title: Accuracy and precision of continuous noninvasive arterial pressure monitoring compared with invasive arterial pressure: a systematic review and meta-analysis.
abstract: BACKGROUND
  Continuous noninvasive arterial pressure monitoring devices are available for bedside use, but the accuracy and precision of these devices have not been evaluated in a systematic review and meta-analysis.
  
  
  METHODS
  The authors performed a systematic review and meta-analysis of studies comparing continuous noninvasive arterial pressure monitoring with invasive arterial pressure monitoring. Random-effects pooled bias and SD of bias for systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure were calculated. Continuous noninvasive arterial pressure monitoring was considered acceptable if pooled estimates of bias and SD were not greater than 5 and 8 mmHg, respectively, as recommended by the Association for the Advancement of Medical Instrumentation.
  
  
  RESULTS
  Twenty-eight studies (919 patients) were included. The overall random-effect pooled bias and SD were -1.6 ± 12.2 mmHg (95% limits of agreement -25.5 to 22.2 mmHg) for systolic arterial pressure, 5.3 ± 8.3 mmHg (-11.0 to 21.6 mmHg) for diastolic arterial pressure, and 3.2 ± 8.4 mmHg (-13.4 to 19.7 mmHg) for mean arterial pressure. In 14 studies focusing on currently commercially available devices, bias and SD were -1.8 ± 12.4 mmHg (-26.2 to 22.5 mmHg) for systolic arterial pressure, 6.0 ± 8.6 mmHg (-10.9 to 22.9 mmHg) for diastolic arterial pressure, and 3.9 ± 8.7 mmHg (-13.1 to 21.0 mmHg) for mean arterial pressure.
  
  
  CONCLUSIONS
  The results from this meta-analysis found that inaccuracy and imprecision of continuous noninvasive arterial pressure monitoring devices are larger than what was defined as acceptable. This may have implications for clinical situations where continuous noninvasive arterial pressure is being used for patient care decisions.
authors.affiliation: From the Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California (S.-H.K., M.L., K.S.S., J.R., M.C.); Department of Anesthesiology and Pain Medicine, University of Soonchunhyang, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea (S.-H.K., C.C.); Department of Anesthesiology and Critical Care, Louis Pradel Hospital, Lyon, France (M.L.); and Department of Statistics, University of California Irvine, Orange, California (Z.Y.).
authors.forename: Sang-Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Marc
authors.initials: M
authors.lastname: Lilot
authors.forename: Kulraj S
authors.initials: KS
authors.lastname: Sidhu
authors.forename: Joseph
authors.initials: J
authors.lastname: Rinehart
authors.forename: Zhaoxia
authors.initials: Z
authors.lastname: Yu
authors.forename: Cecilia
authors.initials: C
authors.lastname: Canales
authors.forename: Maxime
authors.initials: M
authors.lastname: Cannesson
mesh_terms: D062186:Arterial Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods / Q000592:standards; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods / Q000592:standards*; D015924:Blood Pressure Monitors / Q000592:standards*; D006801:Humans