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Frontiers of Medicine

Front Med    2013, Vol. 7 Issue (1) : 91-101     DOI: 10.1007/s11684-013-0239-5
REVIEW |
Non-invasive continuous blood pressure monitoring: a review of current applications
Elena Chung1, Guo Chen2, Brenton Alexander1, Maxime Cannesson1()
1. Department of Anesthesiology & Perioperative Care, University of California, Irvine, CA 92868, USA; 2. Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, China
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Abstract

Blood pressure monitoring has come a long way from the initial observations made by Reverend Hales in the 18th century. There are none that deny the importance of monitoring perioperative blood pressure; however, the limited ability of the current prevalent technology (oscillometric blood pressure monitoring) to offer continuous blood pressure measurements leaves room for improvement. Invasive monitoring is able to detect beat-to-beat blood pressure measurement, but the risks inherent to the procedure make it unsuitable for routine use except when this risk is outweighed by the benefits. This review focuses on the discoveries which have led up to the current blood pressure monitoring technologies, and especially the creation of those offering non-invasive but continuous blood pressure monitoring capabilities, including their methods of measurement and limitations.

Keywords non-invasive blood pressure monitoring      continuous blood pressure monitoring      invasive blood pressure monitoring      Riva-Rocci technique      oscillometric      Pe?áz technique      arterial tonometry      pulse transit time     
Corresponding Authors: Cannesson Maxime,Email:mcanness@uci.edu   
Issue Date: 05 March 2013
 Cite this article:   
Elena Chung,Guo Chen,Brenton Alexander, et al. Non-invasive continuous blood pressure monitoring: a review of current applications[J]. Front Med, 2013, 7(1): 91-101.
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http://journal.hep.com.cn/fmd/EN/Y2013/V7/I1/91
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Elena Chung
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Maxime Cannesson
Fig.1  The first description of blood pressure is often attributed to a country parson, Revered Stephen Hales, in the 18th century. (This image is in the public domain and has been downloaded from the US National Library of Medicine website, http://www.nlm.nih.gov/hmd/ihm/, accessed on April 5, 2012.)
Fig.2  Mercury manometer developed by Poiseuille. (This image is in the public domain and has been downloaded from the US National Library of Medicine website, http://www.nlm.nih.gov/hmd/ihm/, accessed on April 5, 2012.)
Fig.3  Kymograph developed by Ludwig in 1847. (This image is in the public domain and has been downloaded from the US National Library of Medicine website, http://www.nlm.nih.gov/hmd/ihm/, accessed on April 5, 2012.)
Fig.4  In 1855, Vierordt created a non-invasive technique of measuring blood pressure with the sphygmograph. (This image is in the public domain and has been downloaded from the US National Library of Medicine website, http://www.nlm.nih.gov/hmd/ihm/, accessed on April 5, 2012.)
Fig.5  In 1905, Korotkoff, a Russian surgeon, discovered the method in use for over a century — the auscultatory method — which required the inflatable blood pressure cuff and stethoscope. (This image is in the public domain and has been downloaded from Wikimedia website, http://commons.wikimedia.org/wiki/Main_Page, accessed on April 5, 2012.)
Fig.6  Sphygomanometer. (This image is in the public domain and has been downloaded from Wikimedia website, http://commons.wikimedia.org/wiki/Main_Page, accessed on April 5, 2012.)
Method of measurementAdvantagesLimitations
KorotkoffManual auscultatory technique where cuff is inflated and slowly deflated while practitioner listens over brachial artery for Korotkoff sounds (phase I–V)Clinical “gold standard” for non-invasive monitoringInexpensiveNo risk to patient Relies on “trained” personnel Subjective method with possible human errorCuff sizing errorCannot be done continuously
OscillometricAutomated technique where cuff is inflated and slowly deflated while a pressure sensor detects oscillationsConvenientInexpensiveRequires little to no operator skillCuff sizing errorCannot be done continuously
Arterial lineDirect arterial catheterization (radial, femoral, brachial, etc.) connected through a fluid column to a pressure transducer“Gold standard” for invasive monitoringContinuous monitoringRisk to the patientRequires “trained” personnel to place appropriately
Pe?ásVolume clamp method which utilizes a finger cuff that adjusts pressure order to keep optically measured finger vascular volume constantConvenientNon-invasiveContinuous monitoringExpensiveAffected by factors such as cold extremities, vasopressorsNeeds calibration via another method
TonometryUses applanation (flattening) of the radial artery and measures pressure transmitted through skinNon-invasiveContinuous monitoringExpensiveManual positioning of tonometer over radial artery not always accurate
Pulse transit time (photometric)Pulse transducers located at two different sites records the time it takes for a arterial wave to travel between these two pointsNon-invasiveContinuous monitoringRequires no additional monitors over standard ASA monitorsNot fully developed to correlate pulse transit time to blood pressure
Tab.1  Different techniques for blood pressure monitoring
Fig.7  Demonstration of non-invasive and beat-to-beat arterial pressure monitoring systems (“Nexfin,” BMeye [top], and “CNAP,” CNSystem [bottom]).
Fig.8  Demonstration of an arterial tonometry device (T-Line, Tensys Medical).
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