Assessing the eligibility of a non-invasive continuous blood pressure measurement technique for application during total intravenous anaesthesia
-
Robert Huhle
, Joachim Siegert
, Fred Wonka , Christoph Schindler , Marcelo Gama de Abreu , Thea Koch , Ute Morgenstern and Herman Theilen
Abstract
Objective: To assess the eligibility for replacement of invasive blood pressure as measured “within” the arterial vessel (IBP) with non-invasive continuous arterial blood pressure (cNIP) monitoring during total intravenous anaesthesia (TIVA), the ability of cNiP to track fast blood pressure changes needs to be quantified. A new method of statistical data analysis is developed for this purpose.
Methods: In a pilot study on patients undergoing neurosurgical anaesthesia, mean arterial pressure MAPIBP measured with IBP was compared to MAPCNP measured by the CNAP Monitor 500 in ten patients (age: 63±13 a). Correlation analysis of changes of device differences ΔeMAP=ΔMAPCNP-ΔMAPIBP with changes of MAPIBP (ΔMAPIBP) during intervals of vasoactivity was conducted. An innovative technique, of linear trend analysis (LTA) applied to two signals, is described to perform this analysis without a priori knowledge of intervals of vasoactivity.
Results: Analysis of ΔeMAP during vasoactivity revealed that ΔMAPCNP systematically underestimated ΔMAPIBP by 37%. This was confirmed in the complete data set using LTA technique showing a systematic, yet patient specific, underestimation in tracking ΔMAPIBP (16…120%).
Conclusion: The proposed LTA technique is able to detect systematic errors in tracking short-term blood pressure changes otherwise masked by established analysis. LTA may thus be a useful tool to assess the eligibility of cNIP to replace IBP during TIVA.
Acknowledgements
We thank all involved stuff members of the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, for supporting the implementation of this study and especially Dipl.-Ing. Maic Regner and Dr. med. Matthias Burkhardt for their support on conducting this perioperative study in the operation room.
Conflicts of interest: None.
Grants: Roland-Ernst-Stiftung für Gesundheitswesen.
References
[1] BBraun. Physiocheck–Erfassung und Berechnung von dynamischen Kennwerten und systembedingten Fehlern invasiver Druckmessysteme. BBraun Melsungen AG, Berlin, 2002.Search in Google Scholar
[2] BBraun. Gebrauchs- und Fachinformationen–Propofol 2% 20 mg/ml. Rote Liste Service GmbH, 2010.Search in Google Scholar
[3] Benes J, Simanova A, Tovarnicka T, et al. Continuous non-invasive monitoring improves blood pressure stability in upright position: randomized controlled trial. J Clin Monit Comput 2015; 29: 11–17.10.1007/s10877-014-9586-2Search in Google Scholar PubMed
[4] Berghem L, Bergman U, Schildt B, Sörbo B. Plasma atropine concentrations determined by radioimmunoassay after single-dose i.v. and i.m. administration. Br J Anaesth 1980; 52: 597–601.10.1093/bja/52.6.597Search in Google Scholar PubMed
[5] Biais M, Vidil L, Roullet S. et al. Continuous non-invasive arterial pressure measurement: evaluation of CNAP device during vascular surgery. Ann Fr Anesth Reanim 2010; 29: 530–535.10.1016/j.annfar.2010.05.002Search in Google Scholar PubMed
[6] Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; i: 307–310.10.1016/j.ijnurstu.2009.10.001Search in Google Scholar
[7] Cheng H-M, Lang D, Tufanaru C, Pearson A. Measurement accuracy of non-invasively obtained central blood pressure by applanation tonometry: a systematic review and meta-analysis. Int J Cardiol 2013; 167: 1867–1876.10.1016/j.ijcard.2012.04.155Search in Google Scholar PubMed
[8] Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 1999; 15: 85–91.10.1023/A:1009982611386Search in Google Scholar
[9] Dewhirst E, Corridore M, Klamar J, et al. Accuracy of the CNAP monitor, a noninvasive continuous blood pressure device, in providing beat-to-beat blood pressure readings in the prone position. J Clin Anesth 2013; 25: 309–313.10.1016/j.jclinane.2013.01.010Search in Google Scholar PubMed
[10] Fortin J, Marte W, Grüllenberger R, et al. Continuous non-invasive blood pressure monitoring using concentrically interlocking control loops. Comput Biol Med 2006; 36: 941–957.10.1016/j.compbiomed.2005.04.003Search in Google Scholar PubMed
[11] Gaehlings EW. Numerische simulation hämodynamischer prozesse in vaskulären Netzen. PhD Dissertation, RWTH Aachen, Aachen, 1996.Search in Google Scholar
[12] Gayat E, Mongardon N, Tuil O. et al. CNAP® does not reliably detect minimal or maximal arterial blood pressures during induction of anaesthesia and tracheal intubation. Acta Anaesthesiol Scand 2013; 57: 468–473.10.1111/aas.12028Search in Google Scholar PubMed
[13] Gesche H, Grosskurth D, Küchler G, Patzak A. Continuous blood pressure measurement by using the pulse transit time: comparison to a cuff-based method. Eur J Appl Physiol 2012; 112: 309–315.10.1007/s00421-011-1983-3Search in Google Scholar PubMed
[14] Hahn R, Rinösl H, Neuner M, Kettner SC. Clinical validation of a continuous non-invasive haemodynamic monitor (CNAP™ 500) during general anaesthesia. Br J Anaesth 2012; 108: 581–585.10.1093/bja/aer499Search in Google Scholar
[15] Hänel F, Werner C. Remifentanil. Anaesthesist 1997; 46: 897–908.10.1007/978-3-642-72265-3_4Search in Google Scholar
[16] Hildebrandt W, Schütze H, Stegemann J. On the reliability of the Penaz cuff during systemic and local fingertip vasodilatation at rest and in exercise. Eur J Appl Physiol 1991; 62: 175–179.10.1007/BF00643738Search in Google Scholar
[17] Hinderling PH, Gundert-Remy U, Schmidliny O, Heinzel G. Integrated pharmacokinetics and pharmacodynamics of atropine in healthy humans II: pharmacodynamics. J Pharm Sci 1985; 74: 711–717.10.1002/jps.2600740703Search in Google Scholar
[18] Hörnchen U, Schüttler J, Stoeckel H, Ensing K, de Zeeuw RA, Eichelkraut W. Comparison of intravenous and endobronchial atropine: a pharmacokinetic and dynamic study in pigs. Eur J Anaesthesiol 1989; 6: 95–101.Search in Google Scholar
[19] Huhle R. Therapy documentation and determination of specific cardiovascular parameters of patients during acute hypertensive crisis. MSc thesis, Institute of Biomedical Engineering, Dresden University of Technology, Dresden, 2009.Search in Google Scholar
[20] Huhle R, Dietrich H, Idelevich E, et al. Measurement of continuous non-invasive blood pressure during vasoactive treatment in patients with acute hypertensive crisis. In: Biosignal 2010. Berlin 2010.Search in Google Scholar
[21] Ilies C, Bauer M, Berg P, et al. Investigation of the agreement of a continuous non-invasive arterial pressure device in comparison with invasive radial artery measurement. Br J Anaesth 2012; 108: 202–210.10.1093/bja/aer394Search in Google Scholar
[22] Ilies C, Grudev G, Hedderich J, et al. Comparison of a continuous noninvasive arterial pressure device with invasive measurements in cardiovascular postsurgical intensive care patients: a prospective observational study. Eur J Anaesthesiol 2015; 32: 20–28.10.1097/EJA.0000000000000136Search in Google Scholar
[23] Imholz BPM, Wieling W, van Montfrans GA, Wesseling KH. Fifteen years experience with finger arterial pressure monitoring:: assessment of the technology. Cardiovasc Res 1998; 38: 605–616.10.1016/S0008-6363(98)00067-4Search in Google Scholar
[24] ISO 81060-2:2013, Non-invasive sphygmomanometers – Part 2: Clinical investigation of automated measurement type. 2013.Search in Google Scholar
[25] Jagadeesh AM, Singh NG, Mahankali S. A comparison of a continuous noninvasive arterial pressure (CNAPTM) monitor with an invasive arterial blood pressure monitor in the cardiac surgical ICU. Ann Card Anaesth 2012; 15: 180–184.10.4103/0971-9784.97973Search in Google Scholar PubMed
[26] Jeleazcov C, Krajinovic L, Münster T et al. Precision and accuracy of a new device (CNAPTM) for continuous non-invasive arterial pressure monitoring: assessment during general anaesthesia. Br J Anaesth 2010; 105: 264–272.10.1093/bja/aeq143Search in Google Scholar PubMed
[27] Kako H, Corridore M, Rice J, Tobias JD. Accuracy of the CNAPTM monitor, a noninvasive continuous blood pressure device, in providing beat-to-beat blood pressure readings in pediatric patients weighing 20–40 kilograms. Paediatr Anaesth 2013; 23: 989–993.10.1111/pan.12173Search in Google Scholar PubMed
[28] Kanto J, Klotz U. Pharmacokinetic implications for the clinical use of atropine, scopolamine and glycopyrrolate. Acta Anaesthesiol Scand 1988; 32: 69–78.10.1111/j.1399-6576.1988.tb02691.xSearch in Google Scholar PubMed
[29] Kim S-H, Lilot M, Sidhu KS, et al. Accuracy and precision of continuous noninvasive arterial pressure monitoring compared with invasive arterial pressure: a systematic review and meta-analysis. Anesthesiology 2014; 120: 1080–1097.10.1097/ALN.0000000000000226Search in Google Scholar PubMed
[30] Lüllmann H, Mohr K, Wehling M. Pharmakologie und Toxikologie, 16th ed. Georg Thieme Verlag, 2006.10.1055/b-002-44902Search in Google Scholar
[31] McCarthy T, Telec N, Dennis A, Griffiths J, Buettner A. Ability of non-invasive intermittent blood pressure monitoring and a continuous non-invasive arterial pressure monitor (CNAPTM) to provide new readings in each 1-min interval during elective caesarean section under spinal anaesthesia. Anaesthesia 2012; 67: 274–279.10.1111/j.1365-2044.2011.06996.xSearch in Google Scholar PubMed
[32] Molhoek GP, Wesseling KH, Settels JJ, et al. Evaluation of the Penaz servo-plethysmo-manometer for the continuous, non-invasive measurement of finger blood pressure. Basic Res Cardiol 1984; 79: 598–609.10.1007/BF01910489Search in Google Scholar PubMed
[33] Nycomed. Gebrauchs-und Fachinformationen–Ebrantil i.v. 50 mg. Rote Liste Service GmbH, 2007.Search in Google Scholar
[34] Peňáz J. Photoelectric measurement of blood pressure, volume and flow in the finger. In: Digest of the 10th International Conference of Medical and Biological Engineering. Dresden, 1973.Search in Google Scholar
[35] Petersen ME, Williams TR, Sutton R. A comparison of non-invasive continuous finger blood pressure measurement (Finapres) with intra-arterial pressure during prolonged head-up tilt. EurHeart J 1995; 16: 1641–1654.10.1093/oxfordjournals.eurheartj.a060791Search in Google Scholar
[36] Pharma AWD. Gebrauchs-und Fachinformationen–Akrinor, Injektionslösung. Rote Liste Service GmbH, 2001.Search in Google Scholar
[37] Saugel B, Dueck R, Wagner JY. Measurement of blood pressure. Best Pract Res Clin Anaesthesiol 2014; 28: 309–322.10.1016/j.bpa.2014.08.001Search in Google Scholar PubMed
[38] Schmid M, Angerer R. Lehrbuch für den Rettungsdienst, 3rd ed. Hofmann, Hildburghausen, 2003.Search in Google Scholar
[39] Schramm C, Baat L, Plaschke K. Continuous noninvasive arterial pressure: assessment in older and high-risk patients under analgesic sedation. Blood Press Monit 2011; 16: 270–276.10.1097/MBP.0b013e32834d777fSearch in Google Scholar PubMed
[40] Tanaka H, Thulesius O. Effect of temperature on finger artery pressure evaluated by volume clamp technique. Clin Physiol Oxf Engl 1993; 13: 535–545.10.1111/j.1475-097X.1993.tb00469.xSearch in Google Scholar PubMed
[41] Wesseling KH, De Witt B, van der Hoeven GM, Van Goudoever J, Settels JJ. Physiocal, calibrating finger vascular physiology for Finapres. Homeostasis 1995; 36: 67–82.Search in Google Scholar
[42] Zong W, Moody GB, Jiand D. A robust open-source algorithm to detect onset and duration of qrs complexes. Comput Cardiol 2003; 30: 737–740.10.1109/CIC.2003.1291261Search in Google Scholar
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Articles in the same Issue
- Frontmatter
- Editorial
- The face towards nature
- Special issue articles
- Differential osteogenicity of multiple donor-derived human mesenchymal stem cells and osteoblasts in monolayer, scaffold-based 3D culture and in vivo
- Calcium phosphate/microgel composites for 3D powderbed printing of ceramic materials
- Adhesive strength of total knee endoprostheses to bone cement – analysis of metallic and ceramic femoral components under worst-case conditions
- Radiostereometric migration analysis of the Cerafit femoral stem: 28 patients followed for 2 years
- Staphylococcus epidermidis adhesion on surface-treated open-cell Ti6Al4V foams
- Research on polyvinylidene fluoride (PVDF) hollow-fiber hemodialyzer
- Research articles
- Influence of calibration method and material on the accuracy of stress distribution measurement systems
- A secure communication using cascade chaotic computing systems on clinical decision support
- Biomechanical effect of different femoral neck blade position on the fixation of intertrochanteric fracture: a finite element analysis
- Performance of a thrombectomy device for aspiration of thrombus with various sizes based on a computational fluid dynamic modeling
- Analysis of wrist bone motion before and after SL-ligament resection
- Changes of gait characteristics in a child with femoral nerve injury: a 16-month follow-up case study
- Assessing the eligibility of a non-invasive continuous blood pressure measurement technique for application during total intravenous anaesthesia