Tracking hypotension and dynamic changes in arterial blood pressure with brachial cuff measurements.
BACKGROUND
Arterial cannulation is strongly recommended during shock. Nevertheless, this procedure is associated with significant risks and may delay other emergent procedures. We assessed the discriminative power of brachial cuff oscillometric noninvasive blood pressure (NIBP) for identifying patients with an invasive mean arterial blood pressure (MAP) below 65 mm Hg or increasing their invasive MAP after cardiovascular interventions.


METHODS
This prospective study, conducted in three intensive care units, included adults in circulatory failure who underwent 45 degrees passive leg raising, 300 mL fluid loading, and additional 200 mL fluid loading. The collected data were four invasive and noninvasive MAP measurements at each study phase.


RESULTS
Among 111 patients (50 septic, 15 cardiogenic, and 46 other source of shock), when averaging measurements of each study phase, NIBP measurements accurately predicted an invasive MAP lower than 65 mm Hg: area under the receiver operating characteristic curve 0.90 (95% CI: 0.71-1), positive and negative likelihood ratios 7.7 (95% CI: 5.4-11) and 0.31 (95% CI: 0.22-0.44) (cutoff 65 mm Hg). For identifying patients increasing their invasive MAP by more than 10%, the area under the receiver operating characteristic curve was 0.95 (95% CI: 0.92-0.96); positive and negative likelihood ratios (cutoff 10%) were 25.7 (95% CI: 10.8-61.4) and 0.26 (95% CI: 0.2-0.34).


CONCLUSIONS
NIBP measurements have a good discriminative power for identifying hypotensive patients and performed even better in tracking MAP changes, provided that one averages four NIBP measurements.
Lakhal
Karim
K
Service de Réanimation Médicale, Hôpital de La Source, Centre Hospitalier Régional, Assistance Publique des Hôpitaux de Paris, F45067 Orléans cedex 1, France.
Ehrmann
Stephan
S
Runge
Isabelle
I
Legras
Annick
A
Dequin
Pierre-François
PF
Mercier
Emmanuelle
E
Wolff
Michel
M
Régnier
Bernard
B
Boulain
Thierry
T
D000368:Aged; D019540:Area Under Curve; D001158:Arteries / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods* / Q000706:statistics & numerical data; D003627:Data Interpretation, Statistical; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012151:Resuscitation