Accuracy and trending of non-invasive oscillometric blood pressure monitoring at the wrist in obese patients.
Bariatric surgery
Non-invasive blood pressure
Obese
Oscillometry
Journal
Anaesthesia, critical care & pain medicine
ISSN: 2352-5568
Titre abrégé: Anaesth Crit Care Pain Med
Pays: France
ID NLM: 101652401
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
15
11
2019
revised:
07
01
2020
accepted:
10
01
2020
pubmed:
19
2
2020
medline:
21
9
2021
entrez:
19
2
2020
Statut:
ppublish
Résumé
In obese patients, non-invasive blood pressure monitoring in the arm is difficult due to the arm size and morphology. We compared the non-invasive oscillometric wrist blood pressure measurement with the arm and forearm in obese patients monitored with invasive radial blood pressure (reference standard). This prospective observational study included adult obese patients scheduled for bariatric surgery. Non-invasive blood pressure was measured at the arm, upper forearm and wrist of one upper extremity, while invasive blood pressure was simultaneously measured through a radial arterial catheter in the contralateral upper extremity. The accuracy of non-invasive blood pressure reading at each site was evaluated for absolute and trending values using the Bland-Altman analysis and Spearman's correlation coefficient. In 40 patients, 262, 259, and 263 pairs of non-invasive blood pressure readings were obtained from the arm, forearm, and wrist sites, respectively. As primary outcome, the correlation coefficient for systolic blood pressure was higher for the wrist (0.92, 95% confidence interval (CI) [0.9-0.94]) than for the arm (0.74, 95% CI [0.68-0.79]) and the forearm (0.71, 95% CI [0.64-0.76]) (P<0.05). The non-invasive systolic wrist blood pressure showed the least mean bias and the narrowest limits of agreement (-0.3±7.6mmHg) when compared with forearm (4.3±16) and arm measurements (14.2±13.6) (P<0.05). For trending values, the correlation coefficient was the highest at the wrist. In obese patients undergoing bariatric surgery, non-invasive blood pressure measured at the wrist showed the highest accuracy in comparison with the arm and forearm.
Sections du résumé
BACKGROUND
In obese patients, non-invasive blood pressure monitoring in the arm is difficult due to the arm size and morphology. We compared the non-invasive oscillometric wrist blood pressure measurement with the arm and forearm in obese patients monitored with invasive radial blood pressure (reference standard).
METHODS
This prospective observational study included adult obese patients scheduled for bariatric surgery. Non-invasive blood pressure was measured at the arm, upper forearm and wrist of one upper extremity, while invasive blood pressure was simultaneously measured through a radial arterial catheter in the contralateral upper extremity. The accuracy of non-invasive blood pressure reading at each site was evaluated for absolute and trending values using the Bland-Altman analysis and Spearman's correlation coefficient.
RESULTS
In 40 patients, 262, 259, and 263 pairs of non-invasive blood pressure readings were obtained from the arm, forearm, and wrist sites, respectively. As primary outcome, the correlation coefficient for systolic blood pressure was higher for the wrist (0.92, 95% confidence interval (CI) [0.9-0.94]) than for the arm (0.74, 95% CI [0.68-0.79]) and the forearm (0.71, 95% CI [0.64-0.76]) (P<0.05). The non-invasive systolic wrist blood pressure showed the least mean bias and the narrowest limits of agreement (-0.3±7.6mmHg) when compared with forearm (4.3±16) and arm measurements (14.2±13.6) (P<0.05). For trending values, the correlation coefficient was the highest at the wrist.
CONCLUSION
In obese patients undergoing bariatric surgery, non-invasive blood pressure measured at the wrist showed the highest accuracy in comparison with the arm and forearm.
Identifiants
pubmed: 32068134
pii: S2352-5568(20)30024-2
doi: 10.1016/j.accpm.2020.01.006
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
221-227Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.