Arterial blood pressure monitoring using three different technologies during neuro radiological procedure: a prospective, monocentric, observational study

Abstract

Background In the perioperative setting, the most accurate way to continuously measure Arterial Blood Pressure (ABP) is using an arterial catheter. Surrogate methods such as finger cuff have been developped to allow non invasive measurements and are increasingly used, but needs further evaluation. The aim of this study is to evaluate accuracy and clinical concordance between three devices for the measurement of ABP during neuroradiological procedure. Methods This is a prospective, monocentric, observational study. All consecutive patients undergoing a neuro radiological procedure were eligible. Patients who needed arterial catheter for blood pressure measurement were included. During neuroradiological procedure, ABP (systolic, mean and diatolic blood pressure) was measured with three different technologies: radial artery catheter, Arm Cuff and Nexfin. Bland-Altman and error grid analysis were performed to evaluat accuracy and clinical concordance between devices. Results From March 2022 to November 2022, we included 50 patients, mostly ASA 3 (60%) and required a cerebral embolization (94%) under general anaesthesia (96%). Compare to artery catheter, a significant relationship was found for SAP (r2 = 0.78) and MAP (r2 = 0.80) with the Nexfin (p < 0.001). Bias and limits of agreement (LOA) were respectively 9.6 mmHg (-15.6 to 34.8 mmHg) and − 0.8 mmHg (-17.2 to 15.6 mmHg), for SAP and MAP. We found a significant relationship for SAP (r2 = 0.82) and MAP (r2 = 0.74) with Arm Cuff (p < 0.001). Bias and LOA were respectively 5.8 mmHg (-30.4 to 22.9 mmHg) and − 1.4 mmHg (-17.3 to 14.4 mmHg), for SAP and MAP. Error grid analysis showed that 99% of non-invasive ABP measures obtained with the Nexfin and Arm Cuff were located in the risk zone A or B. Conclusions Despite an inaccuracy which are larger than acceptable, ABP measurement with non-invasive devices induced almost no changes in individual patient care during neuro radiological procedure. Trial registration: Clinicaltrials.gov, registration number: NCT05283824