The reliability of continuous noninvasive finger blood pressure measurement in critically ill children.
BACKGROUND
Continuous noninvasive arterial blood pressure can be measured in finger arteries using an inflatable finger cuff (FINAP) with a special device and has proven to be feasible and reliable in adults. We studied prototype pediatric finger cuffs and pediatric software to compare this blood pressure measurement with intraarterially measured blood pressure (IAP) in critically ill children.


METHODS
We included sedated and mechanically ventilated children admitted to our pediatric intensive care unit. We performed simultaneous arterial blood pressure measurements during a relatively stable hemodynamic period and compared FINAP, IAP, and the noninvasive blood pressure oscillometric technique. We also compared IAP to a reconstruction of brachial pressure from finger pressure.


RESULTS
Thirty-five children between 2 and 22 kg body weight were included. In total, 152 attempts to record a FINAP pressure were performed of which 4.6% were unsuccessful. When comparing FINAP to IAP, bias was -16.2, -7.7, and -10.2 mm Hg for systolic arterial blood pressure, diastolic arterial blood pressure, and mean arterial blood pressure. Limits of agreement (LOA) were respectively 26.1%, 30.1%, and 22.6%. When reconstruction of brachial pressure from finger pressure was compared to IAP, these results were -11.8, 0.6, and -0.9 mm Hg for bias and 21.7%, 8.9%, and 8.9% for LOA. When noninvasive blood pressure oscillometric technique was compared to IAP, the results were: -6.8, -0.9, and -3.8 mm Hg for bias and 18.2%, 38.6%, and 22.1% for LOA.


CONCLUSIONS
Beta type continuous noninvasive arterial blood pressure monitoring using a finger cuff with brachial arterial waveform reconstruction seems reliable in hemodynamically stable critically ill children.
Lemson
Joris
J
Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Huispost 632, PO Box 9101, 6500 HB Nijmegen, The Netherlands. j.lemson@ic.umcn.nl
Hofhuizen
Charlotte M
CM
Schraa
Olaf
O
Settels
Jos J
JJ
Scheffer
Gert Jan
GJ
van der Hoeven
Johannes G
JG
D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006993:Hypnotics and Sedatives; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic; D010991:Plethysmography / Q000295:instrumentation* / Q000379:methods*; D012039:Regional Blood Flow / Q000502:physiology; D015203:Reproducibility of Results; D012121:Respiration, Artificial
D006993:Hypnotics and Sedatives