Validation of a noninvasive blood pressure monitoring device in normotensive and hypertensive pediatric intensive care patients

Objective: To evaluate the performance and to define limitations of a noninvasive blood pressure monitoring device in the critically ill pediatric population. Method. Patients were included in the study if they were admitted to the Pediatric Intensive Care Unit, were between the ages of 1 month and 18 years with wrist circumferences of ≥ 10 cm, and had an indwelling arterial line. Patients were excluded if their systolic blood pressure differed by ≥ 7.5% between their upper extremities. The measurements were collected simultaneously with those from an arterial line by a computer interfaced with the noninvasive blood pressure monitoring system and the patient's monitor. Heart rates were calculated from the recorded pulse waveforms of the arterial lines. Comparison analyses were performed via bias and precision plots of the blood pressure and heart rate data in addition to calculation of Pearson's correlation coefficients and concordance correlation coefficients. As a nonparametric method of comparison, the proportion of measurements that differed by greater than 10% was calculated. Results. Blood pressures and heart rates of 20 patients between the ages of 12 months and 17 years were monitored by a noninvasive blood pressure monitor for 30 min per patient. This data collection resulted in 2015 data points for each blood pressure and heart rate for comparison of methods. Concordance correlation coefficients were the following: systolic blood pressure, 0.93; diastolic blood pressure, 0.93; mean blood pressure, 0.94; and heart rate, 0.85. Conclusions. The noninvasive blood pressure monitor is capable of producing an accurate blood pressure measurement every 12-15 heartbeats in addition to providing a pulse waveform and digital display of the heart rate. Our study showed good agreement between the methods in the normotensive and hypertensive critically ill pediatric population with a wrist circumference limitation defined at ≥ 11 cm. © Springer Science + Business Media, Inc. 2005.