômetro no momento em que a palpação do pulso retornava na artéria metacarpiana após a oclusão e subsequente desinsuflação gradual do manguito. A PA foi mensurada simultaneamente pelo método invasivo (direto). Os dados foram comparados pela análise de Bland Altman para verificar a concordância entre os métodos. Foram realizadas 131, 65 e 56 observações em 31 cães, respectivamente em normotensão, hipotensão e hipertensão. Durante a normotensão, hipotensão e hipertensão, os valores do viés para a pressão arterial sistólica (PAS) entre os métodos foram respectivamente 8, -2 e 12 mmHg, demonstrando subestimação desta variável pelo método indireto na normotensão e hipertensão. Para a PAS, as diferenças entre os métodos que constituíram 10 e 20 mmHg foram respectivamente: hipotensão, 49 e 88%; normotensão, 47 e 79%; hipertensão, 25 e 52%. Quando utilizado para a determinação da PAS em cães, o método de palpação digital do pulso periférico apresenta concordância inferior com o método invasivo em relação ao Doppler e similar em relação à PAS mensurada por diversos monitores oscilométricos relatados na literatura, mas não cumpre as exigências estabelecidas pelo CAMIV. O uso do método de palpação do pulso periférico para a monitoração da pressão arterial em cães durante a anestesia requer outros estudos para determinar com maior precisão a acurácia desse método