Intra-Arterial Versus Noninvasive Blood Pressure Monitoring: A Systematic Review and Meta-Analysis

Lauren Becker, Lauren Becker is a critical care medicine fellow, Department of Internal Medicine, University of Maryland School of Medicine, Baltimore.
Vera Bzhilyanskaya, Vera Bzhilyanskaya is a medical student, University of Maryland School of Medicine.
Arjun Sharman, Arjun Sharman is a medical student, University of Maryland School of Medicine.
Madison Moran, Madison Moran is a research associate in emergency medicine and critical care, Department of Emergency Medicine, University of Maryland School of Medicine.
Jasjot Sayal, Jasjot Sayal is a research associate in emergency medicine and critical care, Department of Emergency Medicine, University of Maryland School of Medicine.
Anandita Gaur, Anandita Gaur is a research associate in emergency medicine and critical care, Department of Emergency Medicine, University of Maryland School of Medicine.
Anna Shaw, Anna Shaw is a research associate in emergency medicine and critical care, Department of Emergency Medicine, University of Maryland School of Medicine.
Emily Gorman, Emily Gorman is a research and education librarian, Health Sciences and Human Services Library, University of Maryland, Baltimore.
Ali Pourmand, Ali Pourmand is a professor, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Quincy K. Tran, Quincy K. Tran is director, Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine; an associate professor, Department of Emergency Medicine and Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine.

Document Type

Journal Article

Publication Date

7-1-2025

Journal

American journal of critical care : an official publication, American Association of Critical-Care Nurses

Volume

34

Issue

4

DOI

10.4037/ajcc2025348

Abstract

BACKGROUND: Invasive intra-arterial blood pressure (IABP) monitoring is common in critical care. However, IABP might be unnecessary if noninvasive blood pressure (NIBP) measurements are similar to IABP measurements. OBJECTIVES: To investigate differences between IABP and NIBP measurements and their clinical relevance. METHODS: In a systematic review and meta-analysis, multiple databases were searched for eligible studies from inception to September 2023. Primary and secondary outcomes were differences between invasive and noninvasive measurements of systolic blood pressure (SBP) and mean arterial pressure (MAP), respectively. Tertiary outcomes were differences of 10 mm Hg or greater in SBP and MAP between IABP and NIBP measurements. Outcomes were expressed as standardized mean differences and 95% CIs. Study quality and heterogeneity were assessed. The study was registered with PROSPERO (CRD42022383924). RESULTS: The meta-analysis included 23 observational studies (6549 patients). Standardized mean differences between IABP and NIBP measurements were 0.238 (95% CI, 0.121-0.355; P < .001; I2 = 87%) for SBP and 0.062 (95% CI, -0.065 to 0.189; P = .34; I2 = 87%) for MAP. Bland-Altman plots demonstrated that SBP values were often lower with NIBP than with IABP measurements. The prevalence (95% CI) of differences of 10 mm Hg or greater was 0.500 (0.415-0.584) for SBP and 0.330 (0.227-0.452) for MAP. CONCLUSIONS: Measurement via NIBP may underestimate SBP; differences of 10 mm Hg or greater are relatively frequent. The clinical relevance of these differences remains unclear.

Department

Emergency Medicine

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