Blood pressure measurement in obese patients: non-invasive proximal forearm versus direct intra-arterial measurements
Background: In obesity, accurate perioperative blood pressure measurement using upper arm, non-invasive blood pressure (NIBP) is technically challenging. Proximal forearm NIBP may be an acceptable substitute. Mean arterial blood pressures (MAP) estimated by proximal forearm NIBP were compared with direct intra-arterial measurements. It was hypothesised that the measurement techniques would be interchangeable if between-technique MAP differed ≤ 20% and MAP ratios were < 1.2 and > 0.8.
Method: A total of 30 adults with body mass index ≥ 30 kg/m2 in whom perioperative intra-arterial blood pressure measurement was considered mandatory were enrolled. MAP measurements using the two techniques were obtained at three random intervals in each patient. Bland–Altman analyses were employed.
Results: Forearm mean NIBP MAP overestimated mean intra-arterial MAP by 2.2 (SD 8.1; range from 23.8 to –19.4 mmHg; p = 0.011, 95% CI 3.9 to 0.5). However, Bland–Altman analyses revealed a wide dispersion with several MAP differences and MAP ratios exceeding the pre-specified bounds for interchangeability.
Conclusion: Forearm NIBP could not be considered interchangeable with direct intra-arterial MAP measurements in obese patients.(Full text available online at www.medpharm.tandfonline.com/ojaa) South Afr J Anaesth Analg 2018; DOI: 10.1080/22201181.2018.1461323
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