title: Blood pressure monitoring during arrhythmia: agreement between automated brachial cuff and intra-arterial measurements.
abstract: BACKGROUND
  Since arrhythmia induces irregular pulse waves, it is widely considered to cause flawed oscillometric brachial cuff measurements of blood pressure (BP). However, strong data are lacking. We assessed whether the agreement of oscillometric measurements with intra-arterial measurements is worse during arrhythmia than during regular rhythm.
  
  
  METHODS
  Among patients of three intensive care units (ICUs), a prospective comparison of three pairs of intra-arterial and oscillometric BP readings was performed among patients with arrhythmia and an arterial line already present. After each inclusion in the arrhythmia group, one patient with regular rhythm was included as a control. International Organization for Standardization (ISO) standard validation required a mean bias <5 (sd 8) mm Hg.
  
  
  RESULTS
  In 135 patients with arrhythmia, the agreement between oscillometric and intra-arterial measurements of systolic, diastolic and mean BP was similar to that observed in 136 patients with regular rhythm: for mean BP, similar mean bias [-0.1 (sd 5.2) and 1.9 (sd 5.9) mm Hg]. In both groups, the ISO standard was satisfied for mean and diastolic BP, but not for systolic BP (sd >10 mm Hg) in our ICU population. The ability of oscillometry to detect hypotension (systolic BP <90 mm Hg or mean BP <65 mm Hg), response to therapy (>10% increase in mean BP after cardiovascular intervention) and hypertension (systolic BP >140 mm Hg) was good and similar during arrhythmia and regular rhythm (respective areas under the receiver operating characteristic curves ranging from 0.89 to 0.96, arrhythmia vs regular rhythm between-group comparisons all associated with P>0.3).
  
  
  CONCLUSIONS
  Contrary to widespread belief, arrhythmia did not cause flawed automated brachial cuff measurements.
authors.affiliation: Réanimation chirurgicale polyvalente, service d'anesthésie-réanimation, Hôpital Laënnec, centre hospitalier universitaire, Nantes F-44093, France lakhal_karim@yahoo.fr.
authors.forename: K
authors.initials: K
authors.lastname: Lakhal
authors.affiliation: Service de réanimation polyvalente, CHRU de Tours, Tours F-37044, France INSERM, Centre d'Étude des Pathologies Respiratoires, UMR 1100, Aérosolthérapie et biomédicaments à visée respiratoire, Faculté de médecine, Université François Rabelais, Tours F-37032, France.
authors.forename: S
authors.initials: S
authors.lastname: Ehrmann
authors.affiliation: Réanimation chirurgicale polyvalente, service d'anesthésie-réanimation, Hôpital Laënnec, centre hospitalier universitaire, Nantes F-44093, France.
authors.forename: M
authors.initials: M
authors.lastname: Martin
authors.affiliation: Service de réanimation médicale, Hôpital La Source, centre hospitalier régional, Orléans F-45067, France.
authors.forename: S
authors.initials: S
authors.lastname: Faiz
authors.affiliation: Service de réanimation polyvalente, CHRU de Tours, Tours F-37044, France.
authors.forename: F
authors.initials: F
authors.lastname: Réminiac
authors.affiliation: Réanimation chirurgicale polyvalente, service d'anesthésie-réanimation, Hôpital Laënnec, centre hospitalier universitaire, Nantes F-44093, France.
authors.forename: R
authors.initials: R
authors.lastname: Cinotti
authors.affiliation: Service d'anesthésie-réanimation, Hôpital Lapeyronie, centre hospitalier universitaire, Montpellier F-34295, France.
authors.forename: X
authors.initials: X
authors.lastname: Capdevila
authors.affiliation: Réanimation chirurgicale, service d'anesthésie-réanimation, Hôtel Dieu, centre hospitalier universitaire, Nantes F-44093, France.
authors.forename: K
authors.initials: K
authors.lastname: Asehnoune
authors.affiliation: Réanimation chirurgicale polyvalente, service d'anesthésie-réanimation, Hôpital Laënnec, centre hospitalier universitaire, Nantes F-44093, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Blanloeil
authors.affiliation: Réanimation chirurgicale polyvalente, service d'anesthésie-réanimation, Hôpital Laënnec, centre hospitalier universitaire, Nantes F-44093, France.
authors.forename: B
authors.initials: B
authors.lastname: Rozec
authors.affiliation: Service de réanimation médicale, Hôpital La Source, centre hospitalier régional, Orléans F-45067, France.
authors.forename: T
authors.initials: T
authors.lastname: Boulain
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods; D015924:Blood Pressure Monitors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies
keywords: atrial fibrillation (MeSH); blood pressure determination (MeSH); intensive care units (MeSH); oscillometry; sphygmomanometer