PubMed abstract / permitted excerpt

INTRODUCTION: Osteogenesis imperfecta (OI) is a type I collagen disorder. Fragile and deformed bones increase fracture risk with noninvasive blood pressure (NIBP) cuff use. Patients with OI require multiple surgeries, with blood loss and pain medications risking hypotension. There is not currently a widely accepted protocol for NIBP measurements in patients with OI. We designed a protocol demonstrating the safe implementation of "busting the myth" that this is not feasible. METHODS: We prospectively enrolled patients with OI undergoing spine or extremity procedures. Inclusion criteria were approval by an orthopaedic surgeon, age 1 to 35 years, and postoperative admittance to a non-intensive care unit (ICU). To minimize fracture risk and detect hypotension, low maximum inflation pressures were used: 120 mmHg-neonatal/infant/pediatric-sized cuffs; 140 mmHg-adult cuffs. Blood pressure (BP) measurements were taken per standard institutional postoperative care: no more than every 4 hours for 24 hours and every 8 hours or less thereafter. Upper extremity BP was measured manually by registered nurses who inspected the limb and inquired regarding signs of fracture (pain with palpation and bruising) before and after each measurement. RESULTS: Fifty participants were enrolled (median age 12.5 years; 25 girls). Most had moderate (48%) or severe (42%) disease. Twenty-eight patients underwent extremity surgery, and 22 underwent spine surgery. Thirty-three percent of the humeri used were rodded, with an average of 9.5 BP measurements taken postoperatively. Clinical assessment revealed that no fractures occurred. Two participants (4%) withdrew for reasons unrelated to BP cuff complications. CONCLUSION: Noninvasive BP measurements may be safely obtained in the postoperative period for patients with OI. This study was conducted in a system with a high volume of OI care, and OI-specialized orthopaedic surgeons screened the patients. Within these limitations, we recommend manual cuff use and careful fracture monitoring. This protocol may help patients with OI across other hospitals avoid postoperative arterial catheters and ICU admission and could facilitate preventive care for cardiovascular disease.