Noninvasive continuous or intermittent blood pressure and heart rate patient monitoring in the ED

Nowak, Richard M.; Sen, Ayan; García, Ana Isabel Morales; Wilkie, Heidi; Yang, James; Nowak, Michael R.; Moyer, Michele

doi:10.1016/j.ajem.2011.05.014

Cited by 43 publications

(38 citation statements)

References 18 publications

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“…There is a study, using systemic vasoactive drugs, suggesting that regional vascular tone may not be a significant contributing factor to the results obtained by this technology [42]. Secondly, although many studies have validated the Finapres technology used by Nexfin compared to standard auscultatory sphygmomanometry and intra-arterial catheterization in different populations [14,[16][17][18][19][20][21], our study showed a significant mean percent error with Bland-Altman analysis between the SBP NXF compared to SBP CUFF as well as a concordance of only 81.3%. With the new method described by Critchley et al, primarily for cardiac output monitor trending, the authors recommend a mean polar angle or angular bias of less than ±5°and radial limits of agreement less than ±30°in order for a device to display good trending ability [26].…”

Section: Limitationsmentioning

confidence: 97%

“…The Finapres method allowed for detection of pulse, systolic, diastolic and mean pressure from the finger pressure waveform [11]. The Nexfin is based on this technology, but also incorporates level corrections to reconstruct brachial pressure from radial arterial pressure [14]. In addition, the Nexfin device provides cardiac output values calculated based on a pulse contour analysis method described by Bogert et al [15].…”

Section: Introductionmentioning

confidence: 99%

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Impact of non invasive and beat-to-beat arterial pressure monitoring on intraoperative hemodynamic management

Chen

Chung

Meng

et al. 2012

J Clin Monit Comput

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The Nexfin device allows for non-invasive beat-to-beat blood pressure monitoring (BP(NXF)). Perioperative hypotension and hypertension have been shown to be associated with poor clinical outcomes. The goal of the present study was to assess the ability of this device to decrease the duration of significant intraoperative hypo- or hypertension compared to standard BP monitoring by cuff (BP(CUFF)). We studied25 patients (ASA I-III) undergoing either abdominal or orthopedic surgery. BP(CUFF) was monitored every 5 min from the introduction of anesthesia, while BP(NXF) was monitored continuously on the opposite arm. When systolic BP(NXF) (SBP(NXF)) decreased or increased more than 20% relative to baseline SBP(NXF), a standard BP(CUFF) measurement was taken to compare values. In addition, the time interval between the 20% change in SBP(NXF) and the next scheduled standard SBP(CUFF) measurement was recorded for each event. The mean length of surgery was 3.0 ± 0.3 h. Patients presented with 11 ± 4 episodes of hypotension and 12 ± 4 episodes of hypertension during the surgery. If BP(CUFF) had been used, this would have resulted in 21 ± 7 min of hypotension and 20 ± 10 min of hypertension. If hemodynamic changes seen by SBP(NXF) were appropriately treated, an average of 7 ± 1 min/h of hypotension time, 7 ± 2 min/h of hypertension time and 14 ± 3 min per hour of hypo- or hypertension time may have been identified. The Nexfin BP has the potential to decrease the time of hypotension and hypertension compared to conventional intermittent BP(CUFF) monitoring. Therefore, this device has the potential to positively impact clinical outcomes.

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Section: Limitationsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Impact of non invasive and beat-to-beat arterial pressure monitoring on intraoperative hemodynamic management

Chen

Chung

Meng

et al. 2012

J Clin Monit Comput

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“…Nowak et al 9 studied the use of this method in the emergency room for the treatment of critically-ill patients, comparing systemic blood pressure and heart rate measurements obtained continuously with intermittent measurements obtained manually, with a statistically significant correlation. The same authors 10 studied 40 patients and compared the cardiac index and systemic vascular resistance obtained by continuous noninvasive hemodynamic monitoring with a simple questionnaire applied to the physicians of an emergency unit.…”

Section: Discussionmentioning

confidence: 99%

Uso da monitorização hemodinâmica contínua não invasiva na insuficiência cardíaca descompensada

Lima¹,

Ochiai²,

Vieira³

et al. 2012

Arq. Bras. Cardiol.

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“…[6] Although CNAP has been found to be reliable in patients at risk of hypotensive episodes such as those undergoing caesarean sections under subarachnoid blocks,[7] it is not without its disadvantages which include a lag time of 7.5-10 s,[8] decreased accuracy as compared to invasive techniques[9] and missed blood pressure measurements. [10] Although there are studies supporting the reliability of Nexfin™[111213] some other studies indicate that it is not a reliable replacement for invasive blood pressure where the latter is indicated. [1415] This method is vulnerable to inaccuracies resulting from peripheral vasoconstriction due to vasopressors, cold or systemic and collagen vascular disorders [Table 1].…”

Section: Arterial Blood Pressurementioning

confidence: 99%

Changing trends of hemodynamic monitoring in ICU - from invasive to non-invasive methods: Are we there yet?

Arora

Singh

Goudra

2014

Int J Crit Illn Inj Sci

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Hemodynamic monitoring in the form of invasive arterial, central venous pressure and pulmonary capillary wedge pressure monitoring may be required in seriously ill Intensive care unit patients, in patients undergoing surgeries involving gross hemodynamic changes and in patients undergoing cardiac surgeries. These techniques are considered the gold standards of hemodynamic monitoring but are associated with their inherent risks. A number of non-invasive techniques based on various physical principles are under investigation at present. The goal is to not only avoid the risk of invasive intervention, but also to match the gold standard set by them as far as possible. Techniques based on photoplethysmography, arterial tonometry and pulse transit time analysis have come up for continuous arterial pressure monitoring. Of these the first has been studied most extensively and validated, however it has been shown to be substandard in patients with gross hemodynamic instability. The other two still need further evaluation. While the non-invasive methods for arterial blood pressure monitoring are based on diverse technologies, those for measurement of central venous and pulmonary pressures are mostly based on imaging techniques such as echocardiography, Doppler ultrasound, computed tomography scan and chest X ray. Most of these techniques are based on measurement of the dimensions of the great veins. This makes them operator and observer dependent. However, studies done till now have revealed adequate inter-observer agreement. These techniques are still in their incipience and although initial studies are encouraging, further research is needed on this front.

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Noninvasive continuous or intermittent blood pressure and heart rate patient monitoring in the ED

Cited by 43 publications

References 18 publications

Impact of non invasive and beat-to-beat arterial pressure monitoring on intraoperative hemodynamic management

Impact of non invasive and beat-to-beat arterial pressure monitoring on intraoperative hemodynamic management

Uso da monitorização hemodinâmica contínua não invasiva na insuficiência cardíaca descompensada

Changing trends of hemodynamic monitoring in ICU - from invasive to non-invasive methods: Are we there yet?

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