Comparison between invasive and noninvasive blood pressure measurements in critically ill patients receiving inotropes

Introduction.Noninvasive blood pressure (NIBP) monitoring methods are widely used in critically ill patients despite poor evidence of their accuracy. The erroneous interpretations of blood pressure (BP) may lead to clinical errors.Objectives.To test the accuracy and reliability of aneroid (ABP) and oscillometric (OBP) devices compared to the invasive BP (IBP) monitoring in an ICU population.Materials and Methods.Fifty adult patients (200 comparisons) were included in a randomized crossover trial. BP was recorded simultaneously by IBP and either by ABP or by OBP, taking IBP as gold standard.Results.Compared with ABP, IBP systolic values were significantly higher (mean difference ± standard deviation9.74±13.8;P<0.0001). Both diastolic (-5.13±7.1;P<0.0001) and mean (-2.14±7.1;P=0.0033) IBP were instead lower. Compared with OBP, systolic (10.80±14.9;P<0.0001) and mean (5.36±7.1;P<0.0001) IBP were higher, while diastolic IBP (-3.62±6.0;P<0.0001) was lower. Bland-Altman plots showed wide limits of agreement in both NIBP-IBP comparisons.Conclusions.BP measurements with different devices produced significantly different results. Since in critically ill patients the importance of BP readings is often crucial, noninvasive techniques cannot be regarded as reliable alternatives to direct measurements.

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Mini-epidemic of Erroneous Central Venous Pressure Measurements Resulting from the Malproduction of a Specific Part of a Pressure Transducer System

Anesthesiology ◽

10.1097/aln.0b013e3181a5ce3e ◽

2009 ◽

Vol 110 (6) ◽

pp. 1417-1418 ◽

Cited By ~ 1

Author(s):

Klaus Görlinger ◽

Clemens J. Kehren ◽

Jürgen Peters

Keyword(s):

Blood Pressure ◽

Central Venous Pressure ◽

Critically Ill ◽

Critically Ill Patients ◽

Pressure Transducer ◽

Venous Pressure ◽

Pressure Measurements ◽

Central Venous ◽

Therapeutic Decisions ◽

Specific Part

Electromanometric blood pressure measurements are routine in critically ill patients, and many interventions are based on correct measurements. We report a mini-epidemic of erroneous central venous pressure measurements due to faulty pressure transducer manufacturing resulting in wrong therapeutic decisions.

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Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

Intensive Care Medicine Experimental ◽

10.1186/s40635-019-0280-z ◽

2019 ◽

Vol 7 (1) ◽

Cited By ~ 1

Author(s):

M. Ostermann ◽

A. Schneider ◽

T. Rimmele ◽

I. Bobek ◽

M. van Dam ◽

...

Keyword(s):

Blood Pressure ◽

Critical Care ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Future Research ◽

Knowledge Gaps ◽

Blood Pressure Targets

Abstract Purpose Critical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research. Methods International Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: “AKI diagnosis and evaluation”, “Medical management of AKI” and “Renal Replacement Therapy for AKI.” Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research. Results The following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT). Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT. Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities. Conclusion Consensus was reached on a future research agenda for the AKI section of the ESICM.

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Risk factors for death among critically ill patients with acute renal failure

Sao Paulo Medical Journal ◽

10.1590/s1516-31802006000500004 ◽

2006 ◽

Vol 124 (5) ◽

pp. 257-263 ◽

Cited By ~ 15

Author(s):

Geraldo Bezerra da Silva Júnior ◽

Elizabeth De Francesco Daher ◽

Rosa Maria Salani Mota ◽

Francisco Albano Menezes

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Mechanical Ventilation ◽

Renal Failure ◽

Acute Renal Failure ◽

Intensive Care ◽

Liver Failure ◽

Critically Ill ◽

Critically Ill Patients ◽

Urine Volume

CONTEXT AND OBJECTIVE: Acute renal failure is a common medical problem, with a high mortality rate. The aim of this work was to investigate the risk factors for death among critically ill patients with acute renal failure. DESIGN AND SETTING: Retrospective cohort at the intensive care unit of Hospital Universitário Walter Cantídio, Fortaleza. METHODS: Survivors and non-survivors were compared. Univariate and multivariate analyses were performed to establish risk factors for death. RESULTS: Acute renal failure occurred in 128 patients (33.5%), with mean age of 49 ± 20 years (79 males; 62%). Death occurred in 80 (62.5%). The risk factors most frequently associated with death were hypotension, sepsis, nephrotoxic drug use, respiratory insufficiency, liver failure, hypovolemia, septic shock, multiple organ dysfunction, need for vasoactive drugs, need for mechanical ventilation, oliguria, hypoalbuminemia, metabolic acidosis and anemia. There were negative correlations between death and: prothrombin time, hematocrit, hemoglobin, systolic blood pressure, diastolic blood pressure, arterial pH, arterial bicarbonate and urine volume. From multivariate analysis, the independent risk factors for death were: need for mechanical ventilation (OR = 3.15; p = 0.03), hypotension (OR = 3.48; p = 0.02), liver failure (OR = 5.37; p = 0.02), low arterial bicarbonate (OR = 0.85; p = 0.005), oliguria (OR = 3.36; p = 0.009), vasopressor use (OR = 4.83; p = 0.004) and sepsis (OR = 6.14; p = 0.003). CONCLUSIONS: There are significant risk factors for death among patients with acute renal failure in intensive care units, which need to be identified at an early stage for early treatment.

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Factors influencing the accuracy of oscillometric blood pressure measurement in critically ill patients

Critical Care Medicine ◽

10.1097/01.ccm.0000053650.12025.1a ◽

2003 ◽

Vol 31 (3) ◽

pp. 793-799 ◽

Cited By ~ 74

Author(s):

Andreas Bur ◽

Harald Herkner ◽

Marianne Vlcek ◽

Christian Woisetschläger ◽

Ulla Derhaschnig ◽

...

Keyword(s):

Blood Pressure ◽

Critically Ill ◽

Critically Ill Patients ◽

Pressure Measurement ◽

Blood Pressure Measurement ◽

Factors Influencing ◽

Oscillometric Blood Pressure Measurement

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The effect of Trendelenburg and modified trendelenburg positions on cardiac output, blood pressure, and oxygenation: a preliminary study

American Journal of Critical Care ◽

10.4037/ajcc1994.3.5.382 ◽

1994 ◽

Vol 3 (5) ◽

pp. 382-386 ◽

Cited By ~ 15

Author(s):

CL Ostrow ◽

E Hupp ◽

D Topjian

Keyword(s):

Blood Pressure ◽

Cardiac Output ◽

Critically Ill ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Critically Ill Patients ◽

Hemodynamic Parameters ◽

Trendelenburg Position ◽

Dependent Variables ◽

Preliminary Study

BACKGROUND: Although we have insufficient knowledge about the effects of Trendelenburg positions on various hemodynamic parameters, these positions are frequently used to influence cardiac output and blood pressure in critically ill patients. OBJECTIVES: To determine the effect of Trendelenburg and modified Trendelenburg positions on five dependent variables: cardiac output, cardiac index, mean arterial pressure, systemic vascular resistance, and oxygenation in critically ill patients. METHODS: In this preliminary study subjects were 23 cardiac surgery patients (mean age, 55; SD, 8.09) who had a pulmonary artery catheter for cardiac output determination and who were clinically stable, normovolemic and normotensive. Baseline measurements of the dependent variables were taken in the supine position. Patients were then placed in 10 degrees Trendelenburg or 30 degrees modified Trendelenburg position. The dependent variables were measured after 10 minutes in each position. A 2-period, 2-treatment crossover design with a preliminary baseline measurement was used. RESULTS: Five subjects were unable to tolerate Trendelenburg position because of nausea or pain in the sternal incision. In the 18 who were able to tolerate both position changes, no statistically significant changes were found in the five dependent variables. Changes in systemic vascular resistance over time approached statistical significance and warrant further study. CONCLUSIONS: This preliminary study does not provide support for Trendelenburg positions as a means to influence hemodynamic parameters such as cardiac output and blood pressure in normovolemic and normotensive patients.

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A New Noninvasive Method to Measure Blood Pressure

Anesthesiology ◽

10.1097/00000542-199909000-00021 ◽

1999 ◽

Vol 91 (3) ◽

pp. 686-686 ◽

Cited By ~ 84

Author(s):

Kumar Belani ◽

Makoto Ozaki ◽

James Hynson ◽

Thomas Hartmann ◽

Hugo Reyford ◽

...

Keyword(s):

Blood Pressure ◽

Critically Ill ◽

Radial Artery ◽

Pulse Rate ◽

Critically Ill Patients ◽

Arterial Catheter ◽

Arterial Waveform ◽

Measure Blood Pressure ◽

The Mean ◽

Radial Artery Catheter

Background Blood pressure (BP) monitoring with arterial waveform display requires an arterial cannula. We evaluated a new noninvasive device, Vasotrac (Medwave, Arden Hills, MN) that provides BP measurements approximately every 12-15 beats and displays pulse rate and a calibrated arterial waveform for each BP measurement. Methods Surgical and critically ill patients (n = 80) served as subjects for the study. BPs, pulse waveforms, and pulse rates measured via a radial artery catheter were compared with those obtained by the Vasotrac from the opposite radial artery. Data were analyzed to determine agreement between the two systems of measurement. Results Blood pressure measured noninvasively by the Vasotrac demonstrated excellent correlation (P<0.01) with BP measured via a radial arterial catheter (systolic r2 = 0.93; diastolic r2 = 0.89; mean r2 = 0.95). Differences in BP measured by the Vasotrac versus the radial arterial catheter were small. The mean+/-SD bias and precision were as follows: systolic BP 0.02+/-5.4 mm Hg and 3.9+/-3.7 mm Hg; diastolic BP -0.39+/-3.9 mm Hg and 2.7+/-2.8 mm Hg; mean BP -0.21+/-3.0 mm Hg and 2.1+/-2.2 mm Hg compared with radial artery measurements. The Vasotrac pulse rates were almost identical to those measured directly (r2 = 0.95). The Vasotrac BP waveform resembled those directly obtained radial artery pulsatile waveforms. Conclusions In surgical and critically ill patients, the Vasotrac measured BP, pulse rate, and displayed radial artery waveform, which was similar to direct radial arterial measurements. It should be a suitable device to measure BP frequently in a noninvasive fashion.

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