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Validation of arterial blood pressures observed from the patient monitor; a tool for prehospital research

Journal of Clinical Monitoring and Computing volume 24, pages 93–100 (2010)Cite this article

Abstract

Objectives

For some time, the inaccuracies of non-invasive blood pressure measurement in critically ill patients have been recognised. Measurement difficulties can occur even in optimal conditions, but in prehospital transportation vehicles, problems are exacerbated. Intra-arterial pressures must be used as the reference against which to compare the performance of non-invasive methods in the critically ill patient population. Intra-arterial manometer data observed from the patient monitor has frequently been used as the reference against which to assess the accuracy of noninvasive devices in the emergency setting. To test this method’s validity, this study aimed to determine whether numerical monitor pressures can be considered interchangeable with independently sampled intra-arterial pressures.

Methods

Intensive Care Unit nurses were asked to document arterial systolic, diastolic and mean pressures numerically displayed on the patient monitor. Observed pressures were compared to reference intra-arterial pressures independently recorded to a computer following analogue to digital conversion. Differences between observed and recorded pressures were evaluated using the Association for the Advancement of Medical Instrumentation (AAMI) protocol. Additionally, two-level linear mixed effects analyses and Bland-Altman comparisons were undertaken.

Results

Systolic, diastolic and integrated mean pressures observed during 60 data collection sessions (n = 600) fulfilled AAMI protocol criteria. Integrated mean pressures were the most robust. For these pressures, mean error (reference minus observed) was 0.5 mm Hg (SD 1.4 mm Hg); 95% CI (two-level linear mixed effects analysis) 0.4–0.6 mm Hg; P < 0.001. Bland-Altman plots demonstrated tight 95% limits of agreement (−2.3 to 3.2 mm Hg), and uniform agreement across the range of mean blood pressures.

Conclusions

Integrated mean arterial pressures observed from a well maintained patient monitor can be considered interchangeable with independently sampled intra-arterial pressures and may be confidently used as the reference against which to test the accuracy of non-invasive blood pressure measuring methods in the prehospital or emergency setting.

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Acknowledgments

The authors would like to express their gratitude and admiration to the patients and families who participated in this study. This study relied on the cooperation of the nurses in the Intensive Care Unit at Flinders Medical Centre, and they are thanked for their professional and enthusiastic participation. Thanks are also extended to the hospital’s Biomedical Engineers for their willingness to share their expertise. Philips Medical Systems Australasia provided a blood pressure module that incorporated an analogue output jack for use during bedside data collection.

Author information

Affiliations

  1. Department of Critical Care Medicine, Flinders University, Adelaide, SA, Australia

    Sandy Muecke PhD & Andrew Bersten MBBS, MD

  2. Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, SA, Australia

    Andrew Bersten MBBS, MD

  3. Pain Management Unit, Flinders Medical Centre, Adelaide, SA, Australia

    John Plummer PhD

Authors
  1. Sandy Muecke PhD
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  2. Andrew Bersten MBBS, MD
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  3. John Plummer PhD
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Corresponding author

Correspondence to Sandy Muecke PhD.

Additional information

Muecke S, Bersten A, Plummer J. Validation of arterial blood pressures observed from the patient monitor; a tool for prehospital research.

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Muecke, S., Bersten, A. & Plummer, J. Validation of arterial blood pressures observed from the patient monitor; a tool for prehospital research. J Clin Monit Comput 24, 93–100 (2010). https://doi.org/10.1007/s10877-009-9215-7

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  • DOI: https://doi.org/10.1007/s10877-009-9215-7

Keywords

  • validation
  • blood pressure monitoring
  • prehospital
  • non-invasive
  • critical illness