JAAOS - 2026-09-04 - Journal Article
Postoperative Noninvasive Blood Pressure Monitoring for Patients With Osteogenesis Imperfecta Is Safe and Feasible.
McCarthy A, Hadley M, Zhang R, Sacks K, Miller DJ, Tramontozzi CM, Dubowy SM, Shah SA, Franzone JM
Topics
Key Takeaway
A standardized NIBP protocol with capped inflation pressures (120 mmHg pediatric, 140 mmHg adult) and manual nurse assessment produced zero fractures across 50 OI patients with an average of 9.5 postoperative BP measurements each.
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Summary
This study evaluated whether a structured NIBP protocol could safely replace arterial line monitoring in OI patients (moderate 48%, severe 42%) undergoing spine or extremity surgery, using capped cuff inflation pressures and pre/post-measurement limb inspection by nursing staff. Across 50 patients (median age 12.5 years), 33% with rodded humeri, no fractures occurred over a mean of 9.5 BP measurements per patient. Two withdrawals (4%) were unrelated to cuff complications, supporting protocol feasibility.
Key Limitation
Single-center, high-volume OI program with specialist surgeon pre-screening makes it impossible to determine whether this protocol is safe when implemented without OI-specific expertise.
Original Abstract
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.