J Clin Monit Comput - The mean prehospital machine; accurate prehospital non-invasive blood pressure measurement in the critically ill patient.


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JECTIVE: Non-invasive blood pressure recordings may be inaccurate in the critically ill patient and measurement difficulties are intensified in the prehospital setting. This may adversely impact upon outcomes for many critically ill patients, particularly those with traumatic brain injury and/or lengthy prehospital times. This study aimed to validate a non-invasive, oscillometric, ambulatory blood pressure measuring device, the Oscar 2, Model 222 (SunTech Medical, Morrisville, USA) during the ambulance transport of critically ill patients.METHODS: We have previously shown that mean arterial blood pressures observed by Intensive Care Unit nurses from a patient monitor can be considered interchangeable with reference intra-arterial integrated mean pressures. In the current study, we compared non-invasive device mean pressures to intra-arterial pressures observed by retrieval nurses from the patient monitor, during the ambulance transportation of critically ill patients. Device performance was required to fulfil the Association for the Advancement of Medical Instrumentation (AAMI) protocol requirements. Additionally, linear mixed effects analyses and Bland-Altman comparisons were undertaken.RESULTS: For 157 measurements recorded from 23 patients, when the Oscar 2 did not indicate a measurement was associated with a fault, the device fulfilled the AAMI protocol requirements, with a mean error of -1.1 mmHg (standard deviation 7.8 mmHg), 95% confidence intervals (linear mixed effects analysis) -2.9, 0.8; P = 0.26. Bland-Altman plots indicated uniform agreement across a wide range of blood pressures. Sixteen percent of recordings were associated with a patient, environment, or device generated fault.CONCLUSIONS: When the Oscar 2 does not indicate a fault has occurred, clinicians may be confident the mean pressure, within acceptable limits, is accurate, even during ambulance motion, administration of high doses of vasopressors and mechanical ventilation. The Oscar 2 appears to be an accurate and rugged out-of-hospital device.

Resumo Limpo

jectiv noninvas blood pressur record may inaccur critic ill patient measur difficulti intensifi prehospit set may advers impact upon outcom mani critic ill patient particular traumat brain injuri andor lengthi prehospit time studi aim valid noninvas oscillometr ambulatori blood pressur measur devic oscar model suntech medic morrisvill usa ambul transport critic ill patientsmethod previous shown mean arteri blood pressur observ intens care unit nurs patient monitor can consid interchang refer intraarteri integr mean pressur current studi compar noninvas devic mean pressur intraarteri pressur observ retriev nurs patient monitor ambul transport critic ill patient devic perform requir fulfil associ advanc medic instrument aami protocol requir addit linear mix effect analys blandaltman comparison undertakenresult measur record patient oscar indic measur associ fault devic fulfil aami protocol requir mean error mmhg standard deviat mmhg confid interv linear mix effect analysi p blandaltman plot indic uniform agreement across wide rang blood pressur sixteen percent record associ patient environ devic generat faultconclus oscar indic fault occur clinician may confid mean pressur within accept limit accur even ambul motion administr high dose vasopressor mechan ventil oscar appear accur rug outofhospit devic

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