Continuous Non-Invasive Arterial Pressure Technique Improves Patient Monitoring during Interventional Endoscopy

Abstract

Introduction: Close monitoring of arterial blood pressure (BP) is a central part of cardiovascular surveillance of patients at risk for hypotension. Therefore, patients undergoing diagnostic and therapeutic procedures with the use of sedating agents are monitored by discontinuous non-invasive BP measurement (NIBP). Continuous non-invasive BP monitoring based on vascular unloading technique (CNAP®, CN Systems, Graz) may improve patient safety in those settings. We investigated if this new technique improved monitoring of patients undergoing interventional endoscopy.Methods: 40 patients undergoing interventional endoscopy between April and December 2007 were prospectively studied with CNAP® in addition to standard monitoring (NIBP, ECG and oxygen saturation). All monitoring values were extracted from the surveillance network at one-second intervals, and clinical parameters were documented. The variance of CNAP® values were calculated for every interval between two NIBP measurements.Results: 2660 minutes of monitoring were recorded (mean 60.1±34.4 min/patient). All patients were analgosedated with midazolam and pethidine, and 24/40 had propofol infusion (mean 90.9±70.3 mg). The mean arterial pressure for CNAP® was 102.4±21.2 mmHg and 106.8±24.8 mmHg for NIBP. Based on the first NIBP value in an interval between two NIBP measurements, BP values determined by CNAP® showed a maximum increase of 30.8±21.7% and a maximum decrease of 22.4±28.3% (mean of all intervals).Discussion: Conventional intermittent blood pressure monitoring of patients receiving sedating agents failed to detect fast changes in BP. The new technique CNAP® improved the detection of rapid BP changes, and may contribute to a better patient safety for those undergoing interventional procedures.

Measurement of blood pressure

“…A randomized controlled trial showed that the time spent in hypotension was significantly shorter using continuous CNAP monitoring compared with oscillometry in patients undergoing thyroid surgery in an upright position [58]. The CNAP system improved the detection of fast BP changes in patients receiving sedating agents during interventional endoscopy [59]. Further, it has high potential to improve patient safety during caesarian section [60] and in acutely ill patients admitted to the emergency room [45] -clinical scenarios in which arterial cannulation is not clearly indicated or challenging.…”

“…Noninvasive continuous BP monitoring technologies can improve patient monitoring during interventions and in the operating theatre [58][59][60]. In order to raise the acceptance and application in clinical routine, the next most …”

A comparison of a continuous noninvasive arterial pressure (CNAP™) monitor with an invasive arterial blood pressure monitor in the cardiac surgical ICU

“…This requirement is most commonly met by the placement of an intraarterial catheter and connecting it to a pressure monitoring system, which is considered as the "gold standard" of ABP measurement in patients who may experience rapid changes Recent studies showed that continuous noninvasive ABP measurements generated by a new device, called Infinity ® CNAP™ SmartPod ® (Draeger Medical Systems Inc., Telford, PA, USA), have been superior to intermittent oscillometric measurements during sedation for interventional endoscopy, [3] spinal anesthesia for caesarean section [4] and during general anesthesia. [5] The basic principle of CNAP™ is the vascular unloading technique described by Penaz.…”

Continuous noninvasive arterial pressure

“…CNAP has proven to be superior to the intermittent oscillometric measurements as it can detect rapid changes better [3][4][5]. CNAP has proven to be superior to the intermittent oscillometric measurements as it can detect rapid changes better [3][4][5].…”