Invasive Arterial BP Measurements in the Emergency Department-When, if Ever, is it Indicated?

Extremes of blood pressure (BP) are common among patients that visit emergency departments. In this review article, we discuss the specific indications for invasive blood pressure monitoring in the ED, particularly in the context of undifferentiated shock and hypertensive emergencies.

In most cases, non-invasive techniques suffice for blood pressure monitoring, however, in certain patient presentations intermittent automated oscillometry bears significant drawbacks. The most evident drawback is the extended intervals between measurements. Invasive BP (IBP) monitoring offers a pivotal tool for patients with critical illness who require accurate, timely, blood pressure monitoring and indirectly monitors for complications involving vital organ systems. In the management of patients with critical illness or at risk for end organ injury, invasive methods that directly measure BP via arterial cannulation continues to be an established standard. Overall, evaluating patients on an individual basis, with the understanding that patients who present with extreme blood pressure values need closer monitoring, should prompt consideration of invasive methods of blood pressure monitoring.