Non-invasive continuous blood pressure monitoring using the ClearSight system for pregnant women at high risks of post-partum hemorrhage: comparison with invasive blood pressure monitoring during cesarean section

Abstract

ObjectiveThis study aimed to investigate the accuracy and precision of continuous, non-invasive blood pressure obtained using the ClearSight system by comparing it with invasive arterial blood pressure, and to assess the hemodynamic changes using invasive methods and the ClearSight system in patients undergoing cesarean section. MethodsArterial pressure was measured invasively with an intra-arterial catheter and non-invasively using the ClearSight system during cesarean section in patients with placenta previa or placenta accreta. Blood pressure measurements obtained using these two means were then compared. ResultsTotal 1,277 blood pressure measurement pairs were collected from 21 patients. Under Bland-Altman analysis, the ClearSight system demonstrated an acceptable accuracy with a bias and standard deviation of 8.8±13.4 mmHg for systolic blood pressure, -6.3±7.1 mmHg for diastolic blood pressure, and -2.7±8.0 mmHg for median blood pressure. Cardiac index levels were significantly elevated during fetal delivery and 5 minutes after placental removal, and systemic vascular resistance index levels were significantly decreased during fetal delivery and 40 minutes after placental removal. ConclusionIn patients undergoing cesarean section, the ClearSight system showed excellent accuracy and precision compared to that of the currently used invasive monitoring system.

Finger cuff versus invasive and noninvasive arterial pressure measurement in pregnant patients with obesity

“…only for MAP (participant BMI < 35 kg m À2 ). 17 agreement. 14 Our study fills a knowledge gap, evaluating the FC performance in pregnant women Class 3 obesity.…”

“…The acceptable proportion outside Zone A has not been defined in the cesarean delivery setting but is more likely to be <5%. Misugi et al, in the other study in pregnant patients comparing FC and INV, demonstrated adequate agreement only for MAP (participant BMI < 35 kg m −2 ) 17 . Frassanito et al, in a retrospective study (BMI < 35 kg m −2 ) compared only MAP readings from NIBP and FC during cesarean delivery, reporting good agreement 14 …”

“…reported acceptable agreement of the FC with INV for mean arterial pressure (MAP) only. 17 BMI was demonstrated as the best predictor of arm conicity in pregnancy, 3 however, the ClearSight™ FC has not been evaluated in pregnant patients with BMI > 40 kg m À2 . Arguably, these are the patients who may most benefit from this device.…”

“…Acceptable agreement was demonstrated between the FC and NIBP measurements in pregnant participants with a median BMI less than 35 kg m −2 14–16 . In nonobese pregnant participants, Misugi et al reported acceptable agreement of the FC with INV for mean arterial pressure (MAP) only 17 . BMI was demonstrated as the best predictor of arm conicity in pregnancy, 3 however, the ClearSight™ FC has not been evaluated in pregnant patients with BMI > 40 kg m −2 .…”

Use of vasopressors to manage spinal anesthesia-induced hypotension during cesarean delivery

“…Despite limited data, these noninvasive devices have shown potential for tracking responses to spinal anesthesia-induced sympathetic blockade and vasopressor administration without the need for invasive procedures in cesarean section [25][26][27]. For example, ClearSight™ (Edwards Lifesciences), a noninvasive continuous BP monitoring device using a finger cuff, has demonstrated acceptable accuracy and precision compared to that in invasive monitoring methods [28]. This device has been associated with a reduced incidence of hypotension and maternal nausea under spinal anesthesia [29].…”