Accuracy of invasive arterial pressure monitoring in cardiovascular patients: an observational study (original) (raw)
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Modalities of Invasive Arterial Pressure Monitoring in Critically Ill Patients
Medicine, 2015
Few studies assessed modalities of invasive arterial pressure monitoring (IAPM). We evaluated effects on measured values of various combinations of transducer level, catheter access site, and patient position. Prospective observational study in consecutive adults admitted to a French intensive care unit in 2009 to 2011 and fulfilling our inclusion criteria. Four combinations (B-E) of transducer level, catheter access site, and patient position were compared with a reference combination (A) (A: patient supine with all catheters in the same plane and a single transducer level (M) for zero point reference (Z) aligned on the phlebostatic axis; B: 458 head-of-bed elevation with M and Z aligned on the phlebostatic axis; C: 458 head-of-bed elevation with M aligned on the catheter access site and Z on the phlebostatic axis; D: 458 head-ofbed elevation with M and Z aligned on the catheter access site; and E: 458 head-of-bed elevation with M aligned on the phlebostatic axis and Z on the catheter access site). We included 103 patients, 68 men and 35 women, with a median age of 69 years (interquartile range [IQR], 56-78); at inclusion, 91 (88.3%) received mechanical ventilation, 45 (43.7%) catecholamines, and 66 (64.1%) sedation. The IAPM access site was femoral in 49 (47.6%) and radial in 54 (52.4%) patients, with 62 of 103 (60.2%) catheters on the right side. Measured absolute mean arterial pressure values were significantly higher with 3 study combinations (C-E) than with the reference combination (A). After adjustment, the differences versus A (median, 83 [IQR, 74-92] mm Hg) remained significant for D (median, 91 [IQR, 85-100] mm Hg, P < 0.001) and E (median, 88 [IQR, 77-99] mm Hg, P < 0.001). The difference versus A was not significant for B (median, 85 [IQR, 76-94] mm Hg, P ¼ 0.21) or C (median, 90 [IQR, 84-100] mm Hg, P ¼ 0.006). Several modalities used for zeroing and/or transducer leveling during IAPM may result in statistically and clinically significant overestimation of measured mean arterial pressure values. For patients in the 458 head-of-bed elevation position, aligning the Z on the phlebostatic axis provides values that are not significantly different from those obtained using the reference supine modality. (Medicine 94(39):e1557) Abbreviations: IAPM = invasive arterial pressure monitoring, ICU = intensive care unit, IQR = interquartile range, MAP = mean arterial pressure, M = transducer level, pA = phlebostatic axis, Z = zero reference point.
Cureus, 2021
Invasive intraarterial blood pressure measurement is currently the gold standard for intraoperative hemodynamic monitoring but accurate systolic blood pressure (SBP) measurement is difficult in everyday clinical practice, mostly because of problems with hyper-resonance or damping within the measurement system, which can lead to erroneous treatment decisions if these phenomena are not recognized. A hyperresonant blood pressure trace significantly overestimates true systolic blood pressure while underestimating the diastolic pressure. Invasively measured systolic blood pressure is also significantly more affected than mean blood pressure by the site of measurement within the arterial system. Patients in the intraoperative period should be treated based on the invasively measured mean blood pressure rather than the systolic blood pressure. In this review, we discuss the pros/cons, mechanisms of invasive blood pressure measurements, and the interpretation of the invasively measured systolic blood pressure value.
Methods of Blood Pressure Measurement in the ICU*
Critical Care Medicine, 2013
1 B lood pressure monitoring is essential in managing hemodynamically unstableICU patients. Invasive measurement from an arterial line (invasive arterial blood pressure [IAP]) is generally considered to be the gold standard (1, 2), despite recognition that errors may be introduced by over-or underdamping, calibration errors, and movement artifacts (1, 3, 4). Automated noninvasive blood pressure systems (NIBP) using oscillometric techniques (5, 6) have advantages over invasive arterial lines as they avoid bleeding and infection risk, and can be used outside the ICU. Both theoretical (7) and existing clinical studies have suggested that NIBP measurements may differ from intra-arterial estimates. Clinical data comparing the two techniques in the ICU are sparse, however, particularly at the extremes of blood pressure when the absolute value of blood pressure is most critical. Although both invasive and noninvasive methods report systolic, mean, and diastolic pressures, consensus statements regarding patient management and ICU acuity scores have often recommended systolic rather than mean pressures as targets, and the modality-dependence (invasive vs. noninvasive) of pressure measurement has not been appreciated .
Intra-Arterial Blood Pressure Measurement: Sources of Error and Solutions
2020
ABSTRACTRationaleIntra-arterial blood pressure measurement is the cornerstone of hemodynamic monitoring in Intensive Care Units (ICU). Accuracy of the measurement is dependent on the dynamic response of the measuring system, defined by its natural frequency (fnatural) and damping coefficient (Zdamping) which are estimated with a Fast-flush test. Locating the experimentally measured fnatural and Zdamping on the plot in the original paper by Gardner (1981) which defined the acceptable limits for these 2 parameters, has long been the only way to determine the accuracy of the pressure measurement.In this paper, we extend the current understanding of the effect of poor dynamic response of the measurement system, enhance the usefulness of Gardner’s plots by providing a numerical value for the error in pressure measurement (for a given set of conditions) and depict the gradation of error value as heat maps, and also demonstrate the usefulness of a tunable filter for error correction.Object...
Biomedizinische Technik. Biomedical engineering, 2016
To assess the eligibility for replacement of invasive blood pressure as measured "within" the arterial vessel (IBP) with non-invasive continuous arterial blood pressure (cNIP) monitoring during total intravenous anaesthesia (TIVA), the ability of cNiP to track fast blood pressure changes needs to be quantified. A new method of statistical data analysis is developed for this purpose. In a pilot study on patients undergoing neurosurgical anaesthesia, mean arterial pressure MAPIBP measured with IBP was compared to MAPCNP measured by the CNAP Monitor 500 in ten patients (age: 63±13 a). Correlation analysis of changes of device differences ΔeMAP=ΔMAPCNP-ΔMAPIBP with changes of MAPIBP (ΔMAPIBP) during intervals of vasoactivity was conducted. An innovative technique, of linear trend analysis (LTA) applied to two signals, is described to perform this analysis without a priori knowledge of intervals of vasoactivity. Analysis of ΔeMAP during vasoactivity revealed that ΔMAPCNP system...
Accuracy of non-invasive and minimally invasive hemodynamic monitoring: where do we stand?
Annals of Translational Medicine
One of the most important variables in assessing hemodynamic status in the intensive care unit (ICU) is the cardiac function and blood pressure. Invasive methods such as pulmonary artery catheter and arterial line allow monitoring of blood pressure and cardiac function accurately and reliably. However, their use is not without drawbacks, especially when the invasive nature of these procedures and complications associated with them are considered. There are several newer methods of noninvasive and minimally invasive hemodynamic monitoring available. In this manuscript, we will review these different methods of minimally invasive and non-invasive hemodynamic monitoring and will discuss their advantages, drawbacks and limitations.