Intra-arterial blood pressure measurement: sources of error and solutions

Intra-arterial blood pressure measurement is the cornerstone of hemodynamic monitoring in intensive care units (ICU). Accuracy of the measurement is dependent on the dynamic response of the measuring system, defined by its natural frequency (f_natural) and damping coefficient (Z_damping). Gardner's plot (1981) has long been the only way to determine the accuracy of the pressure measurement. Specific objectives: (i) estimation of the amplitude of error in pressure measurement through simulations based on real-world data, (ii) a novel method to correct the error. Simulated blood pressure waveforms of various heart rates were passed through simulated measurement systems with varying f_natural and Z_damping. The numerical errors in systolic and diastolic pressures and mean error in the measured pressure were used to generate heat maps for the various recording conditions, in the same plot as that by Gardner (1981). f_natural and Z_damping from 121 patient recordings are plotted on these heat maps to demonstrate the fraction of unacceptable recordings. Performance of a tunable filter to correct the error is demonstrated. In many clinical settings, the measurement of intra-arterial pressure is prone to significant error. The proposed tunable filter is shown to improve the accuracy of intra-arterial pressure recording.