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Accuracy of oscillometric blood pressure measurement in critically ill neonates with reference to the arterial pressure wave shape

  • Neonatal and Pediatric Intensive Care
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To perform further evaluation of the oscillometric device for neonatal arterial blood pressure (ABP) measurement, using a catheter-manometer system (CMS) for accurate intraarterial measurement. We aimed to describe the influence of the radial artery wave shape on oscillometric ABP determination, as pressure, wave-shape influences the relationships between systolic arterial pressure (SAP),diastolic arterial pressure (DAP) and mean arterial pressure (MAP) in the wave. These relationships are part of the algorithms contributing to the final ABP determination in the oscillometric device.

Design

Intra-patient comparison of two blood pressure measurement systems.

Setting

Neonatal intensive care unit.

Patients

In 51 critically ill newborn infants, ABP was determined oscillometrically in the brachial artery and, simultaneously, invasively in the radial artery using a high-fidelity CMS. Clinical data of the infants were: gestational age: 29 (25–41) weeks; brithweight: 1200 (500–3675) g, postnatal age: 6 (2–46) h.

Methods

Statistical analysis was performed with the paired Student'st-test. Multiple regression analysis was used to determine the influence of birthweight and height of the blood pressure on the results.

Measurements and main results

In 51 infants, 255 paired values of SAP, DAP and MAP were recorded. In all recordings we determined the relationship between SAP, DAP and MAP, using the equation.

MAP=α%(SAP-DAP)+DAP. For SAP, DAP, MAP and α, we computed mean differences (bias) and the limits of agreement (precision). Biases for SAP, DAP, MAP and α were significantly different from zero (P<0.001) and the limits of agreement for SAP, DAP and MAP were wide: 18.8 mmHg, 17.2 mmHg and 15.2 mmHg respectively The relationship between invasive and noninvasive values is only partly (7–19%) influenced by the height of the blood pressure; low values of SAP, DAP and MAP tend to give overestimated oscillometric values. In the relationship between SAP, DAP and MAP, α was found to be 47% invasively (as generally found in the radial artery in newborns) and 34% noninvasively (as generally found in the brachial/radial artery in adults).

Conclusions

Inaccuracy of the oscillometric device may be partly explained by the incorporation of an inappropriately fixed algorithm for final ABP determination in newborns. Care should be taken when interpreting the oscillometrically derived values in critically ill newborn infants.

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Abbreviations

ABP :

Arterial blood pressure

SAP :

Systolic arterial pressure

MAP:

Mean arterial pressure

DAP :

Diastolic arterial pressure

PP :

Pulse pressure

MAP%:

Level of MAP in the wave in relation to SAP and DAP

MAP%:

(MAP-DAP)/(SAP-DAP)×100%

CMS :

Catheter-manometer system

IRDS :

Idiopathic respiratory distress syndrome

References

  1. Nichols WW, O'Rourke MF (1990) McDonald's blood flow in arteries. Arnold, London

    Google Scholar 

  2. Shinozaki T, Deane RS, Mazuzan JE (1980) The dynamic responses of liquid-filled catheter systems for direct measurements of blood pressure. Anesthesiology 53:498–504

    Google Scholar 

  3. Westerhof N, Sipkema P, Elzinga G, Murgo JP, Giolma JP (1979) Arterial impedance. In: Hwang NHC, Gross DR, Patel DJ (eds) Quantitative cardiovascular studies. Clinical research applications of engineering principles. University Park Press, Baltimore, pp 111–150

    Google Scholar 

  4. Fry DL (1960) Physiologic recording by modern instruments with particular reference to pressure recording. Physiol Rev 40: 753–788

    Google Scholar 

  5. Gardner RM (1981) Direct blood pressure measurement-dynamic response response requirements. Anesthesiology 54: 227–236

    Google Scholar 

  6. Hipkins SF, Rutten AJ, Runciman WB (1989) Experimental analysis of catheter-manometer systems in vitro and in vivo. Anesthesiology 71: 893–906

    Google Scholar 

  7. Evans DH, Lark GM, Archer LNJ, Levene MI (1986) The continuous measurement of intra-arterial pressure in the neonate: method and accuracy. Clin Phys Physiol Meas 7: 179–184

    Google Scholar 

  8. Genderingen van HR, Gevers M, Hack WWM (1994) Prevention of air-introduction in catheter-manometer systems for accurate neonatal blood pressure measurement: an in vitro study. J Clin Monit 10: 35–38

    Google Scholar 

  9. Weindling AM (1989) Blood pressure monitoring in the newborn. Arch Dis Child 64: 444–447

    Google Scholar 

  10. Hack WWM, Westerhof N, Leenhoven T, Okken A (1990) Accurate measurement of intra-arterial pressure through radial artery catheters in neonates. J Clin Monit 6: 211–216

    Google Scholar 

  11. Gevers M, Hack WWM, Ree EF, Lafeber HN, Westerhof N (1993) Arterial blood pressure wave forms in radial and posterior tibial arteries in critically ill newborn infants. J Dev Physiol 19: 179–185

    Google Scholar 

  12. Berne RM, Levy MN (1992) The arterial system. In: Kist K (ed) Cardiovascular Physiology. Mosby Year Book, St Louis, pp 141–142

    Google Scholar 

  13. Ream AK (1985) Mean blood pressure algorithms. J Clin Monit 1: 138–144

    Google Scholar 

  14. Gevers M, Hack WWM, Ree EF, Lafeber HN, Westerhof N (1993) Arithmetical approximation of mean arterial blood pressure in critically ill infants. Basic Res Cardiol 88: 80–85

    Google Scholar 

  15. Friesen RH, Lichtor JL (1981) Indirect measurement of blood pressure in neonates and infants utilizing an automatic noninvasive oscillometric monitor. Anesth Analg 60: 742–745

    Google Scholar 

  16. Kimble KJ, Darnall RA, Yelderman M, Ariagno RL, Ream AK (1981) An automated oscillometric technique for estimating mean arterial pressure in critically ill newborns. Anesthesiology 54: 423–425

    Google Scholar 

  17. Pellegrini-Caliumi G, Agostino R, Nodari S, Maffei G, Moretti C, Bucci G (1982) Evaluation of an automatic oscillometric method and of various cuffs for the measurement of arterial pressure in the neonate. Acta Paediatr Scand 71: 791–797

    Google Scholar 

  18. Lui K, Doyle PE, Buchanan N (1982) Oscillometric and intra-arterial blood pressure measurements in the neonate: a comparison of methods. Aust Pediatr J 18: 32–34

    Google Scholar 

  19. Sonesson SE, Brohberger U (1987) Arterial blood pressure in the very low birthweight neonate. Acta Paediatr Scand 76: 338–341

    Google Scholar 

  20. Diprose GK, Evans DH, Archer LNJ, Levene MI (1986) Dinamap fails to detect hypotension in very low brithweight infants. Arch Dis Child 61: 771–773

    Google Scholar 

  21. Emery EF, Greenough A (1993) Assessment of non-invasive techniques for measuring blood pressure in preterm infants of birthweight less than or equal to 750 grams. Early Hum Dev 33: 217–222

    Google Scholar 

  22. Wareham JA, Haugh LD, Yeager SB, Horbar JD (1987) Prediction of arterial blood pressure in the premature neonate using the oscillometric method. Am J Dis Child 141: 1108–1110

    Google Scholar 

  23. Briassoulis G (1986) Arterial pressure measurement in preterm infants. Crit Care Med 14: 735–737

    Google Scholar 

  24. Ellis DM (1985) Interpretation of beat-to-beat blood pressure values in the presence of ventilatory changes. J Clin Monit 1: 65–70

    Google Scholar 

  25. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet i: 306–310

    Google Scholar 

  26. Marey EJ (1876) Pression et vitesse du sang. Physiologie Experimentale 2: VIII: 307–343

    Google Scholar 

  27. Ramsey M III (1979) Noninvasive automatic determination of mean arterial blood pressure. Med Biol Eng Comput 17: 11–18

    Google Scholar 

  28. Ramsey M III (1991) Blood pressure monitoring: automated oscillometric devices. J Clin Monit 7: 56–67

    Google Scholar 

  29. Yelderman M, Ream AK (1979) Indirect measurement of mean blood pressure in the anesthetized patient. Anesthesiology 50: 253–256

    Google Scholar 

  30. Forster FK, Turney D (1986) Oscillometric determination of diastolic, mean and systolic blood pressure—a numerical model. J Biomech Eng 108: 359–364

    Google Scholar 

  31. Borow KM, Newburger JW (1982) Noninvasive estimation of central aortic pressure using the oscillometric method for analyzing systemic artery pulsatile blood flow: comparative study of indirect systolic, diastolic, and mean brachial artery blood pressure with simultaneous direct ascending aortic pressure measurements. Am Heart J 103: 879–886

    Google Scholar 

  32. Rutten AJ, Ilsley AH, Skowronski GA, Runciman WB (1986) A comparative study of the measurement of mean arterial blood pressure using automatic oscillometers, arterial cannulation and auscultation. Anaesth Intensive Care 14: 58–65

    Google Scholar 

  33. Park MK, Menard SM (1987) Accuracy of blood pressure measurement by the Dinamap monitor in infants and children. Pediatrics 79: 907–914

    Google Scholar 

  34. Lamantia KR, O'Connor T, Barash PG (1990) Comparing methods of measurement: an alternative approach. J Anesthesiol 72: 781–783

    Google Scholar 

  35. Bernards JA, Bouman LN (1985) Fysiologie van de mens. Bohn, Scheltema en Holkema, Utrecht, pp 315–316

    Google Scholar 

  36. Green JH (1972) The heart and the circulation: circulation. In: An introduction to human physiology. Oxford University Press, London, pp 54

    Google Scholar 

  37. Hickey DD (1986) A simple device for the direct measurement of mean arterial pressure and for calibration of arterial pressure monitors. J Med Eng Technol 10: 188–192

    Google Scholar 

  38. Shimosato S (1986) Monitoring myocardial performance in the operating room: practical considerations. Hospimedica i: 37–45

    Google Scholar 

Download references

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Gevers, M., van Genderingen, H.R., Lafeber, H.N. et al. Accuracy of oscillometric blood pressure measurement in critically ill neonates with reference to the arterial pressure wave shape. Intensive Care Med 22, 242–248 (1996). https://doi.org/10.1007/BF01712244

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  • DOI: https://doi.org/10.1007/BF01712244

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