A Randomized Trial of Continuous Noninvasive Blood Pressure Monitoring During Noncardiac Surgery

Abstract

BACKGROUND:Intraoperative hypotension is associated with postoperative mortality. Early detection of hypotension by continuous hemodynamic monitoring might prompt timely therapy, thereby reducing intraoperative hypotension. We tested the hypothesis that continuous noninvasive blood pressure monitoring reduces intraoperative hypotension.METHODS:Patients ≥45 years old with American Society of Anesthesiologists physical status III or IV having moderate-to-high-risk noncardiac surgery with general anesthesia were included. All participating patients had continuous noninvasive hemodynamic monitoring using a finger cuff (ClearSight, Edwards Lifesciences, Irvine, CA) and a standard oscillometric cuff. In half the patients, randomly assigned, clinicians were blinded to the continuous values, whereas the others (unblinded) had access to continuous blood pressure readings. Continuous pressures in both groups were used for analysis. Time-weighted average for mean arterial pressure <65 mm Hg was compared using 2-sample Wilcoxon rank-sum tests and Hodges Lehmann estimation of location shift with corresponding asymptotic 95% CI.RESULTS:Among 320 randomized patients, 316 were included in the intention-to-treat analysis. With 158 patients in each group, those assigned to continuous blood pressure monitoring had significantly lower time-weighted average mean arterial pressure <65 mm Hg, 0.05 [0.00, 0.22] mm Hg, versus intermittent blood pressure monitoring, 0.11 [0.00, 0.54] mm Hg (P = .039, significance criteria P < .048).CONCLUSIONS:Continuous noninvasive hemodynamic monitoring nearly halved the amount of intraoperative hypotension. Hypotension reduction with continuous monitoring, while statistically significant, is currently of uncertain clinical importance.

How to measure blood pressure using an arterial catheter: a systematic 5-step approach

“…In addition, continuous invasive BP monitoring detects twice as much intraoperative hypotension than intermittent non-invasive measurements using oscillometry and triggers vasopressor therapy in adults having non-cardiac surgery [9]. Continuous non-invasive BP monitoring-compared to intermittent non-invasive measurements using oscillometry-also reduces the amount of intraoperative hypotension [10,11]. However, validation studies comparing continuous noninvasive BP measurements to continuous invasive BP measurements using an arterial catheter revealed contradictory results regarding the interchangeability of the methods [12,13].…”

Feasibility of remote digital monitoring using wireless Bluetooth monitors, the Smart AngelTM&nbsp;app and an original web platform for patients following outpatient surgery: A prospective observational pilot study.

“…The main limitation of these systems is the absence of remote data on physical parameters such as heart or respiratory rates, oxygen saturation and blood pressure. This appears to be a major limitation although several studies have demonstrated that remote monitoring of physiological parameters can signi cantly reduce morbidity or mortality over the perioperative period [13,14].…”

Noninvasive continuous monitoring versus intermittent oscillometric measurements for the detection of hypotension during digestive endoscopy

“…In this small exploratory study, we did not look at post-procedural morbidity. However, it is now well established that intraoperative arterial hypotension is an independent predictor of increased one-year mortality, especially in patients with pre-existing comorbidities [17][18][19]. We can only suspect that excess hypotension might be deleterious in patients with cardiovascular comorbidities undergoing gastro-intestinal endoscopy, but further investigation is warranted to explore this hypothesis.…”