Document Detail

Noninvasive monitoring of blood pressure in the critically ill: Reliability according to the cuff site (arm, thigh, or ankle).
MedLine Citation:
PMID:  22425818     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVE: : In the critically ill, blood pressure measurements mostly rely on automated oscillometric devices pending the intra-arterial catheter insertion or after its removal. If the arms are inaccessible, the cuff is placed at the ankle or the thigh, but this common practice has never been assessed. We evaluated the reliability of noninvasive blood pressure readings at these anatomic sites.
DESIGN: : Prospective observational study.
SETTING: : Medical-surgical intensive care unit.
PATIENTS: : Patients carrying an arterial line with no severe occlusive arterial disease.
INTERVENTION: : Each patient underwent a set of three pairs of noninvasive and intra-arterial measurements at each site (arm, ankle, thigh [if Ramsay sedation scale >4]) and, in case of circulatory failure, a second set of measurements after a cardiovascular intervention (volume expansion, change in catecholamine dosage).
MEASUREMENTS AND MAIN RESULTS: : In 150 patients, whatever the cuff site, the agreement between invasive and noninvasive readings was markedly higher for mean arterial pressure than for systolic or diastolic pressure. For mean arterial pressure measurement, arm noninvasive blood pressure was reliable (mean bias of 3.4 ± 5.0 mm Hg, lower/upper limit of agreement of -6.3/13.1 mm Hg) contrary to ankle or thigh noninvasive blood pressure (mean bias of 3.1 ± 7.7 mm Hg and 5.7 ± 6.8 mm Hg and lower/upper limits of agreement of -12.1/18.3 mm Hg and -7.7/19.2 mm Hg, respectively). During acute circulatory failure (n = 83), arm noninvasive blood pressure but also ankle and thigh noninvasive blood pressure allowed a reliable detection of 1) invasive mean arterial pressure <65 mm Hg (area under the receiver operating characteristic curve of 0.98 [0.92-1], 0.93 [0.85-0.97], and 0.93 [0.85-0.98] for arm, ankle, and thigh noninvasive blood pressure, respectively); and 2) a significant (>10%) increase in invasive mean arterial pressure after a cardiovascular intervention (area under the receiver operating characteristic curve of 0.99 [0.92-1], 0.90 [0.80-0.97], and 0.96 [0.87-0.99], respectively).
CONCLUSION: : In our population, arm noninvasive mean arterial pressure readings were accurate. Either the ankle or the thigh may be reliable alternatives, only to detect hypotensive and therapy-responding patients. (Crit Care Med 2012; 40:-1213).
Karim Lakhal; Christine Macq; Stephan Ehrmann; Thierry Boulain; Xavier Capdevila
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  40     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1207-13     Citation Subset:  AIM; IM    
From the Service de réanimation polyvalente (KL, CM, XC), SAR Lapeyronie, Centre hospitalier universitaire, Montpellier, France; Service de réanimation médicale polyvalente (SE), CHRU de Tours, Tours, France; and Service de réanimation médicale (TB), Hôpital La Source, centre hospitalier régional, Orléans, France.
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