Comparison of hemodynamic stability with continuous noninvasive blood pressure monitoring and intermittent oscillometric blood pressure monitoring in hospitalized patients: A systematic review and meta-analysis

Background: Continuous noninvasive monitoring (NIM) of arterial blood pressure (BP) is a noninvasive technique, which can display real-time BP and therefore faster in identifying hemodynamic changes than intermittent oscillometric BP monitoring in patients. Objectives: The objective of this study was to assess the advantages of continuous NIM of arterial BP compared to standard intermittent oscillometric BP monitoring on the hemodynamic stability in hospital clinical care settings. The primary objective of this systematic review was to compare the incidence of hypotension and hypertension with both the above monitoring techniques. Design: This was a systematic review and meta-analysis. Methods: The randomized trials and observational studies that compared the hemodynamic outcomes with continuous NIM and intermittent oscillometric BP monitoring in all types of hospital settings were searched from multiple databases. The data were extracted for synthesis from the eligible studies and the results were summarized. The RoB 2 and Risk of Bias in Non-randomized Studies-of Interventions tools were used to assess the risk of bias for randomized trials and observational studies, respectively. A meta-analysis was performed using a random effects model for the incidence of hypotension and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluations approach. A qualitative review was done for all the other outcomes. Results: Six randomized controlled trials (RCTs) and six observational studies were included. All the studies used a finger cuff BP monitoring device for continuous BP monitoring. The meta-analysis for the incidence of hypotension was done with data from 6 RCTs in a total of 686 patients. The pooled odds ratio from the random effects model was 0.25 (0.10, 0.62), P = 0.003, showing a significant reduction in the incidence of hypotension with continuous noninvasive BP (NIBP) monitoring compared to intermittent oscillometric NIBP monitoring. The incidence of hypertension was similar in the two groups except during emergence from anesthesia. The duration of hypotension and BP outside of normal range in the intraoperative period was reduced to less than half with continuous NIBP monitoring when compared to the intermittent oscillometric NIBP monitoring. The time to detect hypotension was at least 1.5 min earlier with the continuous NIBP monitoring versus intermittent oscillometric NIBP monitoring that was cycled every 3 min during cesarean sections (P < 0.001) and 8 min earlier in ED patients in whom NIBP monitoring was cycled every 15 min. Conclusion: There is moderate quality of evidence to suggest that the incidence of hypotension with continuous NIBP monitoring is less versus intermittent oscillometric BP monitoring based on the data from surgical patients. The duration of hemodynamic instability and time to detect hypotension may be shorter with continuous NIBP monitoring indicating a potential for improving quality of patient care and safety in appropriate clinical settings. The findings in this review thereby warrant further research with studies of large size and better methodological quality in diverse hospital settings.