Janos Cambiaso-Daniel1, Victoria G Rontoyanni2, Guillermo Foncerrada3, Anthony Nguyen4, Karel D Capek5, Paul Wurzer6, Jong O Lee7, Gabriel Hundeshagen8, Charles D Voigt9, Ludwik K Branski10, Celeste C Finnerty11, David N Herndon12. 1. Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria. Electronic address: janos.cambiaso-daniel@medunigraz.at. 2. Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Metabolism Unit, Shriners Hospitals for Children, Galveston, TX, USA. Electronic address: virodoyi@utmb.edu. 3. Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA. Electronic address: gffoncer@utmb.edu. 4. School of Medicine, University of Texas Medical Branch, Galveston, TX, USA. Electronic address: antvnguy@utmb.edu. 5. Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA. Electronic address: kdcapek@utmb.edu. 6. Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria. Electronic address: paul.wurzer@medunigraz.at. 7. Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA. Electronic address: jolee@utmb.edu. 8. Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany. Electronic address: gahundes@utmb.edu. 9. Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA. Electronic address: CharlesVoigt@creighton.edu. 10. Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria. Electronic address: lubransk@utmb.edu. 11. Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA. Electronic address: ccfinner@utmb.edu. 12. Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA. Electronic address: dherndon@utmb.edu.
Abstract
INTRODUCTION: Accurate blood pressure monitoring is essential for burn management, with the intra-arterial line method being the gold standard. Here we evaluated agreement between cuff and intra-arterial line methods. METHODS: Data from burned children admitted from 1997 to 2016 were retrospectively reviewed. Simultaneously collected intra-arterial and cuff measurements were cross-matched and linear regression performed to assess agreement for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). RESULTS: We identified 9969 matches for SBP, DBP, and MAP in 872 patients (579 male) aged 8±5years with burns covering 52±20% of the total body surface area and a hospitalization lasting 33±31 days. Intra-arterial lines had a complication rate of 1%. The mean bias (95% CI) between methods was 1.3 (0.5, 2.1) mm Hg for SBP, -6.4 (-7.0, -5.7) mmHg for DBP, and -5.8 (-6.4, -5.3) mmHg for MAP. The standard deviation of the bias (95% limit of agreement) was 12.1 (-22.5, 25.1) mmHg for SBP, 9.9 (-25.8, 13.0) mmHg for DBP, and 8.7 (-22.8, 11.1) mmHg for MAP. CONCLUSIONS: Cuff measurements vary widely from those of intra-arterial lines, which have a low complication rate. Intra-arterial lines are advisable when tight control of the hemodynamic response is essential.
INTRODUCTION: Accurate blood pressure monitoring is essential for burn management, with the intra-arterial line method being the gold standard. Here we evaluated agreement between cuff and intra-arterial line methods. METHODS: Data from burned children admitted from 1997 to 2016 were retrospectively reviewed. Simultaneously collected intra-arterial and cuff measurements were cross-matched and linear regression performed to assess agreement for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). RESULTS: We identified 9969 matches for SBP, DBP, and MAP in 872 patients (579 male) aged 8±5years with burns covering 52±20% of the total body surface area and a hospitalization lasting 33±31 days. Intra-arterial lines had a complication rate of 1%. The mean bias (95% CI) between methods was 1.3 (0.5, 2.1) mm Hg for SBP, -6.4 (-7.0, -5.7) mmHg for DBP, and -5.8 (-6.4, -5.3) mmHg for MAP. The standard deviation of the bias (95% limit of agreement) was 12.1 (-22.5, 25.1) mmHg for SBP, 9.9 (-25.8, 13.0) mmHg for DBP, and 8.7 (-22.8, 11.1) mmHg for MAP. CONCLUSIONS: Cuff measurements vary widely from those of intra-arterial lines, which have a low complication rate. Intra-arterial lines are advisable when tight control of the hemodynamic response is essential.
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