NDLI: Non-invasive versus arterial pressure monitoring in the pre-hospital critical care environment: a paired comparison of concurrently recorded measurements

Content Provider	Springer Nature : BioMed Central
Author	Perera, Yani Raitt, James Poole, Kurtis Metcalfe, David Lewinsohn, Asher
Abstract	Background Blood pressure monitoring is important in the pre-hospital management of critically ill patients. Non-invasive blood pressure (NIBP) measurements are commonly used but the accuracy of standard oscillometric cuff devices may be affected by extremes of physiology and adverse conditions (e.g. vibration) during transport. This study aimed to quantify the accuracy of NIBP measurements amongst patients requiring pre-hospital critical care. Methods A retrospective cohort study was undertaken using data from patients treated by a pre-hospital critical team between 1st May 2020 and 30th April 2023 that had NIBP measured concurrently with invasive blood pressure (IBP) arterial manometry. An acceptable difference was determined a priori to be < 20mmHg for systolic blood pressure (SBP) and diastolic blood pressure (DBP), and < 10mmHg for mean arterial pressure (MAP). The primary outcome was “pairwise agreement”, i.e. the proportion of paired observations that fell within this range of acceptability. Bland-Altman plots were constructed together with 95% limits of agreement to visualise differences between pairs of data. Associations with patient age, reason for critical care, transport status, haemodynamic shock, severe hypertension, and arterial catheter position were explored in univariate analyses and by fitting multivariable logistic regression models. Results There were 2,359 paired measurements from 221 individual patients with a median age of 57. The most frequent reason for transport was cardiac arrest (79, 35.7%). Bland-Altman analyses suggested unacceptably wide limits of agreement with NIBP overestimating both SBP and MAP during hypotension and underestimating these values during hypertension. Haemodynamic shock (SBP < 90mmHg) was independently associated with reduced pairwise agreement for SBP (adjusted odds ratio [aOR] 0.52, 95% CI 0.35 to 0.77), DBP (aOR 0.65, 95% CI 0.42 to 0.99) and MAP (aOR 0.53, 95% CI 0.36 to 0.78) and severe hypertension (SBP > 160mmHg) with reduced pairwise agreement for SBP (aOR 0.17, 95% CI 0.11 to 0.27). There was no association between patient transport and agreement between the methods for SBP, DBP, or MAP. Conclusions Non-invasive blood pressure measurements are often inaccurate in the pre-hospital critical care setting, particularly in patients with haemodynamic instability. Clinicians should be cautious when interpreting NIBP measurements and consider direct arterial pressure monitoring when circumstances allow.
Related Links	https://sjtrem.biomedcentral.com/counter/pdf/10.1186/s13049-024-01240-y.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
ISSN	17577241
DOI	10.1186/s13049-024-01240-y
Journal	Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Issue Number	1
Volume Number	32
Language	English
Publisher	BioMed Central
Publisher Date	2024-08-27
Access Restriction	Open
Subject Keyword	Scandinavian Journal of Trauma Resuscitation and Emergency Medicine Emergency Medicine Traumatic Surgery Blood pressure monitoring Arterial line Pre-hospital critical care
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine Critical Care and Intensive Care Medicine
Journal Impact Factor	3/2023
5-Year Journal Impact Factor	3.5/2023

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