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Non-invasive blood pressure monitoring with an oscillometric brachial cuff: impact of arrhythmia

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Abstract

Arrhythmia-induced beat-to-beat variability of blood pressure (BP) is deemed to hinder the reliability of non-invasive oscillometric measurements (NIBP) but few data support this belief. We assessed the impact of arrhythmia on a NIBP device never tested for this purpose. We compared, in intensive care unit patients with and without arrhythmia, the agreement between three pairs of NIBP (Infinity™ Delta monitor, Dräger medical systems) and invasive readings. For systolic, diastolic and mean BP, the mean bias between NIBP and invasive measurements was not higher, in 89 patients with arrhythmia, than that observed in 127 patients with regular rhythm (p = 0.93 for mean BP). Averaging three measurements overcame the higher within-subject variability of NIBP measurements during arrhythmia, and yielded similar agreement between the two techniques in patients with arrhythmia and with regular rhythm. The international organization for standardization criteria (mean bias < 5 and SD < 8 mmHg) were satisfied neither during arrhythmia nor during regular rhythm: for mean BP, mean bias of − 8.0 ± 6.5 and − 7.5 ± 6.1 mmHg, respectively. The detection of hypotension (systolic invasive BP < 90 mmHg or mean invasive BP < 65 mmHg) or hypertension (systolic invasive BP > 140 mmHg) by NIBP was similar during arrhythmia and regular rhythm [areas under the receiver operating characteristic curves (AUCROC) of 0.88–0.92, p > 0.13]. The detection of a 10% increase in mean invasive BP after cardiovascular intervention was also associated with similar AUCROCs between the two groups. Provided that triplicates are averaged, the agreement between NIBP measured with the tested device and invasive measurements was not worse during arrhythmia than during regular rhythm.

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Abbreviations

AUCROC :

Area under the receiver operating characteristic curve

BP:

Blood pressure

ICU:

Intensive care unit

ISO:

International organization for standardization

NIBP:

Non-invasive monitoring of blood pressure with oscillometric automated brachial cuff

SD:

Standard deviation

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Authors and Affiliations

  1. Réanimation Chirurgicale Polyvalente, Service d’anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Boulevard Jacques Monod, Saint Herblain, 44093, Nantes, France

    Karim Lakhal, Maëlle Martin & Bertrand Rozec

  2. Médecine Intensive Réanimation, CHRU de Tours, 37044, Tours, France

    Stephan Ehrmann

  3. INSERM, Centre d’Étude des Pathologies Respiratoires, UMR, 1100, Aérosolthérapie et Biomédicaments à Visée Respiratoire, Faculté de Médecine, Université François Rabelais, 37032, Tours, France

    Stephan Ehrmann

  4. Service de Réanimation Médicale, Hôpital La Source, Centre Hospitalier Régional, 45067, Orléans, France

    Sofian Faiz & Thierry Boulain

Authors
  1. Karim Lakhal
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  2. Maëlle Martin
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  3. Stephan Ehrmann
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  4. Sofian Faiz
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  5. Bertrand Rozec
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  6. Thierry Boulain
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Contributions

Conception and design: KL, TB. Acquisition of data: KL, TB, MM, SF. Statistical analysis: TB. Drafting and revision of the manuscript: KL, TB, SE, BR.

Corresponding author

Correspondence to Karim Lakhal.

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Conflict of interest

The authors declare that they have no competing interests. Dräger medical systems (Lübeck, Germany) lent the Infinity Delta monitor to the investigators without being further involved in the study. Hence, the authors were fully independent during data interpretation and manuscript drafting. The authors did not receive any additional support from the company.

Human rights

This study has been approved by the institutional research ethics committee of Orléans Hospital and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Lakhal, K., Martin, M., Ehrmann, S. et al. Non-invasive blood pressure monitoring with an oscillometric brachial cuff: impact of arrhythmia. J Clin Monit Comput 32, 707–715 (2018). https://doi.org/10.1007/s10877-017-0067-2

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  • DOI: https://doi.org/10.1007/s10877-017-0067-2

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