Impact of non invasive and beat-to-beat arterial pressure monitoring on intraoperative hemodynamic management

Abstract

The Nexfin device allows for non-invasive beat-to-beat blood pressure monitoring (BP(NXF)). Perioperative hypotension and hypertension have been shown to be associated with poor clinical outcomes. The goal of the present study was to assess the ability of this device to decrease the duration of significant intraoperative hypo- or hypertension compared to standard BP monitoring by cuff (BP(CUFF)). We studied25 patients (ASA I-III) undergoing either abdominal or orthopedic surgery. BP(CUFF) was monitored every 5 min from the introduction of anesthesia, while BP(NXF) was monitored continuously on the opposite arm. When systolic BP(NXF) (SBP(NXF)) decreased or increased more than 20% relative to baseline SBP(NXF), a standard BP(CUFF) measurement was taken to compare values. In addition, the time interval between the 20% change in SBP(NXF) and the next scheduled standard SBP(CUFF) measurement was recorded for each event. The mean length of surgery was 3.0 ± 0.3 h. Patients presented with 11 ± 4 episodes of hypotension and 12 ± 4 episodes of hypertension during the surgery. If BP(CUFF) had been used, this would have resulted in 21 ± 7 min of hypotension and 20 ± 10 min of hypertension. If hemodynamic changes seen by SBP(NXF) were appropriately treated, an average of 7 ± 1 min/h of hypotension time, 7 ± 2 min/h of hypertension time and 14 ± 3 min per hour of hypo- or hypertension time may have been identified. The Nexfin BP has the potential to decrease the time of hypotension and hypertension compared to conventional intermittent BP(CUFF) monitoring. Therefore, this device has the potential to positively impact clinical outcomes.

Guiding Goal-Directed Therapy

“…Second, the Nexfin device estimates CO based on a pulse contour analysis methodology described by Bogert et al [70]. This device has been somewhat largely validated for CO monitoring and shows promise for future GDT trials [69,[71][72][73].…”

Noninvasive continuous hemodynamic monitoring

“…Oscillometers may be inaccurate [37], and provided values that are frequently lower than direct BP measurements in critically ill patients, [38, 39] whereas detection of large BP changes is unreliable [40]. Due to its intermittent nature hyper- and hypotensive periods may be missed [2]. …”

“…For continuous measurement of BP, cannulation of an artery is the primary approach. However, noninvasive and continuous monitoring of BP has several advantages, particularly if intra-arterial measurement of BP is not warranted while intermittent measurements do not have the required time resolution [2]. Finger cuff technology can provide such continuous and noninvasive monitoring of BP and other hemodynamics parameters.…”

Development of a Multi-Array Pressure Sensor Module for Radial Artery Pulse Wave Measurement

“…In fact, the blood pressure waveform is known to provide vascular stiffness and hemodynamic information, and can also be used to calculate an augmentation index related to cardiovascular disease risk and aging of the arteries [8,9]. Continuous blood pressure is a key indicator that should be measured in patients who need intensive health care [10]. However, because of the burden of invasive measurement methods, continuous blood pressure is measured only for patients who cannot avoid measurement, such as anesthetized, surgical, or critical patients.…”