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Error grid analysis for risk management in the difference between invasive and noninvasive blood pressure measurements

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Abstract

Purpose

Invasive arterial blood pressure (IAP) and noninvasive blood pressure (NIBP) measurements are both common methods. Recently, a new method of error grid analysis was proposed to compare blood pressure obtained using two measurement methods. This study aimed to compare IAP and NIBP measurements using the error grid analysis and investigate potential confounding factors affecting the discrepancies between IAP and NIBP.

Methods

Adult patients who underwent general anesthesia in the supine position with both IAP and NIBP measurements were retrospectively investigated. The error grid analyses were performed to compare IAP and NIBP. In the error grid analysis, the clinical relevance of the discrepancies between IAP and NIBP was evaluated and classified into five zones from no risk (A) to dangerous risk (E).

Results

Overall, data of 1934 IAP/NIBP measurement pairs from 100 patients were collected. The error grid analysis revealed that the proportions of zones A–E for systolic blood pressure were 96.4%, 3.5%, 0.05%, 0%, and 0%, respectively. In contrast, the proportions for mean blood pressure were 82.5%, 16.7%, 0.8%, 0%, and 0%, respectively. The multiple regression analysis revealed that continuous phenylephrine administration (p = 0.016) and age (p = 0.044) were the significant factors of an increased clinical risk of the differences in mean blood pressure.

Conclusions

The error grid analysis indicated that the differences between IAP and NIBP for mean blood pressure were not clinically acceptable and had the risk of leading to unnecessary treatments. Continuous phenylephrine administration and age were the significant factors of an increased clinical risk of the discrepancies between IAP and NIBP.

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References

  1. Tassoudis V, Vretzakis G, Petsiti A, Stamatiou G, Bouzia K, Melekos M, Tzovaras G. Impact of intraoperative hypotension on hospital stay in major abdominal surgery. J Anesth. 2011;25:492.

    Article  Google Scholar 

  2. Sessler DI, Meyhoff CS, Zimmerman NM, Mao G, Leslie K, Vasquez SM, Balaji P, Alvarez-Garcia J, Cavalcanti AB, Parlow JL, Rahate PV, Seeberger MD, Gossetti B, Walker SA, Premchand RK, Dahl RM, Duceppe E, Rodseth R, Botto F, Devereaux PJ. Period-dependent associations between hypotension during and for four days after noncardiac surgery and a composite of myocardial infarction and death: a substudy of the POISE-2 trial. Anesthesiology. 2018;128:317–27.

    Article  Google Scholar 

  3. Antonelli M, Levy M, Andrews PJ, Chastre J, Hudson LD, Manthous C, Meduri GU, Moreno RP, Putensen C, Stewart T, Torres A. Hemodynamic monitoring in shock and implications for management. International Consensus Conference, Paris, France, 27–28 April 2006. Intensive Care Med. 2007;33:575–90.

    Article  Google Scholar 

  4. Bartels K, Esper SA, Thiele RH. Blood pressure monitoring for the anesthesiologist: a practical review. Anesth Analg. 2016;122:1866–79.

    Article  CAS  Google Scholar 

  5. Saherwala AA, Stutzman SE, Osman M, Kalia J, Figueroa SA, Olson DM, Aiyagari V. Correlation of noninvasive blood pressure and invasive intra-arterial blood pressure in patients treated with vasoactive medications in a neurocritical care unit. Neurocrit Care. 2018;28:265–72.

    Article  Google Scholar 

  6. Lehman LW, Saeed M, Talmor D, Mark R, Malhotra A. Methods of blood pressure measurement in the ICU. Crit Care Med. 2013;41:34–40.

    Article  Google Scholar 

  7. Lakhal K, Macq C, Ehrmann S, Boulain T, Capdevila X. Noninvasive monitoring of blood pressure in the critically ill: reliability according to the cuff site (arm, thigh, or ankle). Crit Care Med. 2012;40:1207–13.

    Article  Google Scholar 

  8. Romagnoli S, Ricci Z, Quattrone D, Tofani L, Tujjar O, Villa G, Romano SM, De Gaudio AR. Accuracy of invasive arterial pressure monitoring in cardiovascular patients: an observational study. Crit Care. 2014;18:644.

    Article  Google Scholar 

  9. Pytte M, Dybwik K, Sexton J, Straume B, Nielsen EW. Oscillometric brachial mean artery pressures are higher than intra-radial mean artery pressures in intensive care unit patients receiving norepinephrine. Acta Anaesthesiol Scand. 2006;50:718–21.

    Article  CAS  Google Scholar 

  10. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.

    Article  CAS  Google Scholar 

  11. Saugel B, Grothe O, Nicklas JY. Error grid analysis for arterial pressure method comparison studies. Anesth Analg. 2018;126:1177–85.

    Article  Google Scholar 

  12. Clarke WL, Cox D, Gonder-Frederick LA, Carter W, Pohl SL. Evaluating clinical accuracy of systems for self-monitoring of blood glucose. Diabetes Care. 1987;10:622–8.

    Article  CAS  Google Scholar 

  13. 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;126:47–65.

    Article  Google Scholar 

  14. Bland JM, Altman DG. Agreement between methods of measurement with multiple observations per individual. J Biopharm Stat. 2007;17:571–82.

    Article  Google Scholar 

  15. Alpert BS, Quinn DE, Friedman BA. A review of the latest guidelines for NIBP device validation. Blood Press Monit. 2013;18:297–302.

    Article  Google Scholar 

  16. Bur A, Hirschl MM, Herkner H, Oschatz E, Kofler J, Woisetschlager C, Laggner AN. Accuracy of oscillometric blood pressure measurement according to the relation between cuff size and upper-arm circumference in critically ill patients. Crit Care Med. 2000;28:371–6.

    Article  CAS  Google Scholar 

  17. Steyerberg EW, Eijkemans MJ, Harrell FE Jr, Habbema JD. Prognostic modeling with logistic regression analysis: in search of a sensible strategy in small data sets. Med Decis Mak. 2001;21:45–56.

    Article  CAS  Google Scholar 

  18. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–9.

    Article  CAS  Google Scholar 

  19. Monk TG, Bronsert MR, Henderson WG, Mangione MP, Sum-Ping ST, Bentt DR, Nguyen JD, Richman JS, Meguid RA, Hammermeister KE. Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery. Anesthesiology. 2015;123:307–19.

    Article  Google Scholar 

  20. van Waes JA, van Klei WA, Wijeysundera DN, van Wolfswinkel L, Lindsay TF, Beattie WS. Association between intraoperative hypotension and myocardial injury after vascular surgery. Anesthesiology. 2016;124:35–44.

    Article  Google Scholar 

  21. Wax DB, Lin HM, Leibowitz AB. Invasive and concomitant noninvasive intraoperative blood pressure monitoring: observed differences in measurements and associated therapeutic interventions. Anesthesiology. 2011;115:973–8.

    Article  Google Scholar 

  22. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ, Subcommittee of P, Public Education of the American Heart Association Council on High Blood Pressure R. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension. 2005;45:142–61.

    Article  CAS  Google Scholar 

  23. Anast N, Olejniczak M, Ingrande J, Brock-Utne J. The impact of blood pressure cuff location on the accuracy of noninvasive blood pressure measurements in obese patients: an observational study. Can J Anaesth. 2016;63:298–306.

    Article  Google Scholar 

  24. Lakhal K, Martin M, Ehrmann S, Faiz S, Rozec B, Boulain T. Non-invasive blood pressure monitoring with an oscillometric brachial cuff: impact of arrhythmia. J Clin Monit Comput. 2018;32:707–15.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City, Osaka, 545-8586, Japan

    Takashi Juri, Koichi Suehiro, Akihiro Uchimoto, Yohei Fujimoto, Takashi Mori & Kiyonobu Nishikawa

  2. Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan

    Hirofumi Go

Authors
  1. Takashi Juri
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  2. Koichi Suehiro
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  3. Akihiro Uchimoto
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  4. Hirofumi Go
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  5. Yohei Fujimoto
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  6. Takashi Mori
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  7. Kiyonobu Nishikawa
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Correspondence to Koichi Suehiro.

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Juri, T., Suehiro, K., Uchimoto, A. et al. Error grid analysis for risk management in the difference between invasive and noninvasive blood pressure measurements. J Anesth 35, 189–196 (2021). https://doi.org/10.1007/s00540-020-02893-6

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  • DOI: https://doi.org/10.1007/s00540-020-02893-6

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