Accuracy and precision of continuous, non-invasive blood pressure devices: a systematic review and meta-analyses.
Stefanie Lischker, Gunther J Pestel, Irene Schmidtmann et al.
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In 30 seconds
This systematic review and six meta-analyses assessed continuous non-invasive blood pressure technologies against invasive arterial measurements in adults, using data from 65 studies. The review examined volume clamp, applanation tonometry and photoplethysmography devices, evaluating bias and precision for mean, systolic and diastolic pressure against AAMI criteria. Most devices did not meet the criteria for both bias and standard deviation, and limits of agreement were wide. Among the devices assessed, N-CAT met AAMI standard-deviation criteria for all three pressure measures; photoplethysmography met them for MAP and DBP.
Key findings
- None of the volume clamp technologies met AAMI criteria for bias and standard deviation across MAP, SBP and DBP.
- N-CAT met AAMI standard-deviation criteria for MAP (6.97 mmHg), SBP (7.14 mmHg) and DBP (6.55 mmHg).
- Photoplethysmography met AAMI criteria for bias and standard deviation for MAP (-0.09 mmHg; 6.86 mmHg) and DBP (-0.26 mmHg; 6.38 mmHg).
- T-Line, Vasotrac and N-CAT met AAMI bias criteria for MAP, SBP and DBP, but only N-CAT met standard-deviation criteria for all three.
Why it matters
Continuous non-invasive monitoring may offer an alternative to arterial catheter measurement, but agreement with invasive readings is important when blood pressure informs peri-operative management. The review indicates that performance varies by technology and pressure measure, and that acceptable average bias alone does not ensure adequate precision. Awareness of these differences can help prevent assuming that non-invasive and invasive readings are interchangeable.
What to keep in mind
The review reports wide limits of agreement and that most devices did not meet AAMI criteria for both bias and standard deviation.