Continuous invasive arterial pressure monitoring increased detection of AUC-MAP <65 mm Hg compared to oscillometric monitoring (OR 1.78; 95% CI 1.18-2.70; P=0.006).
RCT (n=306)
Does continuous invasive arterial pressure monitoring reduce AUC-MAP <65 mm Hg compared to intermittent oscillometric monitoring in adults having noncardiac surgery?
Continuous invasive arterial pressure monitoring during noncardiac surgery detects significantly more hypotension compared to intermittent oscillometric monitoring.
Odds Ratio: 1.78 (95% CI 1.18–2.7)
p-value: p=0.006
BACKGROUND: Continuous blood pressure monitoring may facilitate early detection and prompt treatment of hypotension. We tested the hypothesis that area under the curve (AUC) mean arterial pressure (MAP) 91 mm Hg × minutes of AUC-MAP <65 mm Hg (ie, no hypotension and 3 equally sized groups of increasing hypotension). RESULTS: One hundred fifty-two patients were randomly assigned to arterial catheter use and 154 to oscillometric monitoring. For various clinical reasons, 143 patients received an arterial catheter, while 163 were monitored oscillometrically. There were a median Q1, Q3 of 246 187, 308 pressure measurements in patients with arterial catheters versus 55 (46, 75) measurements in patients monitored oscillometrically. In the primary intent-to-treat analysis, catheter-based monitoring increased detection of AUC-MAP <65 mm Hg, with an estimated proportional odds ratio (ie, odds of being in a worse hypotension category) of 1.78 (95% confidence interval CI, 1.18-2.70; P = .006). The result was robust over an as-treated analysis and for sensitivity analyses with thresholds of 60 and 70 mm Hg. CONCLUSIONS: Intraoperative blood pressure monitoring with arterial catheters detected nearly twice as much hypotension as oscillometric measurements.
Naylor et al. (2019) conducted an RCT in Major noncardiac surgery (n=306). Continuous invasive arterial pressure monitoring vs. Intermittent oscillometric blood pressure monitoring was evaluated on Area under the curve (AUC) mean arterial pressure (MAP) <65 mm Hg (OR 1.78, 95% CI 1.18-2.70, p=0.006). Continuous invasive arterial pressure monitoring increased detection of AUC-MAP <65 mm Hg compared to oscillometric monitoring (OR 1.78; 95% CI 1.18-2.70; P=0.006).