Non-invasive measurement of pulse pressure variation using a finger-cuff method in obese patients having laparoscopic bariatric surgery

Abstract

Pulse pressure variation (PPV) is a dynamic cardiac preload variable used to predict fluid responsiveness. PPV can be measured non-invasively using innovative finger-cuff systems allowing for continuous arterial pressure waveform recording, e.g., the Nexfin system [BMEYE B.V., Amsterdam, The Netherlands; now Clearsight (Edwards Lifesciences, Irvine, CA, USA)] (PPVFinger). However, the agreement between PPVFinger and PPV derived from an arterial catheter (PPVART) in obese patients having laparoscopic bariatric surgery is unknown. We compared PPVFinger and PPVART at 6 time points in 60 obese patients having laparoscopic bariatric surgery in a secondary analysis of a prospective method comparison study. We used Bland–Altman analysis to assess absolute agreement between PPVFinger and PPVART. The predictive agreement for fluid responsiveness between PPVFinger and PPVART was evaluated across three PPV categories (PPV < 9%, PPV 9–13%, PPV > 13%) as concordance rate of paired measurements and Cohen’s kappa. The overall mean of the differences between PPVFinger and PPVART was 0.5 ± 4.6% (95%-LoA − 8.6 to 9.6%) and the overall predictive agreement was 72.4% with a Cohen’s kappa of 0.53. The mean of the differences was − 0.7 ± 3.8% (95%-LoA − 8.1 to 6.7%) without pneumoperitoneum in horizontal position and 1.1 ± 4.8% (95%-LoA − 8.4 to 10.5%) during pneumoperitoneum in reverse-Trendelenburg position. The absolute agreement and predictive agreement between PPVFinger and PPVART are moderate in obese patients having laparoscopic bariatric surgery.

Non-invasive measurement of pulse pressure variation using a finger-cuff method (CNAP system): a validation study in patients having neurosurgery

“…In recent years, innovative finger-cuff technologies became available that allow continuous recording of the arterial blood pressure waveform and PPV calculation in a non-invasive manner [5][6][7][8][9][10]. The CNAP system (CNAP Monitor 500; CNSystems Medizintechnik, Graz, Austria) is one commercially available finger-cuff system and has been validated for arterial blood pressure and cardiac output measurements [11].…”

Patent landscape review of non-invasive medical sensors for continuous monitoring of blood pressure and their validation in critical care practice

“…However, the correlation of measurements using the ClearSight system and an arterial catheter was moderate in obese patients after laparoscopic bariatric surgery ( n = 44). It has been established that the ClearSight system-derived cardiac index is insufficiently accurate in patients undergoing off-pump coronary artery bypass graft surgery who have a lower ejection fraction ( 38 , 39 ). However, in patients with low ejection fraction, ClearSight’s system accuracy and trending capabilities for mean arterial pressure were clinically acceptable.…”