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Oscillometric versus invasive blood pressure measurement in patients with shock: a prospective observational study in the emergency department

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Abstract

In emergency medicine, blood pressure is often measured by an oscillometric device using an upper arm cuff. However, measurement accuracy of this technique in patients suffering from hypotensive shock has not been sufficiently evaluated. We designed a prospective observational study investigating the accuracy of an oscillometric device in hypotensive patients admitted to the resuscitation area of the emergency department. Patients admitted to the resuscitation area of a university hospital, who were equipped with an arterial catheter and found to be hypotensive (mean arterial pressure (MAP) < 60 mmHg) were eligible for the study. Blood pressure was measured simultaneously via upper arm cuff and invasively under routine clinical conditions. After data extraction, Bland–Altman analysis, correlation coefficient and percentage error of mean and systolic blood pressure pairs were performed. We analysed 75 simultaneously obtained blood pressure measurements of 30 patients in hypotension, 11 (37%) were female, median age was 76.5 years (IQR 63–82). Oscillometric MAP was markedly higher than invasive MAP with a mean of the differences of 13 ± 15 mmHg (oscillometric—invasive), 95% limits of agreement − 16 to 41 mmHg, percentage error was 76%. In 64% of readings, values obtained by the upper arm cuff were not able to detect hypotension. Oscillometric blood pressure measurement is not able to reliably detect hypotension in emergency patients. Therefore, direct measurement of blood pressure should be established as soon as possible in patients suffering from shock.

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Funding

Financial support and sponsorship: institutional sources.

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Correspondence to Agnes S. Meidert.

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All authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was obtained for this study from the Ethikkommission bei der LMU München, Chairman W. Eisenmenger (approval number 751-15). All study procedures were performed in accordance with the ethical standards of this institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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Meidert, A.S., Dolch, M.E., Mühlbauer, K. et al. Oscillometric versus invasive blood pressure measurement in patients with shock: a prospective observational study in the emergency department. J Clin Monit Comput (2020). https://doi.org/10.1007/s10877-020-00482-2

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Keywords

  • Emergency medicine
  • Oscillometric blood pressure
  • Shock
  • Resuscitation area
  • Hypotension