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Fundora MP, Beshish AG, Rao N, Berry CM, Figueroa J, McCracken C, Maher KO. Comparison of Invasive and Oscillometric Blood Pressure Measurement in Obese and Nonobese Children. Am J Hypertens 2021; 34:619-625. [PMID: 33693473 DOI: 10.1093/ajh/hpab049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/23/2020] [Accepted: 03/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obesity and hypertension are public health priorities, with obesity considered to be a potential cause of hypertension. Accurate blood pressure (BP) determination is required and often obtained by automated oscillometric cuff devices. We sought to determine the correlation of oscillometric measurement in children, and if obesity was associated with worse correlation between methods than nonobese children. METHODS Retrospective matched case-controlled study of 100 obese (97-99th percentile) and 100 nonobese (25-70th percentile) children after cardiac surgery with simultaneous systolic, diastolic, and mean invasive and oscillometric measurements. Matching was 1:1 for age, sex, race, and Risk Adjustment for Congenital Heart Surgery-1 score. Intraclass correlation coefficients and Bland-Altman plots were used to determine agreement with 0.75 as threshold. RESULTS Median age was 13 years (10-15). Agreement was low for systolic (0.65 and 0.61), diastolic (0.68 and 0.61), and mean measurements (0.73 and 0.69) (obese/nonobese). Bland-Altman plots demonstrated oscillometric BP measurements underestimated systolic hypertension (oscillometric readings lower than intra-arterial). Oscillometric measurements underestimated hypotension (systolic oscillometric measurements were higher than intra-arterial). This occurred in obese and nonobese patients. Correlation of oscillometric measurements was similar for nonobese and obese patients. CONCLUSIONS In this first ever study of simultaneous BP measurement by oscillometric vs. intra-arterial in obese and nonobese children, correlation is below accepted norms. The correlation of oscillometric cuff measurements is not affected by habitus in children. There is less correlation between oscillometric measurements and intra-arterial measurements during hypertension or hypotension. Healthcare providers should be aware of the limitations of oscillometric measurements.
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Affiliation(s)
- Michael P Fundora
- Children’s Healthcare of Atlanta, Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Asaad G Beshish
- Children’s Healthcare of Atlanta, Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nikita Rao
- Children’s Healthcare of Atlanta, Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Janet Figueroa
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kevin O Maher
- Children’s Healthcare of Atlanta, Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Measurement reliability of automated oscillometric blood pressure monitor in the elderly with atrial fibrillation: a systematic review and meta-analysis. Blood Press Monit 2020; 25:2-12. [DOI: 10.1097/mbp.0000000000000414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Inoue A, Okamoto H, Hifumi T, Goto T, Hagiwara Y, Watase H, Hasegawa K. The incidence of post-intubation hypertension and association with repeated intubation attempts in the emergency department. PLoS One 2019; 14:e0212170. [PMID: 30742676 PMCID: PMC6370241 DOI: 10.1371/journal.pone.0212170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 01/29/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies in the non-emergency department (ED) settings have reported the relationships of post-intubation hypertension with poor patient outcomes. While ED-based studies have examined post-intubation hypotension and its sequelae, little is known about, post-intubation hypertension and its risk factors in the ED settings. In this context, we aimed to identify the incidence of post-intubation hypertension in the ED, and to test the hypothesis that repeated intubation attempts are associated with an increased risk of post-intubation hypertension. METHODS This study is a secondary analysis of the data from a multicenter prospective observational study of emergency intubations in 15 EDs from 2012 through 2016. The analytic cohort comprised all adult non-cardiac-arrest patients undergoing orotracheal intubation without pre-intubation hypotension. The primary exposure was the repeated intubation attempts, defined as ≥2 laryngoscopic attempts. The outcome was post-intubation hypertension defined as an increase in systolic blood pressure (sBP) of >20% along with a post-intubation sBP of >160 mmHg. To investigate the association of repeated intubation attempts with the risk of post-intubation hypertension, we fit multivariable logistic regression models adjusting for ten potential confounders and patient clustering within the EDs. RESULTS Of 3,097 patients, the median age was 69 years, 1,977 (64.0%) were men, and 991 (32.0%) underwent repeated intubation attempts. Post-intubation hypertension was observed in 276 (8.9%). In the unadjusted model, the incidence of post-intubation hypertension did not differ between the patients with single intubation attempt and those with repeated attempts (8.5% versus 9.8%, unadjusted P = 0.24). By contrast, after adjusting for potential confounders and patient clustering in the random-effects model, the patients who underwent repeated intubation attempts had a significantly higher risk of post-intubation hypertension (OR, 1.56; 95% CI, 1.11-2.18; adjusted P = 0.01). CONCLUSIONS We found that 8.9% of patients developed post-intubation hypertension, and that repeated intubation attempts were significantly associated with a significantly higher risk of post-intubation hypertension in the ED.
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Affiliation(s)
- Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Hyogo, Japan
- Faculty of Medicine, Graduate School of Medicine, Kagawa University, Miki, Kita, Kagawa, Japan
- * E-mail:
| | - Hiroshi Okamoto
- Center for Clinical Epidemiology, St. Luke’s International University, Chuo-ku, Tokyo, Japan
| | - Toru Hifumi
- Emergency and Critical Care medicine, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Yusuke Hagiwara
- Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Hiroko Watase
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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Celler BG, Argha A, Le PN, Ambikairajah E. Novel methods of testing and calibration of oscillometric blood pressure monitors. PLoS One 2018; 13:e0201123. [PMID: 30080862 PMCID: PMC6078288 DOI: 10.1371/journal.pone.0201123] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/09/2018] [Indexed: 12/03/2022] Open
Abstract
We present a robust method for testing and calibrating the performance of oscillometric non-invasive blood pressure (NIBP) monitors, using an industry standard NIBP simulator to determine the characteristic ratios used, and to explore differences between different devices. Assuming that classical auscultatory sphygmomanometry provides the best approximation to intra-arterial pressure, the results obtained from oscillometric measurements for a range of characteristic ratios are compared against a modified auscultatory method to determine an optimum characteristic ratio, Rs for systolic blood pressure (SBP), which was found to be 0.565. We demonstrate that whilst three Chinese manufactured NIBP monitors we tested used the conventional maximum amplitude algorithm (MAA) with characteristic ratios Rs = 0.4624±0.0303 (Mean±SD) and Rd = 0.6275±0.0222, another three devices manufactured in Germany and Japan either do not implement this standard protocol or used different characteristic ratios. Using a reference database of 304 records from 102 patients, containing both the Korotkoff sounds and the oscillometric waveforms, we showed that none of the devices tested used the optimal value of 0.565 for the characteristic ratio Rs, and as a result, three of the devices tested would underestimate systolic pressure by an average of 4.8mmHg, and three would overestimate the systolic pressure by an average of 6.2 mmHg.
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Affiliation(s)
- Branko G. Celler
- Biomedical Systems Research Laboratory, School of Electrical Engineering and Telecommunications, University of NSW, Sydney, NSW, Australia
| | - Ahmadreza Argha
- Biomedical Systems Research Laboratory, School of Electrical Engineering and Telecommunications, University of NSW, Sydney, NSW, Australia
| | - Phu Ngoc Le
- Biomedical Systems Research Laboratory, School of Electrical Engineering and Telecommunications, University of NSW, Sydney, NSW, Australia
| | - Eliathamby Ambikairajah
- Biomedical Systems Research Laboratory, School of Electrical Engineering and Telecommunications, University of NSW, Sydney, NSW, Australia
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Takahashi J, Goto T, Okamoto H, Hagiwara Y, Watase H, Shiga T, Hasegawa K. Association of fentanyl use in rapid sequence intubation with post-intubation hypotension. Am J Emerg Med 2018; 36:2044-2049. [PMID: 29653790 DOI: 10.1016/j.ajem.2018.03.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The anesthesia literature has reported that pre-intubation fentanyl use is associated with post-intubation hypotension which is a risk factor of poor post-emergency department (ED) prognosis. However, little is known about the relations between fentanyl use for intubation and post-intubation hypotension in the ED. We aimed to determine whether pretreatment with fentanyl was associated with a higher risk of post-intubation hypotension in the ED. METHODS We conducted a secondary analysis of data of ED airway management collected from a multicenter prospective study of 14 Japanese EDs from February 2012 through November 2016. We included all adult non-cardiac-arrest patients who underwent rapid sequence intubation for medical indication. Patients were divided into fentanyl and non-fentanyl groups. The primary outcome was post-intubation hypotension (systolic blood pressure ≤90mmHg) in the ED. RESULTS Of 1263 eligible patients, 466 (37%) patients underwent pretreatment with fentanyl. The fentanyl group had a higher risk of post-intubation hypotension (17% vs. 6%; unadjusted OR, 1.73; 95%CI, 1.01-2.97; P=0.048) compared to the non-fentanyl group. In the multivariable analysis adjusting for age, sex, weight, principal indication, sedatives, intubator's specialty, number of intubation attempts, and patient clustering within EDs, the fentanyl group had a higher risk of post-intubation hypotension (adjusted OR, 1.87; 95%CI, 1.05-3.34; P=0.03) compared to the non-fentanyl group. In the sensitivity analysis using propensity score matching, this association remained significant (OR, 3.17; 95%CI, 1.96-5.14; P<0.01). CONCLUSION In this prospective multicenter study of ED airway management, pretreatment with fentanyl in rapid sequence intubation was associated with higher risks of post-intubation hypotension.
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Affiliation(s)
- Jin Takahashi
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba 279-0001, Japan.
| | - Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street Boston, Suite 920, Boston, MA 02114, USA
| | - Hiroshi Okamoto
- Center for Clinical Epidemiology, St. Luke's International University, 3-6 Tsukiji, Chuo, Tokyo 104-0045, Japan
| | - Yusuke Hagiwara
- Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8561, Japan
| | - Hiroko Watase
- Department of Radiology, University of Washington, 850 Republican Street Seattle, WA 98006, USA
| | - Takashi Shiga
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba 279-0001, Japan; Department of Emergency Medicine, International University of Health and Welfare, 1-4-3 Mita, Minato, Tokyo 108-8329, Japan
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street Boston, Suite 920, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
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Celler BG, Le P, Basilakis J, Ambikairajah E. Improving the quality and accuracy of non-invasive blood pressure measurement by visual inspection and automated signal processing of the Korotkoff sounds. Physiol Meas 2017; 38:1006-1022. [DOI: 10.1088/1361-6579/aa6b7e] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Liu B, Li Q, Qiu P. Comparison between invasive and non-invasive blood pressure in young, middle and old age. Blood Press 2015; 25:155-61. [DOI: 10.3109/08037051.2015.1110935] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bing Liu
- Department of Cardiology, Jinan Fourth Hospital, Jinan, Shandong, PR China
| | - Qiao Li
- Institute of Biomedical Engineering, School of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Peng Qiu
- College of Science and Technology, Shandong Traditional Chinese Medicine University, Jinan, Shandong, PR China
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Keegan J, Raphael CE, Parker K, Simpson RM, Strain S, de Silva R, Di Mario C, Collinson J, Stables RH, Wage R, Drivas P, Sugathapala M, Prasad SK, Firmin DN. Validation of high temporal resolution spiral phase velocity mapping of temporal patterns of left and right coronary artery blood flow against Doppler guidewire. J Cardiovasc Magn Reson 2015; 17:85. [PMID: 26428627 PMCID: PMC4591589 DOI: 10.1186/s12968-015-0189-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 09/10/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Temporal patterns of coronary blood flow velocity can provide important information on disease state and are currently assessed invasively using a Doppler guidewire. A non-invasive alternative would be beneficial as it would allow study of a wider patient population and serial scanning. METHODS A retrospectively-gated breath-hold spiral phase velocity mapping sequence (TR 19 ms) was developed at 3 Tesla. Velocity maps were acquired in 8 proximal right and 15 proximal left coronary arteries of 18 subjects who had previously had a Doppler guidewire study at the time of coronary angiography. Cardiovascular magnetic resonance (CMR) velocity-time curves were processed semi-automatically and compared with corresponding invasive Doppler data. RESULTS When corrected for differences in heart rate between the two studies, CMR mean velocity through the cardiac cycle, peak systolic velocity (PSV) and peak diastolic velocity (PDV) were approximately 40 % of the peak Doppler values with a moderate - good linear relationship between the two techniques (R(2): 0.57, 0.64 and 0.79 respectively). CMR values of PDV/PSV showed a strong linear relationship with Doppler values with a slope close to unity (0.89 and 0.90 for right and left arteries respectively). In individual vessels, plots of CMR velocities at all cardiac phases against corresponding Doppler velocities showed a consistent linear relationship between the two with high R(2) values (mean +/-SD: 0.79 +/-.13). CONCLUSIONS High temporal resolution breath-hold spiral phase velocity mapping underestimates absolute values of coronary flow velocity but allows accurate assessment of the temporal patterns of blood flow.
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Affiliation(s)
- Jennifer Keegan
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Claire E Raphael
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Kim Parker
- Department of Bioengineering, Imperial College London, London, UK.
| | - Robin M Simpson
- Radiological Physics, University Medical Centre, Freiburg, Germany.
| | - Stephen Strain
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Ranil de Silva
- National Heart and Lung Institute, Imperial College London, London, UK.
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Carlo Di Mario
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Julian Collinson
- Department of Cardiology, Chelsea and Westminster Hospital, London, UK.
| | - Rod H Stables
- Institue of Cardiovascular Science and Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK.
| | - Ricardo Wage
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Peter Drivas
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Malindie Sugathapala
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - Sanjay K Prasad
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | - David N Firmin
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
- National Heart and Lung Institute, Imperial College London, London, UK.
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