Continuous noninvasive pulse wave analysis using finger cuff technologies for arterial blood pressure and cardiac output monitoring in perioperative and intensive care medicine: a systematic review and meta-analysis

Saugel, Bernd; Hoppe, Phillip; Nicklas, Julia Y.; Kouz, Karim; Körner, Annmarie; Hempel, Cordelia; Vos, Jaap Jan; Schön, Gerhard; Scheeren, Thomas

doi:10.1016/j.bja.2020.03.013

Cited by 82 publications

(94 citation statements)

References 73 publications

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“…Several previous studies compared ccNexfin/ClearSight blood pressure measurements with intraarterial reference blood pressure measurements using an arterial catheter in mixed patient populations not explicitly focusing on obese patients. 14 Between these studies, there is substantial variability regarding the blood pressure measurement performance of the finger cuff technology, with several studies demonstrating interchangeability between blood pressure values obtained by either method, but others showing poor agreement. 14 However, data on the measurement performance of finger cuff technologies in severely obese patients are scarce.…”

Section: Discussionmentioning

confidence: 99%

“…14 Between these studies, there is substantial variability regarding the blood pressure measurement performance of the finger cuff technology, with several studies demonstrating interchangeability between blood pressure values obtained by either method, but others showing poor agreement. 14 However, data on the measurement performance of finger cuff technologies in severely obese patients are scarce. A study in 35 severely obese patients having bariatric surgery showed that ClearSight blood pressure measurements showed good agreement with intraarterial blood pressure measurements for mean arterial pressure and diastolic blood pressure.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative Blood Pressure Monitoring in Obese Patients

et al. 2020

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Background The optimal method for blood pressure monitoring in obese surgical patients remains unknown. Arterial catheters can cause potential complications, and noninvasive oscillometry provides only intermittent values. Finger cuff methods allow continuous noninvasive monitoring. The authors tested the hypothesis that the agreement between finger cuff and intraarterial measurements is better than the agreement between oscillometric and intraarterial measurements. Methods This prospective study compared intraarterial (reference method), finger cuff, and oscillometric (upper arm, forearm, and lower leg) blood pressure measurements in 90 obese patients having bariatric surgery using Bland–Altman analysis, four-quadrant plot and concordance analysis (to assess the ability of monitoring methods to follow blood pressure changes), and error grid analysis (to describe the clinical relevance of measurement differences). Results The difference (mean ± SD) between finger cuff and intraarterial measurements was −1 mmHg (± 11 mmHg) for mean arterial pressure, −7 mmHg (± 14 mmHg) for systolic blood pressure, and 0 mmHg (± 11 mmHg) for diastolic blood pressure. Concordance between changes in finger cuff and intraarterial measurements was 88% (mean arterial pressure), 85% (systolic blood pressure), and 81% (diastolic blood pressure). In error grid analysis comparing finger cuff and intraarterial measurements, the proportions of measurements in risk zones A to E were 77.1%, 21.6%, 0.9%, 0.4%, and 0.0% for mean arterial pressure, respectively, and 89.5%, 9.8%, 0.2%, 0.4%, and 0.2%, respectively, for systolic blood pressure. For mean arterial pressure and diastolic blood pressure, absolute agreement and trending agreement between finger cuff and intraarterial measurements were better than between oscillometric (at each of the three measurement sites) and intraarterial measurements. Forearm performed better than upper arm and lower leg monitoring with regard to absolute agreement and trending agreement with intraarterial monitoring. Conclusions The agreement between finger cuff and intraarterial measurements was better than the agreement between oscillometric and intraarterial measurements for mean arterial pressure and diastolic blood pressure in obese patients during surgery. Forearm oscillometry exhibits better measurement performance than upper arm or lower leg oscillometry. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intraoperative Blood Pressure Monitoring in Obese Patients

et al. 2020

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“…As none of our volunteers had peripheral vasoconstriction, the volume clamp method can provide reliable estimates of changing stroke volume [ 31 ]. While we have shown that changing SV, measured by volume clamp, is also tracked by Doppler of the descending aorta and bioreactance technologies [ 28 ], volume clamp is an indirect measure and may not be valid in surgical patients and the critically ill as compared to thermodilution [ 39 , 40 ]. The advantages of the volume clamp method are that it is non-invasive and non-operator dependent.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic characteristics of 11 formulae for calculating corrected flow time as measured by a wearable Doppler patch

Kenny

MacKenzie

Eibl

et al. 2020

ICMx

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Background Change of the corrected flow time (Ftc) is a surrogate for tracking stroke volume (SV) in the intensive care unit. Multiple Ftc equations have been proposed; many have not had their diagnostic characteristics for detecting SV change reported. Further, little is known about the inherent Ftc variability induced by the respiratory cycle. Materials and methods Using a wearable Doppler ultrasound patch, we studied the clinical performance of 11 Ftc equations to detect a 10% change in SV measured by non-invasive pulse contour analysis; 26 healthy volunteers performed a standardized cardiac preload modifying maneuver. Results One hundred changes in cardiac preload and 3890 carotid beats were analyzed. Most of the 11 Ftc equations studied had similar diagnostic attributes. Wodeys’ and Chambers’ formulae had identical results; a 2% change in Ftc detected a 10% change in SV with a sensitivity and specificity of 96% and 93%, respectively. Similarly, a 3% change in Ftc calculated by Bazett’s formula displayed a sensitivity and specificity of 91% and 93%. FtcWodey had 100% concordance and an R2 of 0.75 with change in SV; these values were 99%, 0.76 and 98%, 0.71 for FtcChambers and FtcBazetts, respectively. As an exploratory analysis, we studied 3335 carotid beats for the dispersion of Ftc during quiet breathing using the equations of Wodey and Bazett. The coefficient of variation of Ftc during quiet breathing for these formulae were 0.06 and 0.07, respectively. Conclusions Most of the 11 different equations used to calculate carotid artery Ftc from a wearable Doppler ultrasound patch had similar thresholds and abilities to detect SV change in healthy volunteers. Variation in Ftc induced by the respiratory cycle is important; measuring a clinically significant change in Ftc with statistical confidence requires a large sample of beats.

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“…In recent years, innovative finger-cuff technologies became available that allow continuous recording of the arterial blood pressure waveform and PPV calculation in a non-invasive manner [5][6][7][8][9][10]. The CNAP system (CNAP Monitor 500; CNSystems Medizintechnik, Graz, Austria) is one commercially available finger-cuff system and has been validated for arterial blood pressure and cardiac output measurements [11]. Using a proprietary algorithm, the CNAP system also automatically calculates PPV (PPV CNAP ).…”

Section: Introductionmentioning

confidence: 99%

Non-invasive measurement of pulse pressure variation using a finger-cuff method (CNAP system): a validation study in patients having neurosurgery

Flick

Hoppe

Mehr

et al. 2021

J Clin Monit Comput

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The finger-cuff system CNAP (CNSystems Medizintechnik, Graz, Austria) allows non-invasive automated measurement of pulse pressure variation (PPVCNAP). We sought to validate the PPVCNAP-algorithm and investigate the agreement between PPVCNAP and arterial catheter-derived manually calculated pulse pressure variation (PPVINV). This was a prospective method comparison study in patients having neurosurgery. PPVINV was the reference method. We applied the PPVCNAP-algorithm to arterial catheter-derived blood pressure waveforms (PPVINV−CNAP) and to CNAP finger-cuff-derived blood pressure waveforms (PPVCNAP). To validate the PPVCNAP-algorithm, we compared PPVINV−CNAP to PPVINV. To investigate the clinical performance of PPVCNAP, we compared PPVCNAP to PPVINV. We used Bland–Altman analysis (absolute agreement), Deming regression, concordance, and Cohen's kappa (predictive agreement for three pulse pressure variation categories). We analyzed 360 measurements from 36 patients. The mean of the differences between PPVINV−CNAP and PPVINV was −0.1% (95% limits of agreement (95%-LoA) −2.5 to 2.3%). Deming regression showed a slope of 0.99 (95% confidence interval (95%-CI) 0.91 to 1.06) and intercept of −0.02 (95%-CI −0.52 to 0.47). The predictive agreement between PPVINV−CNAP and PPVINV was 92% and Cohen’s kappa was 0.79. The mean of the differences between PPVCNAP and PPVINV was −1.0% (95%-LoA−6.3 to 4.3%). Deming regression showed a slope of 0.85 (95%-CI 0.78 to 0.91) and intercept of 0.10 (95%-CI −0.34 to 0.55). The predictive agreement between PPVCNAP and PPVINV was 82% and Cohen’s kappa was 0.48. The PPVCNAP-algorithm reliably calculates pulse pressure variation compared to manual offline pulse pressure variation calculation when applied on the same arterial blood pressure waveform. The absolute and predictive agreement between PPVCNAP and PPVINV are moderate.

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Continuous noninvasive pulse wave analysis using finger cuff technologies for arterial blood pressure and cardiac output monitoring in perioperative and intensive care medicine: a systematic review and meta-analysis

Cited by 82 publications

References 73 publications

Intraoperative Blood Pressure Monitoring in Obese Patients

Intraoperative Blood Pressure Monitoring in Obese Patients

Diagnostic characteristics of 11 formulae for calculating corrected flow time as measured by a wearable Doppler patch

Non-invasive measurement of pulse pressure variation using a finger-cuff method (CNAP system): a validation study in patients having neurosurgery

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