Clinical Evaluation of a High-fidelity Upper Arm Cuff to Measure Arterial Blood Pressure during Noncardiac Surgery

Abstract

Background In most patients having noncardiac surgery, blood pressure is measured with the oscillometric upper arm cuff method. Although the method is noninvasive and practical, it is known to overestimate intraarterial pressure in hypotension and to underestimate it in hypertension. A high-fidelity upper arm cuff incorporating a hydraulic sensor pad was recently developed. The aim of the present study was to investigate whether noninvasive blood pressure measurements with the new high-fidelity cuff correspond to invasive measurements with a femoral artery catheter, especially at low blood pressure. Methods Simultaneous measurements of blood pressure recorded from a femoral arterial catheter and from the high-fidelity upper arm cuff were compared in 110 patients having major abdominal surgery or neurosurgery. Results 550 pairs of blood pressure measurements (5 pairs per patient) were considered for analysis. For mean arterial pressure measurements, the average bias was 0 mmHg, and the precision was 3 mmHg. The Pearson correlation coefficient was 0.96 (P < 0.0001; 95% CI, 0.96 to 0.97), and the percentage error was 9%. Error grid analysis showed that the proportions of mean arterial pressure measurements done with the high-fidelity cuff method were 98.4% in zone A (no risk), 1.6% in zone B (low risk) and 0% in zones C, D, and E (moderate, significant, and dangerous risk, respectively). The high-fidelity cuff method detected mean arterial pressure values less than 65 mmHg with a sensitivity of 84% (95% CI, 74 to 92%) and a specificity of 97% (95% CI, 95% to 98%). To detect changes in mean arterial pressure of more than 5 mmHg, the concordance rate between the two methods was 99.7%. Comparable accuracy and precision were observed for systolic and diastolic blood pressure measurements. Conclusions The new high-fidelity upper arm cuff method met the current international standards in terms of accuracy and precision. It was also very accurate to track changes in blood pressure and reliably detect severe hypotension during noncardiac surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

High-fidelity Cuff to Measure Blood Pressure: Reply

“…We thank Dr. Dueck 1 for his thoughtful reading of our article. 2 Dr. Dueck’s first comment was also made by Saugel et al in the accompanying editorial to our article. 3 Therefore, we take the opportunity to comment on the issues raised and to discuss our statistical approach as detailed in the supplements.…”

“…3 Therefore, we take the opportunity to comment on the issues raised and to discuss our statistical approach as detailed in the supplements. 2…”

Perioperative Blood Pressure Management

“…41 In pilot randomized trials, continuous noninvasive finger cuff blood pressure monitoring reduced intraoperative hypotension compared to intermittent oscillometric blood pressure monitoring. 24,42 Other blood pressure monitoring methods-such as the hydraulic coupling method, 43 applanation tonometry, 44 the pulse wave transit time method, 45 or the pulse decomposition method 46 -may prove to be important alternatives to conventional perioperative blood pressure monitoring methods, but all have inherent technical limitations and need meticulous validation before being broadly adopted in routine care. 47,48 Anesthesia professionals routinely evaluate blood pressure changes and try to predict when patients will become hypotensive.…”

Measurement error risk for finger-cuff blood pressure after aortic valve replacement are aortic valve area index and heart rate; FloTrac vs ClearSight

“…Several studies have compared non-invasive BP measurement with a nger-cuff to direct BP measurement with an invasive arterial catheter in a variety of patients, without an explicit focus on patients after valve replacement surgery [20][21][22][23]. Those studies have shown that the measurement accuracy of the nger-cuff method is reduced in hypertensive patients and the elderly because peripheral small arteries such as the ngertips may be occluded or stenotic secondary to the effect of hypertension [7,24,25].…”