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A comparison of invasive arterial blood pressure measurement with oscillometric non-invasive blood pressure measurement in patients with sepsis

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Abstract

Purpose

This study aimed to compare non-invasive oscillometric blood pressure (NIBP) measurement with invasive arterial blood pressure (IBP) measurement in patients with sepsis.

Methods

We conducted a retrospective study to evaluate the agreement between IBP and NIBP using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Paired blood pressure measurements of mean arterial pressure (MAP), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were compared using Bland–Altman analysis and paired Student’s t test. We also focus on the effect of norepinephrine (NE) on the agreement between the two methods and the association between blood pressure and mortality during intensive care unit (ICU) stay.

Results

A total of 96,673 paired blood pressure measurements from 6060 unique patients were analyzed in the study. In Bland–Altman analysis, the bias (± SD, 95% limits of agreement) was 6.21 mmHg (± 12.05 mmHg, − 17.41 to 29.83 mmHg) for MAP, 0.39 mmHg (± 19.25 mmHg, − 37.34 to 38.12 mmHg) for SBP, and 0.80 mmHg (± 12.92 mmHg, − 24.52 to 26.12 mmHg) for DBP between the two techniques. Similarly, large limits of agreement were shown in different groups of NE doses. NE doses significantly affected the agreement between IBP and NIBP. SBP between the two methods gave an inconsistent assessment of patients’ risk of ICU mortality.

Conclusion

IBP and NIBP were not interchangeable in septic patients. Clinicians should be aware that non-invasive MAP was clinically and significantly underestimated invasive MAP.

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Data availability

All Data was extracted from the Medical Information Mart for Intensive Care IV v1.0, a freely accessible public database constructed by the Massachusetts Institute of Technology Computational Physiology Laboratory (https://mimic.mit.edu/).

Abbreviations

IBP:

Invasive arterial blood pressure

NIBP:

Non-invasive oscillometric blood pressure

NE:

Norepinephrine

ICU:

Intensive care unit

MIMIC-IV:

Medical Information Mart for Intensive Care IV

BMI:

Body mass index

SOFA:

Sequential Organ Failure Assessment

SAPS II:

Simplified Acute Physiology Score II

CVP:

Central venous pressure

IMAP:

Invasive mean arterial pressure

ISBP:

Invasive systolic blood pressure

IDBP:

Invasive diastolic blood pressure

NIMAP:

Non-invasive mean arterial pressure

NISBP:

Non-invasive systolic blood pressure

NIDBP:

Non-invasive diastolic blood pressure

MAP:

Mean arterial pressure

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

AAMI:

Association for the Advancement of Medical Instrumentation

SD:

Standard deviation

IQR:

Interquartile range

LOA:

Limits of agreement

AKI:

Acute kidney injury

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Acknowledgements

The authors express their sincere appreciation to the staff members of the Massachusetts Institute of Technology Computational Physiology Laboratory and the Beth Israel Deaconess Medical Center, who have participated in the Medical Information Mart for Intensive Care IV.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Candidate of Master’s Degree, The First Clinical Medical College, Guangzhou University of Chinese Medicine, Baiyun District, Guangzhou, Guangdong Province, China

    Ziqing Jiang & Shaoying Li

  2. The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China

    Lin Wang, Feng Yu, Yanping Zeng, Hongbo Li, Jun Li, Zhanfeng Zhang & Junling Zuo

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  1. Ziqing Jiang
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Contributions

ZJ: Conceptualization, Methodology, Formal analysis, Data Curation, Writing—Original Draft. SL: Conceptualization, Methodology, Writing—Original Draft. WL: Conceptualization, Writing—Review and Editing. FY: Conceptualization, Writing—Review and Editing. YZ: Formal analysis, Writing—Original Draft. HL: Formal analysis, Writing—Original Draft. JL: Formal analysis, Writing—Original Draft. ZZ: Formal analysis, Writing—Original Draft. JLZ: Conceptualization, Methodology, Writing—Review and Editing.

Corresponding author

Correspondence to Junling Zuo.

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Conflict of interest

All authors declare that there is no conflict of interest.

Ethics approval and consent to participate

The author who had finished the online training for the Collaborative Institutional Training Initiative Program can access the database (Record ID 40486481). The MIMIC-IV v1.0 contain no identifiers and are publicly available for studies of critical care. The Institutional Review Board approval and the need for informed consent was waived.

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Not applicable.

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Supplementary Information

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540_2023_3304_MOESM1_ESM.pdf

Supplementary file1 Figure S1. The association between MAP and ICU mortality. Error bars show 95% confidence intervals of the mortality rates. No difference between MAP measurements in terms of their ICU mortality was observed (p>0.05) based on the chi-square test. ICU intensive care unit, MAP mean arterial pressure. (PDF 387 KB)

540_2023_3304_MOESM2_ESM.pdf

Supplementary file2 Figure S2. The association between DBP and ICU mortality. Error bars show 95% confidence intervals of the mortality rates. No difference between DBP measurements in terms of their ICU mortality was observed (p>0.05) based on the chi-square test. ICU intensive care unit, DBP diastolic blood pressure. (PDF 387 KB)

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Jiang, Z., Li, S., Wang, L. et al. A comparison of invasive arterial blood pressure measurement with oscillometric non-invasive blood pressure measurement in patients with sepsis. J Anesth 38, 222–231 (2024). https://doi.org/10.1007/s00540-023-03304-2

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  • DOI: https://doi.org/10.1007/s00540-023-03304-2

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