Non-invasive blood pressure monitoring in the critically ill: time to abandon the intra-arterial catheter?
Chest. 2017 Nov 03;:
Authors: Lakhal K, Ehrmann S, Boulain T
Although its reliability is often questioned, non-invasive blood pressure (NIBP) monitoring with an oscillometric arm cuff is widely used, even in shocked critically ill patients. When correctly implemented, modern arm NIBP devices actually can provide accurate and precise measurements of mean blood pressure as well as clinically meaningful information such as identification of hypo- and hypertensive patients and monitoring of response to therapy. Even in specific circumstances such as arrhythmia, hypotension, vasopressor infusion and possibly in obese patients, arm NIBP could be useful, contrary to widespread belief. Hence, postponing the arterial catheter insertion pending the initiation of more urgent diagnostic and therapeutic measures could be a suitable strategy. Given the arterial catheter-related burden, fully managing critically ill patients without any arterial catheter may also be an option. Indeed, the benefit patients may experience from an arterial catheter is questioned in recent studies failing to demonstrate that its use reduces mortality. However, randomized controlled trials to confirm that NIBP can safely fully replace the arterial catheter are yet to be done. Besides intermittent measurements, continuous NIBP monitoring is a booming field, as illustrated by the release onto the market of user-friendly devices, based on digital volume clamp and applanation tonometry. Their imperfect accuracy and precision would probably benefit from technical refinements but their good ability to track, in real time, the direction of changes in BP is an undeniable asset. Their drawbacks and advantages and whether these devices are, today, ready-to-use in the critically ill patient are discussed in this review.
PMID: 29108815 [PubMed - as supplied by publisher]