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Measurement of blood pressure

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Blood pressure is overwhelmingly the most commonly measured parameter for the assessment of haemodynamic stability. In clinical routine in the operating theatre and in the intensive care unit, blood pressure measurements are usually obtained intermittently and non-invasively using oscillometry (upper-arm cuff method) or continuously and invasively with an arterial catheter. However, both the oscillometric method and arterial catheter-derived blood pressure measurements have potential limitations. A basic technical understanding of these methods is crucial in order to avoid unreliable blood pressure measurements and consequential treatment errors. In the recent years, technologies for continuous non-invasive blood pressure recording such as the volume clamp method or radial artery applanation tonometry have been developed and validated. The question in which patient groups and clinical settings these technologies should be applied to improve patient safety or outcome has not been definitively answered. In critically ill patients and high-risk surgery patients, further improvement of these technologies is needed before they can be recommended for routine clinical use.

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Why and since when do we measure blood pressure?

The first recorded measurement of blood pressure (BP) as a marker of circulation took place in the middle of the 18th century with the experiments of the reverend Stephen Hales in England [1]. He performed direct BP measurements in a horse by inserting a 3-m-high glass tube into an artery and determining the height of the rising blood column. Then he let the horse bleed and repeated the BP measurement. This was performed several times in a row – the BP progressively decreased – until the horse

The arterial BP waveform

The first device for recording a human pulse wave with a transducer was probably developed in 1855 by the physiologist Karl von Vierordt [5]. A permanent record of pulse curves was obtained by levers on the radial artery and weights to determine the amount of external pressure that was necessary to stop the blood flow in the radial artery. A few years later, Étienne-Jules Marey further developed the method and invented the sphygmograph [6]. The British physician Frederick Akbar Mohamed later

Invasive BP measurement using an arterial catheter

Continuous direct arterial BP measurement with an invasive catheter has become a standard of care for critically ill patients and for BP monitoring during higher-risk surgical or interventional procedures. Particularly in view of the broad use of invasive BP recordings, usually by placing an arterial catheter in the radial, brachial or femoral artery, every anaesthesiologist and intensivist must be aware of the weaknesses, risks and pitfalls of this widely accepted clinical gold standard. This

Intermittent non-invasive BP measurement: the oscillometric method

Over 30 years ago, the first devices for oscillometric arterial BP measurement became commercially available. BP measurement using an upper-arm cuff dates back to 1896 when Riva-Rocci introduced it into clinical sphygmomanometry [32]. Since then, arterial BP was determined by an upper-arm cuff and palpation and later (1905) by detecting the Korotkoff sounds. The principle of oscillometry was first described by Marey in 1875 and further established by Erlanger [33]. Oscillations of the arterial

Continuous non-invasive BP measurements

Continuous non-invasive BP monitoring systems are now available in the operating theatre or at the bedside. They are based on either the volume clamp method or radial artery applanation tonometry. Both systems provide a continuous arterial BP waveform without the risks of an arterial catheter [46]. With regard to a consensus statement on haemodynamic monitoring that declared an ‘ideal haemodynamic monitoring technique provides accurate and reproducible measurements, is easy to use, is readily

The volume clamp method

The Czech physiologist Jan Peňáz was the first to describe in 1973 a new approach to continuously and non-invasively measure BP using the finger arteries – the so-called volume clamp method (also named the vascular unloading technique) [48]. In the following years, the method was continuously developed further and improved by Peňáz himself and other scientists [49], [50], [51], *[52]. The volume clamp method basically functions as follows: an inflatable finger cuff containing an infrared

Radial artery applanation tonometry

The first approaches to measure arterial BP non-invasively by applanation tonometry date back to the 1960s when Pressman and Newgard published their findings about transducers used to measure BP at large superficial arteries [64]. They described an artery wall flattening as essential for maximum pulse amplitude sensing. Later, this newly developed method was further supported by the work of Stein and Blick [65] as well as by Drzewiecki and Nordergraaf [66]. The applanation tonometry required

Non-invasive continuous BP measurement devices – the future?

The non-invasive continuous BP monitoring devices available today are promising considering the potential improvement of patient safety in a variety of clinical settings. Particularly with regard to the shortcomings of the widely used and well-accepted oscillometric method, the non-invasive technologies deserve the practising physician's attention as a valid alternative. Non-invasive continuous BP monitoring technologies can improve patient monitoring during interventions and in the operating

Summary

In clinical routine in the operating theatre and the ICU, BP measurements are usually obtained intermittently and non-invasively using oscillometry (upper-arm cuff method) or continuously and invasively with an arterial catheter. Although the oscillometric method and invasive arterial catheters are both routinely used and well accepted for BP measurement, they have potential limitations. Every anaesthesiologist and intensivist must understand the underlying technology basics in order to

Conflict of interest statement

BS received unrestricted research grants from Tensys Medical, Inc. (San Diego, CA, USA) and refunds of travel expenses from CNSystems Medizintechnik AG (Graz, Austria). BS collaborates with Pulsion Medical Systems SE (Feldkirchen, Germany) as member of the Medical Advisory Board.
RD has received research funding from Tensys Medical, Inc. (San Diego, CA, USA), via contract with Veterans Medical Research Foundation, San Diego, CA, and currently serves as a member of the Medical Advisory Board of

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