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Arterial Line or Cuff BP?Arterial-Line or Cuff BP? FREE TO VIEW

Daniel Horowitz, MD; Yaw Amoateng-Adjepong, MD, PhD; Stuart Zarich, MD; Allan Garland, MD; Constantine A. Manthous, MD, FCCP
Author and Funding Information

From the Department of Medicine (Drs Horowitz, Amoateng-Adjepong, Zarich, and Manthous), Bridgeport Hospital and Yale School of Medicine; and Faculty of Medicine (Dr Garland), University of Manitoba.Dr Manthous is currently at The Hospital of Central Connecticut (New Britain, CT).

Correspondence to: Constantine A. Manthous, MD, FCCP, Department of Internal Medicine, The Hospital of Central Connecticut, 100 Grand St, New Britain, CT 06050; e-mail: cmanthous@thocc.org


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):270-271. doi:10.1378/chest.12-1358
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To the Editor:

Arterial catheterization (AC) is commonly used in critically ill patients despite the lack of data supporting the benefit of use in clinical practice and substantial risk.1-5 We investigated the relationship between cuff- and AC-measured BPs in 34 patients with shock treated in our medical ICU. A total of 1,363 paired arterial and cuff BP readings (13-82 per patient) were measured within 1 to 2 min and recorded by bedside nurses. Bland-Altman analysis for systolic BP (arterial − cuff) showed a bias of 0.9 mm Hg (95% limit of agreement [LOA], −32.2 to +34.1 mm Hg) (Fig 1). Bias for diastolic BP was −1.3 mm Hg (95% LOA, −24.9 to +23.3 mm Hg) (Fig 2).

Figure Jump LinkFigure 1. Bland-Altman plot of A-line − cuff BP (mm Hg) vs mean systolic BP (mm Hg). A-line = arterial line.Grahic Jump Location
Figure Jump LinkFigure 2. Bland-Altman plot of A-line − cuff BP (mm Hg) vs mean diastolic BP (mm Hg). See Figure 1 legend for expansion of abbreviation.Grahic Jump Location

Overall, 18.9% of the paired systolic BP readings differed by at least 20 mm Hg, and 29.1% of paired diastolic BP readings differed by at least 10 mm Hg. To adjust for potential clustering of measurements, bootstrap Bland-Altman analysis averaged over 5,000 replications yielded similar results to unclustered analyses for systolic BP (bias, 1.2 mm Hg; 95% LOA, −35.7 to +38.0 mm Hg) and diastolic BP (bias, −1.2 mm Hg; 95% LOA, −24.9 to +22.4 mm Hg).

These data, representing the largest report of paired cuff and AC BP measurements to our knowledge, demonstrate significant differences between cuff and AC BP measurements within and across patients. These differences are likely to have an impact on management decisions until more-robust efficacy data arrive to inform optimal BP monitoring.

References

Garland A, Connors AF Jr. Indwelling arterial catheters in the intensive care unit: necessary and beneficial, or a harmful crutch?. Am J Respir Crit Care Med. 2010;182(2):133-134. [CrossRef] [PubMed]
 
Fessler HE, Shade D. Measurement of vascular pressures.. In:.Tobin MJ.,ed. Principles and Practice of Intensive Care Monitoring. New York, NY: McGraw-Hill; 1997:91-106.
 
Traoré O, Liotier J, Souweine B. Prospective study of arterial and central venous catheter colonization and of arterial- and central venous catheter-related bacteremia in intensive care units. Crit Care Med. 2005;33(6):1276-1280. [CrossRef] [PubMed]
 
Band JD, Maki DG. Infections caused by arterial catheters used for hemodynamic monitoring. Am J Med. 1979;67(5):735-741. [CrossRef] [PubMed]
 
Scheer BV, Perel A, Pfeiffer UJ. Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care. 2002;6(3):199-204. [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1. Bland-Altman plot of A-line − cuff BP (mm Hg) vs mean systolic BP (mm Hg). A-line = arterial line.Grahic Jump Location
Figure Jump LinkFigure 2. Bland-Altman plot of A-line − cuff BP (mm Hg) vs mean diastolic BP (mm Hg). See Figure 1 legend for expansion of abbreviation.Grahic Jump Location

Tables

References

Garland A, Connors AF Jr. Indwelling arterial catheters in the intensive care unit: necessary and beneficial, or a harmful crutch?. Am J Respir Crit Care Med. 2010;182(2):133-134. [CrossRef] [PubMed]
 
Fessler HE, Shade D. Measurement of vascular pressures.. In:.Tobin MJ.,ed. Principles and Practice of Intensive Care Monitoring. New York, NY: McGraw-Hill; 1997:91-106.
 
Traoré O, Liotier J, Souweine B. Prospective study of arterial and central venous catheter colonization and of arterial- and central venous catheter-related bacteremia in intensive care units. Crit Care Med. 2005;33(6):1276-1280. [CrossRef] [PubMed]
 
Band JD, Maki DG. Infections caused by arterial catheters used for hemodynamic monitoring. Am J Med. 1979;67(5):735-741. [CrossRef] [PubMed]
 
Scheer BV, Perel A, Pfeiffer UJ. Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care. 2002;6(3):199-204. [CrossRef] [PubMed]
 
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