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

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, Jaeschke R, Mebazaa A, Pinsky MR, Teboul JL, Vincent JL, Rhodes A. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40(12):1795–815. https://doi.org/10.1007/s00134-014-3525-z.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Wax DB, Lin HM, Leibowitz AB. Invasive and concomitant noninvasive intraoperative blood pressure monitoring: observed differences in measurements and associated therapeutic interventions. Anesthesiology. 2011;115(5):973–8. doi:https://doi.org/10.1097/ALN.0b013e3182330286.

    Article  PubMed  Google Scholar 

  3. 3.

    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7. https://doi.org/10.1016/S0140-6736(07)61602-X.

    Article  Google Scholar 

  4. 4.

    Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, Van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304–77. https://doi.org/10.1007/s00134-017-4683-6.

    Article  Google Scholar 

  5. 5.

    Salmasi V, Maheshwari K, Yang D, Mascha EJ, Singh A, Sessler DI, Kurz A. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiology. 2017;126(1):47–65. https://doi.org/10.1097/ALN.0000000000001432.

    Article  PubMed  Google Scholar 

  6. 6.

    Ahuja S, Mascha EJ, Yang D, Maheshwari K, Cohen B, Khanna AK, Ruetzler K, Turan A, Sessler DI. Associations of intraoperative radial arterial systolic, diastolic, mean, and pulse pressures with myocardial and acute kidney injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiol J Am Soc Anesthesiol. 2019; https://doi.org/10.1097/aln.0000000000003048.

    Article  Google Scholar 

  7. 7.

    Arnal D, Garutti I, Perez-Pena J, Olmedilla L, Tzenkov IG. Radial to femoral arterial blood pressure differences during liver transplantation. Anaesthesia. 2005;60(8):766–71. doi:https://doi.org/10.1111/j.1365-2044.2005.04257.x.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Jones DA, DeVita MA, Bellomo R. Rapid-response teams. N Engl J Med. 2011;365(2):139–46. doi:https://doi.org/10.1056/NEJMra0910926.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8(2):135–60.

    CAS  Article  Google Scholar 

  10. 10.

    Saugel B, Grothe O, Nicklas JY. Error grid analysis for arterial pressure method comparison studies. Anesth Analg. 2018;126(4):1177–85. https://doi.org/10.1213/ANE.0000000000002585.

    Article  PubMed  Google Scholar 

  11. 11.

    Grothe O, Kaplan A, Kouz K, Saugel B. Computer program for error grid analysis in arterial blood pressure method comparison studies. Anesth Analg. 2019; https://doi.org/10.1213/ANE.0000000000004584.

    Article  PubMed  Google Scholar 

  12. 12.

    Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput. 1999;15(2):85–91.

    CAS  Article  Google Scholar 

  13. 13.

    Lehman LW, Saeed M, Talmor D, Mark R, Malhotra A. Methods of blood pressure measurement in the ICU. Crit Care Med. 2013;41(1):34–40. https://doi.org/10.1097/CCM.0b013e318265ea46.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Seidlerova J, Tumova P, Rokyta R, Hromadka M. Factors influencing the accuracy of non-invasive blood pressure measurements in patients admitted for cardiogenic shock. BMC Cardiovasc Disord. 2019;19(1):150. doi:https://doi.org/10.1186/s12872-019-1129-9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Drzewiecki G, Hood R, Apple H. Theory of the oscillometric maximum and the systolic and diastolic detection ratios. Ann Biomed Eng. 1994;22(1):88–96.

    CAS  Article  Google Scholar 

  16. 16.

    Lakhal K, Ehrmann S, Boulain T. Non-invasive blood pressure monitoring in the critically ill: time to abandon the intra-arterial catheter? Chest. 2017; https://doi.org/10.1016/j.chest.2017.10.030.

    Article  PubMed  Google Scholar 

  17. 17.

    Chatterjee A, DePriest K, Blair R, Bowton D, Chin R. Results of a survey of blood pressure monitoring by intensivists in critically ill patients: a preliminary study. Crit Care Med. 2010;38(12):2335–8. https://doi.org/10.1097/CCM.0b013e3181fa057f.

    Article  PubMed  Google Scholar 

  18. 18.

    Bhattacharjee P, Edelson DP, Churpek MM. Identifying patients with sepsis on the hospital wards. Chest. 2017;151(4):898–907. https://doi.org/10.1016/j.chest.2016.06.020.

    Article  PubMed  Google Scholar 

  19. 19.

    Magder SA. The highs and lows of blood pressure: toward meaningful clinical targets in patients with shock. Crit Care Med. 2014;42(5):1241–51. doi:https://doi.org/10.1097/CCM.0000000000000324.

    Article  PubMed  Google Scholar 

  20. 20.

    Hasanin A, Mukhtar A, Nassar H. Perfusion indices revisited. J Intensive Care. 2017;5:24. doi:https://doi.org/10.1186/s40560-017-0220-5.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Hernandez G, Ospina-Tascon GA, Damiani LP, Estenssoro E, Dubin A, Hurtado J, Friedman G, Castro R, Alegria L, Teboul JL, Cecconi M, Ferri G, Jibaja M, Pairumani R, Fernandez P, Barahona D, Granda-Luna V, Cavalcanti AB, Bakker J, Investigators AS, the Latin America Intensive Care N. Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock: the ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA. 2019;321(7):654–64. https://doi.org/10.1001/jama.2019.0071.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Mignini MA, Piacentini E, Dubin A. Peripheral arterial blood pressure monitoring adequately tracks central arterial blood pressure in critically ill patients: an observational study. Crit Care. 2006;10(2):R43. https://doi.org/10.1186/cc4852.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

Financial support and sponsorship: institutional sources.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Agnes S. Meidert.

Ethics declarations

Conflict of interest

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

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