Continuous Noninvasive Arterial Pressure Monitoring Using the Vascular Unloading Technique (CNAP System) in Obese Patients During Laparoscopic Bariatric Operations

Rogge, Dorothea E.; Nicklas, Julia Y.; Haas, Sebastian; Reuter, Daniel A.; Saugel, Bernd

doi:10.1213/ane.0000000000002660

Cited by 23 publications

(13 citation statements)

References 26 publications

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“…The validity of non-invasive or semi-invasive CO measurements has been demonstrated in previous studies in different populations including normal-weight patient groups and surgical settings [11,[33][34][35]. In morbidly obese patients undergoing bariatric surgery, 4 prospective observational studies tested the performance of the vascular unloading technique for arterial blood pressure measurements [36][37][38][39]. While the one study did not demonstrate interchangeability between the Nexfin® system and Riva-Rocci/Korotkoff-derived blood pressure measurements in 33 patients [36], the other three studies could show clinically useful trend ability of the arterial pressure values [37][38][39].…”

Section: Discussionmentioning

confidence: 98%

“…In morbidly obese patients undergoing bariatric surgery, 4 prospective observational studies tested the performance of the vascular unloading technique for arterial blood pressure measurements [36][37][38][39]. While the one study did not demonstrate interchangeability between the Nexfin® system and Riva-Rocci/Korotkoff-derived blood pressure measurements in 33 patients [36], the other three studies could show clinically useful trend ability of the arterial pressure values [37][38][39]. Thus far, evidence on non-or semi-invasive CI measurements in the perioperative setting of bariatric surgery is limited to one case series and one prospective observational study [10,40].…”

Section: Discussionmentioning

confidence: 99%

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Perioperative non-invasive versus semi-invasive cardiac index monitoring in patients with bariatric surgery – a prospective observational study

Lorenzen¹,

Pohlmann²,

Hansen³

et al. 2020

BMC Anesthesiol

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Background: In morbidly obese patients undergoing laparoscopic bariatric surgery, the combination of obesityrelated comorbidities, pneumoperitoneum and extreme posture changes constitutes a high risk of perioperative hemodynamic complications. Thus, an advanced hemodynamic monitoring including continuous cardiac index (CI) assessment is desirable. While invasive catheterization may bear technical difficulties, transesophageal echocardiography is contraindicated due to the surgical procedure. Evidence on the clinical reliability of alternative semi-or non-invasive cardiac monitoring devices is limited. The aim was to compare the non-invasive vascular unloading to a semi-invasive pulse contour analysis reference technique for continuous CI measurements in bariatric surgical patients. Methods: This prospective observational study included adult patients scheduled for elective, laparoscopic bariatric surgery after obtained institutional ethics approval and written informed consent. CI measurements were performed using the vascular unloading technique (Nexfin®) and semi-invasive reference method (FloTrac™). At 10 defined measurement time points, the influence of clinically indicated body posture changes, passive leg raising, fluid bolus administration and pneumoperitoneum was evaluated pre-and intraoperatively. Correlation, Bland-Altman and concordance analyses were performed.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Perioperative non-invasive versus semi-invasive cardiac index monitoring in patients with bariatric surgery – a prospective observational study

Lorenzen¹,

Pohlmann²,

Hansen³

et al. 2020

BMC Anesthesiol

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“…In short, the analysis includes blood pressure wave form documentation and provides derived parameters. The device has been validated in clinical trials indicating an excellent comparability with invasive measurements ( Smolle et al, 2015 ; Wagner et al, 2015 ; Rogge et al, 2017 ). In the course of preparations of the project, a specially trained CNAP ® instructor was invited from Austria for hands-on training sessions with our team of operators.…”

Section: Methodsmentioning

confidence: 99%

Comprehensive Analysis of Macrocirculation and Microcirculation in Microgravity During Parabolic Flights

et al. 2020

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Background Profound knowledge about cardiovascular physiology in the setting of microgravity can help in the course of preparations for human space missions. So far, influences of microgravity on the cardiovascular system have been demonstrated, particularly pertaining to venous fluid shifts. Yet, little is known about the mechanisms of these adaptations on continuous macrocirculatory level and regarding the microcirculation. Methods Twelve healthy volunteers were subjected to alternating microgravity and hypergravity in the course of parabolic flight maneuvers. Under these conditions, as well as in normal gravity, the sublingual microcirculation was assessed by intravital sidestream dark field microscopy. Furthermore, hemodynamic parameters such as heart rate, blood pressure, and cardiac output were recorded by beat-to-beat analysis. In these settings, data acquisition was performed in seated and in supine postures. Results Systolic [median 116 mmHg (102; 129) interquartile range (IQR) vs. 125 mmHg (109; 136) IQR, p = 0.01] as well as diastolic [median 72 mmHg (61; 79) IQR vs. 80 mmHg (69; 89) IQR, p = 0.003] blood pressure was reduced, and cardiac output [median 6.9 l/min (6.5; 8.8) IQR vs. 6.8 l/min (6.2; 8.5) IQR, p = 0.0002] increased in weightlessness compared to normal gravitation phases in the seated but not in the supine posture. However, microcirculation represented by perfused proportion of vessels and by total vessel density was unaffected in acute weightlessness. Conclusion Profound changes of the macrocirculation were found in seated postures, but not in supine postures. However, microcirculation remained stable in all postures.

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“…In such nonlongitudinal studies, it is often more of convenience than scientific interest that multiple measurements are obtained in the same subjects. For example, Rogge et al 15 studied the agreement between an invasive and a noninvasive blood pressure measurement technique in 29 patients undergoing bariatric operations, by analyzing a total of 6864 pairs of simultaneous invasive and noninvasive measurements. These repeated measurements clearly do not provide independent information, so the analysis adjusted for the nonindependence.…”

Section: Techniques For Analyzing Repeated Measures: General Overviewmentioning

confidence: 99%

Repeated Measures Designs and Analysis of Longitudinal Data: If at First You Do Not Succeed—Try, Try Again

Schober

Vetter

2018

Anesthesia &Amp; Analgesia

150

111

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Anesthesia, critical care, perioperative, and pain research often involves study designs in which the same outcome variable is repeatedly measured or observed over time on the same patients. Such repeatedly measured data are referred to as longitudinal data, and longitudinal study designs are commonly used to investigate changes in an outcome over time and to compare these changes among treatment groups. From a statistical perspective, longitudinal studies usually increase the precision of estimated treatment effects, thus increasing the power to detect such effects. Commonly used statistical techniques mostly assume independence of the observations or measurements. However, values repeatedly measured in the same individual will usually be more similar to each other than values of different individuals and ignoring the correlation between repeated measurements may lead to biased estimates as well as invalid P values and confidence intervals. Therefore, appropriate analysis of repeated-measures data requires specific statistical techniques. This tutorial reviews 3 classes of commonly used approaches for the analysis of longitudinal data. The first class uses summary statistics to condense the repeatedly measured information to a single number per subject, thus basically eliminating within-subject repeated measurements and allowing for a straightforward comparison of groups using standard statistical hypothesis tests. The second class is historically popular and comprises the repeated-measures analysis of variance type of analyses. However, strong assumptions that are seldom met in practice and low flexibility limit the usefulness of this approach. The third class comprises modern and flexible regression-based techniques that can be generalized to accommodate a wide range of outcome data including continuous, categorical, and count data. Such methods can be further divided into so-called “population-average statistical models” that focus on the specification of the mean response of the outcome estimated by generalized estimating equations, and “subject-specific models” that allow a full specification of the distribution of the outcome by using random effects to capture within-subject correlations. The choice as to which approach to choose partly depends on the aim of the research and the desired interpretation of the estimated effects (population-average versus subject-specific interpretation). This tutorial discusses aspects of the theoretical background for each technique, and with specific examples of studies published in Anesthesia & Analgesia, demonstrates how these techniques are used in practice.

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Continuous Noninvasive Arterial Pressure Monitoring Using the Vascular Unloading Technique (CNAP System) in Obese Patients During Laparoscopic Bariatric Operations

Cited by 23 publications

References 26 publications

Perioperative non-invasive versus semi-invasive cardiac index monitoring in patients with bariatric surgery – a prospective observational study

Perioperative non-invasive versus semi-invasive cardiac index monitoring in patients with bariatric surgery – a prospective observational study

Comprehensive Analysis of Macrocirculation and Microcirculation in Microgravity During Parabolic Flights

Repeated Measures Designs and Analysis of Longitudinal Data: If at First You Do Not Succeed—Try, Try Again

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