The Accuracy of the CNAP®Device Compared with Invasive Radial Artery Measurements for Providing Continuous Noninvasive Arterial Blood Pressure Readings at a Medical Intensive Care Unit

Smolle, Karl-Heinz; Schmid, Martin; Prettenthaler, Helga; Weger, Christian

doi:10.1213/ane.0000000000000965

Cited by 43 publications

(26 citation statements)

References 34 publications

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“…The “trending ability” of the oscillometric method in tracking dependable changes with the invasive method was evaluated with a four-quadrant plot and a polar plot as reported previously [ 13 ]. Both analysis were repeated for SAP, DAP and MAP; the concordance rate was calculated as the percentage of data points outside the exclusion zone representing 5% or 10% changes in arterial blood pressure, in the upper right and lower left quadrant over the data points in all quadrants.…”

Section: Methodsmentioning

confidence: 99%

“…Data points, which lay in an exclusion zone of 5 and 10%, are suggesting small variations in arterial blood pressure, depending rather on the precision of the device than being a reflection of real changes in haemodynamics [ 14 ]. A concordance rate over 90% was judged indicative of good trending ability [ 13 , 15 ]. The polar plot was used to quantify the trending ability that was considered adequate if mean polar angle and radial limit of agreement were lower than 5° and ± 30° respectively [ 13 – 15 ].…”

Section: Methodsmentioning

confidence: 99%

“…A concordance rate over 90% was judged indicative of good trending ability [ 13 , 15 ]. The polar plot was used to quantify the trending ability that was considered adequate if mean polar angle and radial limit of agreement were lower than 5° and ± 30° respectively [ 13 – 15 ].…”

Section: Methodsmentioning

confidence: 99%

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Prospective clinical study to evaluate an oscillometric blood pressure monitor in pet rabbits

et al. 2018

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BackgroundRabbits are particularly sensitive to develop hypotension during sedation or anaesthesia. Values of systolic or mean non-invasive arterial blood pressure below 80 or 60 mmHg respectively are common under anaesthesia despite an ongoing surgery. A reliable method of monitoring arterial blood pressure is extremely important, although invasive technique is not always possible due to the anatomy and dimension of the artery. The aim of this study was to evaluate the agreement between a new oscillometric device for non-invasive arterial blood pressure measurement and the invasive method. Moreover the trending ability of the device, ability to identify changes in the same direction with the invasive methods, was evaluated as well as the sensibility of the device in identifying hypotension arbitrarily defined as invasive arterial blood pressure below 80 or 60 mmHg.ResultsBland-Altman analysis for repeated measurements showed a poor agreement between the two methods; the oscillometric device overestimated the invasive arterial blood pressure, particularly at high arterial pressure values. The same analysis repeated considering oscillometric measurement that match invasive mean pressure lower or equal to 60 mmHg showed a decrease in biases and limits of agreement between methods. The trending ability of the device, evaluated with both the 4-quadrant plot and the polar plot was poor. Concordance rate of mean arterial blood pressure was higher than systolic and diastolic pressure although inferior to 90%. The sensibility of the device in detecting hypotension defined as systolic or mean invasive arterial blood pressure lower than 80 or 60 mmHg was superior for mean oscillometric pressure rather than systolic. A sensitivity of 92% was achieved with an oscillometric measurement for mean pressure below 65 mmHg instead of 60 mmHg. Non-invasive systolic blood pressure is less sensitive as indicator of hypotension regardless of the cutoff limit considered.ConclusionsAlthough mean invasive arterial blood pressure is overestimated by the device, the sensitivity of this non-invasive oscillometric monitor in detecting invasive mean pressure below 60 mmHg is acceptable but a cutoff value of 65 mmHg needs to be used.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Prospective clinical study to evaluate an oscillometric blood pressure monitor in pet rabbits

et al. 2018

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“…Fonkoue et al, 2019;Lázaro et al, 2019;Simpson et al, 2019;Wakeham et al, 2019). Continuously and non-invasively measured peripheral BP was demonstrated to give a good approximation of intra-arterial radial BP in different clinical populations (Pinna et al, 2000;Ameloot et al, 2014;Smolle et al, 2015;Berkelmans et al, 2017).…”

Section: Accuracy Of the Bp Measurements Used As A Gold Standardmentioning

confidence: 99%

Multimodal Monitoring of Cardiovascular Responses to Postural Changes

et al. 2020

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Background: In the poorly understood relationship between orthostatic hypotension and falls, next to blood pressure (BP), baroreflex sensitivity (BRS) and cerebral autoregulation (CAR) may be key measures. The posture-and movement dependency of orthostatic hypotension requires continuous and unobtrusive monitoring. This may be possible using simultaneous photoplethysmography (PPG), electrocardiography (ECG), and near-infrared spectroscopy (NIRS) signal recordings, from which pulse wave velocity (PWV; potentially useful for BP estimation), BRS and CAR can be derived. The PPG, NIRS and PWV signal correlation with BP and BRS/CAR reliability and validity need to be addressed. Methods: In 34 healthy adults (mean age 25 years, inter quartile range 22-45; 10 female), wrist and finger PPG, ECG, bifrontal NIRS (oxygenated and deoxygenated hemoglobin) and continuous BP were recorded during sit to stand and supine to stand movements. Sixteen participants performed slow and rapid supine to stand movements; eighteen other participants performed a 1-min squat movement. Pulse wave velocity (PWV) was defined as the inverse of the ECG R-peak to PPG pulse delay; PPG, NIRS and PWV signal correlation with BP as their Pearson correlations with mean arterial pressure (MAP) within 30 s after the postural changes; BRS as inter beat interval drop divided by systolic BP (SBP) drop during the postural changes; CAR as oxygenated hemoglobin drop divided by MAP drop. BRS and CAR were separately computed using measured and estimated (linear regression) BP. BRS/CAR reliability was defined by the intra class correlation between repeats of the same postural change; validity as the Pearson correlation between BRS/CAR values based on measured and estimated BP. Results: The highest correlation with MAP was found for finger PPG and oxygenated hemoglobin, ranging from 0.75-0.79 (sit to stand), 0.66-0.88 (supine to stand), and 0.82-0.94 (1-min squat). BRS and CAR reliability was highest during the different supine

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“…Continuous ECG was recorded simultaneously with the neurogram using a bioamp system. Beat-to-beat arterial BP was measured noninvasively using finger cuffs that detect digital blood flow and translate blood flow oscillations into continuous pulsepressure waveforms and beat-to-beat values of BP (CNAP, CNSystems) (20,46,47,52,55). Absolute values of BP were internally calibrated using a concomitant upper arm BP reading and were calibrated at the start and every 15 min throughout the study.…”

Section: Measurements and Proceduresmentioning

confidence: 99%

Tetrahydrobiopterin ameliorates the exaggerated exercise pressor response in patients with chronic kidney disease: a randomized controlled trial

Lin

Liao

Millson

et al. 2016

American Journal of Physiology-Renal Physiology

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Chronic kidney disease (CKD) patients have an exaggerated increase in blood pressure (BP) during rhythmic handgrip exercise (RHG 20%) and static handgrip exercise (SHG 30%). Nitric oxide levels increase during exercise and help prevent excessive hypertension by both increasing vasodilation and reducing sympathetic nerve activity (SNA). Therefore, we hypothesized that tetrahydrobiopterin (BH4), an essential cofactor for nitric oxide synthase, would ameliorate the exaggerated exercise pressor response in CKD patients. In a randomized, double-blinded, placebo-controlled trial, we tested the effects of 12 wk of sapropterin dihydrochloride (6R-BH4; n = 18) versus placebo (n = 14) treatement on BP and muscle SNA (MSNA) responses during RHG 20% and SHG 30% in CKD patients. The 6R-BH4-treated group had a significantly lower systolic BP (+6 ± 1 vs. +13 ± 2 mmHg, P = 0.002) and mean arterial pressure response (+5 ± 1 vs. +10 ± 2 mmHg, P = 0.020) during RHG 20% and a significantly lower systolic BP response (+19 ± 3 vs. +28 ± 3 mmHg, P = 0.043) during SHG 30%. Under baseline conditions, there was no significant difference in MSNA responses between the groups; however, when the BP response during exercise was equalized between the groups using nitroprusside, the 6R-BH4-treated group had a significantly lower MSNA response during RHG 20% (6R-BH4 vs. placebo, +12 ± 1 vs. +21 ± 2 bursts/min, P = 0.004) but not during SHG 30%. These findings suggest that 6R-BH4 ameliorates the augmented BP response during RHG 20% and SHG 30% in CKD patients. A reduction in reflex activation of SNA may contribute to the decreased exercise pressor response during RHG 20% but not during SHG 30% in CKD patients.

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The Accuracy of the CNAP®Device Compared with Invasive Radial Artery Measurements for Providing Continuous Noninvasive Arterial Blood Pressure Readings at a Medical Intensive Care Unit

Cited by 43 publications

References 34 publications

Prospective clinical study to evaluate an oscillometric blood pressure monitor in pet rabbits

Prospective clinical study to evaluate an oscillometric blood pressure monitor in pet rabbits

Multimodal Monitoring of Cardiovascular Responses to Postural Changes

Tetrahydrobiopterin ameliorates the exaggerated exercise pressor response in patients with chronic kidney disease: a randomized controlled trial

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