|
|
|
| Accuracy of noninvasive blood pressure measurement in critically ill patients and and its impact on clinical decision-making |
| YAN Ming, XU Ying, GU Qin |
(Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing Jiangsu 210008, China)
|
|
|
|
Abstract ［Abstract］Objective： To investigate the accuracy of noninvasive blood pressure measurement and the impact on clinical decisionmaking in critically ill patients. Methods： Using a prospective observational study, a total of 133 critically ill patients with established invasive blood pressure monitoring in the ICU of Nanjing Drum tower Hospital from March to December 2021 were included. Non-invasive and invasive blood pressure were measured and recorded simultaneously within 1 h after admission. The patients were divided into shock group with vasoactive drugs and non-shock group without vasoactive drugs. Spearman, Bland-Altman correlation analysis and interclass correlation coefficient (ICC) were applied to verify the consistency of the two monitoring methods, and the error grid method was used to analyze the effect of noninvasive blood pressure on guiding clinical decision-making. Results： ① Spearman correlation results showed that in nonshock patients, there were significant positive correlation between invasive and the non-invasive blood pressure (r of SBP, DBP, MAP were 0.69, 0.72, 0.70, all P<0.001). In shock patients, there was a significant positive correlation between SBPinvasive-SBPnoninvasive (r=0.34, P<0.05), while DBPinvasive-DBPnoninvasive, MAPinvasiveMAPnoninvasive without significant correlation (both P>0.05). ② Simple linear regression analysis revealed that in non-shock patients, there was a significant positive correlation between invasive and non-invasive blood pressure (R2 of SBP, DBP, MAP were 0.56, 0.58, 0.43, all P<0.05). In shock patients, invasive and noninvasive SBP and MAP were significantly positively correlated (R2 of SBP, MAP were 0.20, 0.10, P<005). DBPinvasive and DBPnoninvasive linear regression equation was not statistically significant (P>0.05). ③ The Bland-Altman analysis results showed that patients in the non-shock and shock groups, the proportion of data points between invasive and noninvasive blood pressure in the mean difference interval ±10 mmHg did not meet the non-invasive blood pressure measurement criteria of AAMI. Poor consistency (SBPinvasive-SBPnoninvasive, DBPinvasive-DBPnoninvasive, MAPinvasive-MAPnoninvasive data points in the average difference range of 10 mmHg: 63%, 73% and 76% of patients in non-shock group, and 35%, 50% and 52% in the shock group, respectively, all P<0.05). ④ The ICCs showed that in nonshock group patients, there was a significant positive correlation between SBPinvasive and SBPnoninvasive (the absolute consistency was 0.76＞0.75, P<0.001). In shock group patients, there were bad consistency coefficients between SBPinvasive and SBPnoninvasive, MAPinvasive and MAPnoninvasive (the absolute consistencies were 0.33, 0.31<0.4, both P<0.001), and the noncorrelation between DBPinvasive and DBPnoninvasive (P>0.05). ⑤ Error grid analysis results showed that in the shock group patients, the proportions of SBP measurements in the A to E hazard areas were 88.7%, 6.5%, 4.8%, 0%, and 0%. The proportions of the MAP measurements were 61.3%, 38.7%, 0%, 0%, and 0%. In the nonshock group .atients, the proportions of SBP measurements in the A to E hazard zone were 95.8%, 4.2%, 0%, 0%, and 0%. The proportions of MAP measurements were 97.2%, 1.4%, 1.4%, 0%, and 0%. ⑥ The multivariate Logistic regression showed that shock was a risk factor for the difference between non-invasive and invasive SBP, DBP and MAP greater than 10 mmHg (P<0.05), age was a risk factor for the difference between noninvasive and invasive SBP and MAP greater than 10 mmHg (P<0.05); heart rate was a risk factor for the difference between non-invasive and invasive SBP greater than 10 mmHg (P<0.05), and was a protective factor for the difference between noninvasive and invasive DBP and MAP greater than 10 mmHg (P<0.05). Conclusion： For critically ill patients with nonshock, the accuracy of non-invasive blood pressure measurement is better, and is more reliable to guide clinical decisionmaking with non-invasive MAP. It should be cautious when using non-invasive blood pressure instead of invasive blood pressure measurement in critically ill patients with shock.
|
|
Received: 05 December 2022
|
|
|
|
［1］Kaufmann T, Cox EGM, Wiersema R, et al. Noninvasive oscillometric versus invasive arterial blood pressure measurements in critically ill patients: A post hoc analysis of a prospective observational study［J］. J Crit care, 2020, 57: 118-123.
［2］Stergiou GS, Alpert B, Mieke S, et al. A universal standard for the validation of blood pressure measuring devices: Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Collaboration Statement［J］. J Hypertens, 2018, 36(3): 472-478.
［3］Lehman LW, Saeed M, Talmor D, et al. Methods of blood pressure measurement in the ICU［J］. Crit Care Med, 2013, 41(1): 34-40.
［4］Nuttall G, Burckhardt J, Hadley A, et al. Surgical and patient risk factors for severe arterial line complications in adults［J］. Anesthesiology, 2016, 124(3): 590-597.
［5］Lakhal K, Ehrmann S, Boulain T. Noninvasive BP monitoring in the critically ill: time to abandon the arterial catheter?［J］. Chest, 2018, 153(4): 1023-1039.
［6］Pytte M, Dybwik K, Sexton J, et al. Oscillometric brachial mean artery pressures are higher than intraradial mean artery pressures in intensive care unit patients receiving norepinephrine［J］. Acta anaesthesiol Scand, 2006, 50(6): 718-721.
［7］Saugel B, Grothe O, Nicklas JY. Error gid analysis for arterial pressure method comparison studies［J］. Anesth Analg, 2018, 126(4): 1177-1185.（下转第111页）第2期李艳秀，等.脓毒症血管活性药物的选择第33卷第2期2023年3月江 苏 大 学 学 报(医 学 版)JournalofJiangsuUniversity(Medicine Edition)Vol.33No.2Mar. 2023脓毒症血管活性药物的选择
［8］Giavarina D. Understanding Bland Altman analysis［J］. Biochem Med (Zagreb), 2015, 25(2): 141-151.
［9］朱灵妍, 姚成增. 高血压病血压昼夜节律与靶器官损害［J］. 江苏大学学报(医学版), 2013, 23(2): 180-184.
［10］Saugel B, Kouz K, Meidert AS, et al. How to measure blood pressure using an arterial catheter: a systematic 5step approach［J］. Crit Care, 2020, 24(1): 172.
［11］Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine［J］. Intensive Care Med, 2014, 40(12): 1795-1815.
［12］Lakhal K, Ehrmann S, Runge I, et al. Tracking hypotension and dynamic changes in arterial blood pressure with brachial cuff measurements［J］. Anesth Analg, 2009, 109(2): 494-501.
［13］Lakhal K, Ehrmann S, Martin M, et al. Blood pressure monitoring during arrhythmia: agreement between automated brachial cuff and intraarterial measurements［J］. Br J Anaesth, 2015, 115(4): 540-549.
［14］Lakhal K, Macq C, Ehrmann S, et al. Noninvasive monitoring of blood pressure in the critically ill: reliability according to the cuff site (arm, thigh, or ankle)［J］. Crit Care Med, 2012, 40(4): 1207-1213.
［15］Riley LE, Chen GJ, Latham HE. Comparison of noninvasive blood pressure monitoring with invasive arterial pressure monitoring in medical ICU patients with septic shock［J］. Blood Press Monit, 2017, 22(4): 202-207.
［16］Stergiou GS, Palatini P, Asmar R, et al. Recommendations and Practical Guidance for performing and reporting validation studies according to the Universal Standard for the validation of blood pressure measuring devices by the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO)［J］. J Hypertens, 2019, 37(3): 459-466.
［17］Parkes JL, Slatin SL, Pardo S, et al. A new consensus error grid to evaluate the clinical significance of inaccuracies in the measurement of blood glucose［J］. Diabetes Care, 2000, 23(8): 1143-1148.
［18］Klonoff DC, Lias C, Vigersky R, et al. The surveillance error grid［J］. J Diabetes Sci Technol, 2014, 8(4): 658-672.
|
|
|
|
