Pression artérielle non invasive : principes et indications aux urgences et en réanimation

Non-invasive blood pressure measurements, using sphygmomanometry or oscillometry are heavily biased towards invasive intra-arterial measurements. Limits of agreement are large and blood pressure may be overestimated in some patients and underestimated in others. Sphygmomanometry allows measurement of systolic and arterial pressures, mean arterial pressure being calculated using a formula not validated in shocked patients. Only mean arterial pressure can be reliably measured using oscillometry. Despite these important drawbacks which render precise non invasive arterial blood pressure measurement delusive, oscillometry may find clinical applications in the setting of acute hypotension. In fact, performance for detecting patients with a mean arterial pressure below 65 mmHg is fair and performance for detecting a 10% increase in mean arterial pressure is good. These clinical objectives of blood pressure measurement being more relevant than crude precision itself deserve to be further evaluated.