Key result
Optimally damped arterial lines occurred in only 46% of critically ill children, and there was significant, unpredictable variability between non-invasive cuff and invasive arterial blood pressures.
Why the study?
Does non-invasive cuff blood pressure accurately reflect invasive arterial blood pressure in critically ill children?
Cross-Sectional (n=100)
No
Does non-invasive cuff blood pressure accurately reflect invasive arterial blood pressure in critically ill children?
In critically ill children, arterial lines are frequently not optimally damped, and non-invasive blood pressure measurements show wide variability compared to invasive measurements, suggesting NIBP may not be accurate enough to guide hemodynamic management.
Answers are grounded in this paper and cite their sources.
NIBP may not reliably guide hemodynamics in critically ill children; hypothesis-generating for damping standards and prospective validation.
BACKGROUND: The accuracy of arterial lines (AL) using the flush test or stopcock test has not been described in children, nor has the difference between invasive arterial blood pressure (IABP) versus non-invasive cuff (NIBP) blood pressure. METHODS: After ethics approval and consent, we performed the flush test and stopcock test on AL (to determine over damping, under damping, and optimal damping), and determined the difference (NIBP-IABP) in systolic, diastolic, and mean blood pressure (ΔSBP, ΔDBP, and ΔMAP). The primary outcome was incidence (95 % CI) of optimally damped AL. Predictors of ΔBP (effect size (95 % CI)) were determined using multiple linear regression. RESULTS: There were 147 AL tests in 100 enrolled patients with mean age 44.7 (SD 56) months, weight 16.8 (SD 18.3) kg, male 59 %, postoperative-cardiovascular 52 %, peripheral-AL 78 %, inotropes 29 %, vasodilators 15 %, and ventilated 73 %. The flush test performed in 66 patients (45 %) showed optimal damping in 30 (46 %; 95 % CI 34, 57 %), over damping in 25 (38 %) and under damping in 11 patients (17 %). The stopcock test was over-damped in 128/146 patients (88 %), with the same damping as the flush test in 24/64 (38 %). In optimally damped (flush test) AL, ΔSBP, ΔDBP, and ΔMAP were 0.8 (SD 12.2), -5.2 (SD 8.7), and -4.9 (7.6) respectively. A second set of AL tests was done 2 h later on the same day in 62 patients; AL damping often changed (10/28 flush tests) and ΔBPs correlated poorly (r = 0.31-0.55). Predictors (effect size) of ΔDBP were vasodilator infusion (15.6 (2.9 to 28.3); p = 0.016) and optimal damping (-7.2 (-12.2 to 2.2); p = 0.005); and of ΔMAP were vasodilator infusion (10.0 (-0.3 to 20.4); p = 0.057) and optimal damping (-4.0 (-8 to 0.1); p = 0.058). There were no independent predictors of damping category (n = 66 flush tests). CONCLUSIONS: Optimally damped AL occur in half of critically ill children, and this is not predictable. There is much variability in ∆BP between NIBP and the gold standard IABP, and this varies even in the same patient on the same day, and is not easily predictable. In critically ill children, NIBP may not be accurate enough to guide management, and more attention to ensuring the AL is optimally damped is needed.
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Joffe et al. (2016) conducted a cross-sectional in Critically ill children requiring arterial line monitoring (n=100). Arterial line flush test was evaluated on Incidence of optimally damped arterial lines (95% CI 34-57). Optimally damped arterial lines occurred in only 46% of critically ill children, and there was significant, unpredictable variability between non-invasive cuff and invasive arterial blood pressures.
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