Feasibility of Noninvasive Continuous Finger Arterial Blood Pressure Measurements in Very Young Children, Aged 0–4 Years

Abstract

ABSTRACT:Our goal was to study the feasibility of continuous noninvasive finger blood pressure (BP) monitoring in very young children, aged 0 -4 y. To achieve this, we designed a set of smallsized finger cuffs based on the assessment of finger circumference. Finger arterial BP measured by a volume clamp device (Finapres technology) was compared with simultaneously measured intra-arterial BP in 15 very young children (median age, 5 mo; range, 0 -48), admitted to the intensive care unit for vital monitoring. The finger cuff-derived BP waveforms showed good resemblance with the invasive arterial waveforms (mean root-mean-square error, 3 mm Hg). The correlation coefficient between both methods was 0.79 Ϯ 0.19 systolic and 0.74 Ϯ 0.24 diastolic. The correlation coefficient of beat-to-beat changes between both methods was 0.82 Ϯ 0.18 and 0.75 Ϯ 0.21, respectively. Three measurements were related to measurement errors (loose cuff application; wrong set-point). Excluding these erroneous measurements resulted in clinically acceptable measurement bias (Ϫ3.8 mm Hg) and 95% limits of agreement (Ϫ10.4 to ϩ 2.8 mm Hg) of mean BP values. We conclude that continuous finger BP measurement is feasible in very young children. However, cuff application is critical, and the current set-point algorithm needs to be revised in very young children. I n human adults, continuous noninvasive finger blood pressure (BP) measurement has been available using the Finapres (FINger Arterial PRESsure) device (1). It has been widely used in the investigation of autonomic function in adults and has proven to be a reliable substitute for intraarterial measurements (2). The device is based on a photoplethysmographic system applied to the finger and provides beat-to-beat arterial finger BP with the use of the volume clamp technique of Peñáz (3). The Finapres method is evaluated in children aged 6 -16 y, showing similar accuracy as that in adults (4,5). Because no appropriate finger cuff exists for the children below 6 y of age, the applicability of the method is limited in this age group. Still, in the evaluation of pediatric patients with cardiovascular abnormalities (e.g. sepsis) or autonomic dysfunction (e.g. syncope), it is desirable to have continuous BP measurements.Recently, there are several publications in which investigators performed BP measurements with the Finapres method in newborns by simply applying the (commercially available) finger cuff around the wrist (6 -9). However, Finapres was not designed for BP measurements on the wrist. First, the method of volume clamping is only validated with an appropriate cuff applied to the midphalanx of the finger. Second, the difference between fingers of adults and children may not only be the size but also the physiologic properties of the arteries and thus need an adaptation of the autocalibration (algorithm). Third, applying the cuff around the wrist will result in venous congestion of the whole hand and not just the fingertip, and will ultimately limit its clinical applicability. Measurements on...

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“…In the same time generally, using non-invasive method is simpler, save, less complications as bleeding and distal limb ischemia and less cost than invasive method. (32) These results were in line with Andriessen et al (33) who concluded that in pediatric patients, non-invasive ABP reading showed worthy similarities with invasive ones. Additionally, Gevers et al (34) concluded presence of a big similarity between invasive and non-invasive ABP reading.…”

“…Therefore, it is important to consider using appropriate cuff pressure for age to measure noninvasive arterial blood pressure. Moreover, Andriessen (33) established in children that applying cuff pressure correctly seemed to be very serious when measuring ABP.…”

“…Over and above, this method is inherent with a risk of bleeding, infection, and distal limb ischemia for these reasons; noninvasive MAP is until now repeatedly used in very young pediatric patients. (7,10) Invasive MAP monitoring is a widespread procedure in critical care units. Its reliability is pivotal in assessing the circulatory system and managing medication therapy for hemodynamic support.…”

The Reliability of Continuous Noninvasive Finger Blood Pressure Measurement in Critically Ill Children

“…The bias for MAP and DAP was lower (Ϫ18.6% and Ϫ18.8%, respectively) and in concordance with results in adults. 17,18 Interestingly, Andriessen et al 6 using similar prototype equipment, observed a smaller bias in newborns. They observed that the (not reconstructed) mean finger pressure was on average about 5 mm Hg lower than the invasive mean pressure.…”

“…4,5 Recently, prototype small finger cuffs especially designed for the pediatric population were developed by BMEYE, and a pilot study has shown promising results. 6 In the current study, we used these prototype pediatric finger cuffs (four different sizes) and pediatric software to compare this new noninvasive continuous blood pressure measurement with intraarterially measured blood pressure in critically ill children. In a subgroup, we also compared IAP measurements with the standard NIBP technique.…”