“Comparison of Invasive Blood Pressure Monitoring Versus Non-Invasive Blood Pressure Monitoring in Critically Ill Children Receiving Vasoactive Agents – A Prospective Observational study Provisionally Accepted
Amita Kaul- 1Surya Mother and Child Superspecialty Hospital ,Pune, India, India
Objective:
The primary aim of this study was to compare non-invasive blood pressure (NIBP) measurement using the automated oscillometric method with invasive blood pressure (IBP) measurement using peripheral arterial line insertion in critically ill children receiving vasoactive agents.
Design:
Single-centre, prospective cohort study.
Setting:
Tertiary care 15 bedded Pediatric ICU in Urban Indian city
Subjects:
All critically ill children between the ages of 1 month to 16 years with shock on vasoactive medications and with IBP monitoring.
Intervention:
None
Measurements and main results:
Forty children with 1072 paired BP measurements were incorporated in the final analysis. Among all normotensive children (Total number of paired measurements = 623) receiving vasoactive agents, Bland–Altman analysis revealed an acceptable agreement between Invasive mean blood pressure (MBP) and non-invasive MBP with a bias of -2.10 mmHg (SD 11.35). The 95% limits of agreement were from -24.34 to 20.14 mmHg.
In children with hypotension (Total number of paired measurements = 449), Bland–Altman analysis showed disagreement between Invasive MBP and non-invasive MBP i.e., a bias of -8.44 mmHg (SD 9.62). The 95% limits of agreement were from -27.29 to 10.41 mmHg.
Conclusion:
A limited agreement exists between invasive blood pressure (IBP) and non-invasive blood pressure (NIBP) measurements in critically ill children requiring vasoactive agents. This discrepancy can lead to either an underestimation or an overestimation of blood pressure. While NIBP can serve as a screening tool for hemodynamically stable children, those who are hemodynamically unstable and necessitate the initiation of vasoactive agents should undergo IBP monitoring.
Keywords: Non Invasive Blood Pressure, Invasive Blood Pressure (IBP), Vasoactive agents, Shock, PICU (pediatric intensive care unit)
Received: 25 Jan 2024;
Accepted: 13 May 2024.
Copyright: © 2024 Shah, Kaul, Nagarkar and Thorat. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr. Amita Kaul, Surya Mother and Child Superspecialty Hospital ,Pune, India, Pune, Maharashtra, India