Blood Pressure Monitoring in Critically Ill Patients

­­When it comes to treating critically-ill patients in hospitals, you’d think there’d be consensus on how to monitor their blood pressure. But a recent article appearing in the Journal of Critical Care Medicine casts some doubt on that assertion.

The article summarizes survey results which polled a group of physicians, fellows, nurses, and medical students that work in intensive care units (ICUs) in the United States. The authors write that while both non-invasive blood pressure (NIBP) and inter-arterial blood pressure (IABP) are commonly used in the ICU, there appears to be quite a bit of variance with the types of patients on which NIBP is used, how NIBP is used to make management decisions, and even on how to determine what size cuff to put on a patient!

Alarmingly, only 19% of the respondents said that they measured the patient’s arm directly, and 11% did not know how cuff size was determined. The balance of responders simply estimated which cuff size to use—in other words, they took an educated guess.

While there have been plenty of studies that emphasize the importance of correct cuff sizing, the authors note that there isn’t much published guidance for health professionals when it comes to the use of NIBP on ICU patients, which surely only adds to the confusion. What is perhaps most troubling about these results is that ICU patients are usually quite ill and desperately in need of the best possible medical care.

While NIBP is certainly a valuable tool for assessing patient health and guiding treatments, there clearly needs to be more work done on how it should be used for seriously ill patients. But clinical use notwithstanding, there’s really no excuse for improper technique.