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A prospective comparison of invasive and non-invasive blood pressure in children undergoing cardiac catheterization
Richard Beringer1, Alastair Keith1, Elin Jones2
1Bristol Royal Hospital for Children, Bristol, UK.
Insights
Automated blood pressure monitoring is unreliable in children during anesthesia. Invasive monitoring is recommended for high-risk procedures like cardiac catheterization to ensure accurate readings.
Area of Science:
- Pediatric Anesthesiology
- Cardiovascular Monitoring
- Medical Device Validation
Background:
- Blood pressure measurement is crucial during general anesthesia, with automated oscillometric devices being common but less validated in pediatric populations.
- Few studies have assessed the agreement between invasive and non-invasive blood pressure measurements in children undergoing anesthesia.
Purpose of the Study:
- To evaluate the agreement between invasive and non-invasive blood pressure measurements in children under 16 undergoing cardiac catheterization with general anesthesia.
- To determine the reliability of automated oscillometric devices in this specific pediatric population.
Main Methods:
- A multi-center prospective observational study involving 254 children under 16 years old.
- Paired invasive and non-invasive blood pressure measurements were collected during general anesthesia for cardiac catheterization.
- Agreement was assessed using Bland-Altman methodology, with bias and standard deviation analyzed, including during hypotension.
Main Results:
- 683 paired blood pressure values were analyzed, showing an overall bias (SD) of 7.2 (11.4) mmHg for mean arterial pressure (MAP).
- During hypotension, the bias (SD) increased to 15 (11.0) mmHg, indicating significant unreliability.
- Discrepancies in non-invasive MAP readings were noted, being higher in infants and lower in older children compared to invasive measurements.
Conclusions:
- Automated oscillometric blood pressure measurement is unreliable in anesthetized children undergoing cardiac catheterization.
- Invasive blood pressure monitoring should be considered for high-risk pediatric cases to ensure accurate cardiovascular assessment.
Background:
Blood pressure measurement is a standard of monitoring during general anesthesia. Invasive measurement is considered the gold standard but is less commonly used than non-invasive. Automated oscillometric blood pressure devices measure the mean arterial pressure (MAP) and use an algorithm to determine the systolic and diastolic pressures. Few devices have been validated in children, particularly during anesthesia. Few studies have assessed the agreement between invasive and non-invasive blood pressure measurements in children.
Methods:
This was a multi-center prospective observational study of children under 16 years undergoing cardiac catheterization with general anesthesia. Paired invasive and non-invasive blood pressure measurements were recorded for each patient during stable periods of the procedure. Correlation within and between sites was assessed with Pearson's correlation coefficient, and agreement was examined using Bland-Altman methodology to determine bias. Agreement during episodes of hypotension and for age and weight was also determined. Bias greater than 5 mmHg and standard deviation greater than 8 mmHg was considered clinically significant. The primary end point was agreement of MAP measurements.
Results:
A total of 683 paired blood pressure values were collected from 254 children in three pediatric hospitals. Median [IQR] age and weight were 3 [1-7] years and 13.9 [8-23] Kg. The overall bias (SD) for mean arterial pressure values was 7.2 (11.4) mmHg. During hypotension (190 readings), the bias (SD) was 15 (11.0) mmHg. The non-invasive MAP was frequently higher than invasive MAP during infancy, and lower in older children.
Conclusion:
Automated oscillometric blood pressure measurement is unreliable in anesthetized children during cardiac catheterization. Invasive pressure measurement should be considered for high-risk cases.
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