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Oscillometric blood pressure measurements by different devices are not interchangeable
M A Kaufmann1, H Pargger, L J Drop
1Department of Anesthesia, Massachusetts General Hospital, Boston 02114, USA.
Insights
Noninvasive blood pressure (NIBP) monitors from different brands are not interchangeable. Studies show significant variability in readings between devices, exceeding established guidelines and impacting clinical decisions.
Area of Science:
- Medical Devices
- Clinical Measurement
- Cardiovascular Monitoring
Background:
- Noninvasive blood pressure (NIBP) monitoring is crucial in patient care.
- Oscillometric devices from different manufacturers are widely used.
- The interchangeability of NIBP readings across brands has not been consistently established.
Purpose of the Study:
- To evaluate the concordance of blood pressure (BP) measurements between different NIBP devices.
- To assess if readings from SpaceLabs (SpL) and Marquette (Marq) devices are interchangeable with Dinamap (DIN).
Main Methods:
- Simultaneous BP measurements were taken on opposite arms of 25 patients undergoing electroconvulsive therapy (ECT).
- Devices used included SpL, Marq, and Dinamap 1846SX (DIN).
- Bland-Altman plots and American Association for Advancement of Medical Instrumentation (AAMI) guidelines were used for agreement analysis.
Main Results:
- Dinamap devices showed high reproducibility (SDD: SBP 7 mm Hg, DBP 6.3 mm Hg).
- SpL vs. DIN showed higher variability (SDD: SBP 9.1 mm Hg, DBP 8.3 mm Hg) with significant mean differences.
- Marq vs. DIN also showed high variability (SDD: SBP 11.8 mm Hg, DBP 9.7 mm Hg).
- Systolic BP differences exceeding 10 mm Hg occurred in 31% (SpL vs. DIN) and 32% (Marq vs. DIN) of observations, surpassing AAMI guidelines.
Conclusions:
- Measurements from SpL and Marq NIBP devices are not interchangeable with Dinamap devices.
- Significant variability in BP readings exists between different oscillometric monitors.
- Clinical decisions should consider potential inaccuracies when using NIBP devices from different brands.
Abstract:
Blood pressure (BP) is frequently measured in patients by noninvasive blood pressure (NIBP) monitors. Values obtained by oscillometric devices of different brands may appear in one patient's record as if they were interchangeable; their concordance, however, has not been established. In 25 patients with major depression who were treated with electroconvulsive therapy (ECT) BP was measured on either arm by devices manufactured by SpaceLabs (SpL, 12 patients, 182 data points) and Marquette (Marq, 13 patients, 193 data points), respectively, and comparisons were made with simultaneous measurements on the opposite arm by Dinamap 1846SX (DIN), during the awake state and at 1-min intervals up to 5-7 min after ECT. Because ECT is associated with an intense, but short-lasting hyperdynamic state, comparisons of BP values could be made over a wide range of pressures. Bland-Altman plots were constructed to show the distribution of pressure differences at all pressures. Agreements between two instruments were judged according to guide lines by the American Association for Advancement of Medical Instrumentation (AAMI). The standard deviation of the difference (SDD) between two DIN devices was 7 mm Hg for systolic (SBP) and 6.3 mm Hg for diastolic blood pressure (DBP), whereas mean differences were 0.9 and 0.2 mm Hg, respectively (P = not significant [NS]), thus showing reproducibility. Corresponding SDD values SpL versus DIN were 9.1 for SBP and 8.3 mm Hg for DBP, while the mean differences were 1.6 (P = 0.026) and 7.3 (P = 0.0001) mm Hg, respectively. Corresponding SDD values for Marq versus DIN were 11.8 and 9.7 mm Hg with mean differences of 0.8 (P = NS) and 0.3 (P = NS) mm Hg. Whereas SBP differences DIN versus DIN exceeded 10 mm Hg in only 10% of observations, they exceeded that threshold in 31% and 32% of observations for SpL versus DIN and Marq versus DIN, respectively. In view of the variability that exceeds the AAMI guidelines and the one out of three occurrence of individual SBP differences exceeding 10 mm Hg for comparisons of SpL or Marq versus DIN, measurements by these three oscillometric devices are not interchangeable.
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