Blood pressure measurement in obese patients: non-invasive proximal forearm versus direct intra-arterial measurements

  • A Verkhovsky Stellenbosch University
  • A Smit Stellenbosch University
  • A Levin Stellenbosch University
  • J F Coetzee Stellenbosch University
Keywords: Blood pressure monitoring, comparative study, forearm, intra-arterial, obese

Abstract

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

Author Biographies

A Verkhovsky, Stellenbosch University
Department of Anaesthesiology and Critical Care, Stellenbosch University, Tygerberg
A Smit, Stellenbosch University
Department of Anaesthesiology and Critical Care, Stellenbosch University, Tygerberg
A Levin, Stellenbosch University
Department of Anaesthesiology and Critical Care, Stellenbosch University, Tygerberg
J F Coetzee, Stellenbosch University
Department of Anaesthesiology and Critical Care, Stellenbosch University, Tygerberg
Published
2018-06-23
Section
Research Articles