title: Noninvasive techniques for blood pressure measurement are not a reliable alternative to direct measurement: a randomized crossover trial in ICU.
abstract: BACKGROUND
  Noninvasive blood pressure (NIBP) monitoring methods are widely used in critically ill patients despite poor evidence of their accuracy. The erroneous interpretations of blood pressure (BP) may lead to clinical errors.
  
  
  OBJECTIVE
  To test the accuracy and reliability of aneroid (ABP) and oscillometric (OBP) devices compared to the invasive BP (IBP) monitoring in an ICU population.
  
  
  METHODS
  Fifty adult patients (200 comparisons) were included in a randomized crossover trial. BP was recorded simultaneously by IBP and either by ABP or by OBP, taking IBP as gold standard.
  
  
  RESULTS
  Compared with ABP, IBP systolic values were significantly higher (mean difference ± standard deviation 9.74 ± 13.8; P < 0.0001). Both diastolic (-5.13 ± 7.1; P < 0.0001) and mean (-2.14 ± 7.1; P=0.0033) IBP were instead lower. Compared with OBP, systolic (10.80 ± 14.9; P < 0.0001) and mean (5.36 ± 7.1; P < 0.0001) IBP were higher, while diastolic IBP (-3.62 ± 6.0; P < 0.0001) was lower. Bland-Altman plots showed wide limits of agreement in both NIBP-IBP comparisons.
  
  
  CONCLUSIONS
  BP measurements with different devices produced significantly different results. Since in critically ill patients the importance of BP readings is often crucial, noninvasive techniques cannot be regarded as reliable alternatives to direct measurements.
authors.affiliation: School of Nursing, University of Trieste, 34100 Trieste, Italy.
authors.forename: Sara
authors.identifier: 0000-0002-4501-9851
authors.initials: S
authors.lastname: Ribezzo
authors.affiliation: Intensive Care Unit, University Hospital of Trieste, 34100 Trieste, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Spina
authors.affiliation: Department of Anesthesia 1, University Hospital of Udine, 33100 Udine, Italy ; Emilia-Romagna Regional Agency for Health and Social Care, 40100 Bologna, Italy.
authors.forename: Stefano
authors.identifier: 0000-0002-3468-9358
authors.initials: S
authors.lastname: Di Bartolomeo
authors.affiliation: School of Nursing, University of Trieste, 34100 Trieste, Italy.
authors.forename: Gianfranco
authors.identifier: 0000-0001-8319-635X
authors.initials: G
authors.lastname: Sanson
mesh_terms: D000368:Aged; D001795:Blood Pressure Determination / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results