Perioperative non-invasive versus semi-invasive cardiac index monitoring in patients with bariatric surgery – a prospective observational study

Lorenzen, Ulf; Pohlmann, Markus; Hansen, Jonathan; Klose, Phil; Gruenewald, Matthias; Renner, Jochen; Elke, Gunnar

doi:10.1186/s12871-020-01110-x

Cited by 6 publications

(10 citation statements)

References 49 publications

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“…The majority of studies retrieved concerned the cardiovascular ( n = 14) [ 9 – 22 ], respiratory ( n = 7) [ 23 – 29 ], and neurological ( n = 9) [ 30 – 37 ] systems. Two pertained to point-of-care testing [ 38 , 39 ].…”

Section: Resultsmentioning

confidence: 99%

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Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

et al. 2021

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With the increasing prevalence of obesity in the population, anaesthetists must confidently manage both the pathophysiological and technical challenges presented in bariatric and non-bariatric surgery. The intraoperative period represents an important opportunity to optimise and mitigate risk. However, there is little formal guidance on what intraoperative monitoring techniques should be used in this population. This narrative review collates the existing evidence for intraoperative monitoring devices in the obese patients. Although a number of non-invasive blood pressure monitors have been tested, an invasive arterial line remains the most reliable monitor if accurate, continuous monitoring is required. Goal-directed fluid therapy is recommended by clinical practice guidelines, but the methods tested to assess this had guarded applicability to the obese population. Transcutaneous carbon dioxide (CO 2 ) monitoring may offer additional benefit to standard capnography in this population. Individually titrated positive end expiratory pressure (PEEP) and recruitment manoeuvres improved intraoperative mechanics but yielded no benefit in the immediate postoperative period. Depth of anaesthesia monitoring appears to be beneficial in the perioperative period regarding recovery times and complications. Objective confirmation of reversal of neuromuscular blockade continues to be a central tenet of anaesthesia practice, particularly relevant to this group who have been characterised as an “at risk” extubation group. Where deep neuromuscular blockade is used, continuous neuromuscular blockade is suggested. Both obesity and the intraoperative context represent somewhat unstable search terms, as the clinical implications of the obesity phenotype are not uniform, and the type and urgency of surgery have significant impact on the intraoperative setting. This renders the generation of summary conclusions around what intraoperative monitoring techniques are suitable in this population highly challenging.

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Section: Resultsmentioning

confidence: 99%

“…The majority of studies retrieved concerned the cardiovascular (n = 14) [9][10][11][12][13][14][15][16][17][18][19][20][21][22], respiratory (n = 7) [23][24][25][26][27][28][29], and neurological (n = 9) [30][31][32][33][34][35][36][37] systems. Two pertained to point-of-care testing [38,39].…”

Section: Resultsmentioning

confidence: 99%

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

et al. 2021

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“…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]. In these patients, measurement by the nger-cuff method may be di cult even if there are no anatomical abnormalities.…”

Section: Discussionmentioning

confidence: 99%

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

Yahagi

Sasaki

Omi

et al. 2022

Preprint

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Purpose: The accuracy of ClearSightTM blood pressure measurements in patients with postaortic valve replacement may be inaccurate compared to intra-arterial pressure, the clinical risk of measurement discrepancy remains uncertain. This study aimed to determine the factors associated with errors in measurement. Methods: From October 2020 to November 2021, we collected 881 pairs of intra-arterial/ClearSight blood pressure measurements from 30 adults who underwent transcatheter aortic valve replacement. The agreement of ClearSight blood pressure with intra-arterial pressure was compared, and the clinical risk was evaluated by classifying measurement errors into zones A (no risk) to E (dangerous risk) using error grid analysis. Results: The bias and precision of ClearSight measurement were −4.88 ± 15.46 (mmHg) for systolic, 4.73 ± 8.95 (mmHg) for the mean and 9.53 ± 9.01 (mmHg) for the diastolic blood pressure. The proportions of measurement pairs in zones A were 88.0% for systolic BP and 71.2% for mean BP, respectively. Logistic regression analysis revealed that the risk of measurement error being outside zone A was heart rate [odds ratio, 1.24; 95% confidence interval, 1.15 to 1.35; p<0.001] for systolic and mean blood pressure, and aortic valve area index < 1.0 (cm2. m−2) [odds ratio, 1.62; 95% confidence interval, 1.21 to 2.16; p=0.02] for mean blood pressure.Conclusion: These findings could help to identify patients of unsuitable for ClearSight blood pressure measurement. Our results demonstrate that the small aortic valve area index and low cardiac index are risk factors for measurement error.

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“…This is a planned secondary analysis of a single-center prospective observational cohort study where the comparison of continuous cardiac index measurements by Nexfin® and a semi-invasive reference method was previously published [ 28 ]. The single-center prospective observational cohort study was conducted at the Department of Anaesthesiology and Intensive Care Medicine and General Surgery, University Medical Center, Schleswig-Holstein, Campus Kiel, the protocol was approved by the local ethics committee of the Christian-Albrechts-University Kiel (file number: A 132/14).…”

Section: Methodsmentioning

confidence: 99%

“…A description of the study participants’ instrumentation, hemodynamic monitoring and anesthesia was already described previously [ 28 ].…”

Section: Methodsmentioning

confidence: 99%

Comparison of oscillometric, non-invasive and invasive arterial pressure monitoring in patients undergoing laparoscopic bariatric surgery – a secondary analysis of a prospective observational study

et al. 2022

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Background Oscillometric, non-invasive blood pressure measurement (NIBP) is the first choice of blood pressure monitoring in the majority of low and moderate risk surgeries. In patients with morbid obesity, however, it is subject to several limitations. The aim was to compare arterial pressure monitoring by NIBP and a non-invasive finger-cuff technology (Nexfin®) with the gold-standard invasive arterial pressure (IAP). Methods In this secondary analysis of a prospective observational, single centre cohort study, systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP) were measured at 16 defined perioperative time points including posture changes, fluid bolus administration and pneumoperitoneum (PP) in patients undergoing laparoscopic bariatric surgery. Absolute arterial pressures by NIBP, Nexfin® and IAP were compared using correlation and Bland Altman analyses. Interchangeability was defined by a mean difference ≤ 5 mmHg (SD ≤8 mmHg). Percentage error (PE) was calculated as an additional statistical estimate. For hemodynamic trending, concordance rates were analysed according to the Critchley criterion. Results Sixty patients (mean body mass index of 49.2 kg/m2) were enrolled and data from 56 finally analysed. Pooled blood pressure values of all time points showed a significant positive correlation for both NIPB and Nexfin® versus IAP. Pooled PE for NIBP versus IAP was 37% (SAP), 35% (DAP) and 30% (MAP), for Nexfin versus IAP 23% (SAP), 26% (DAP) and 22% (MAP). Correlation of MAP was best and PE lowest before induction of anesthesia for NIBP versus IAP (r = 0.72; PE 24%) and after intraoperative fluid bolus administration for Nexfin® versus IAP (r = 0.88; PE: 17.2%). Concordance of MAP trending was 90% (SAP 85%, DAP 89%) for NIBP and 91% (SAP 90%, DAP 86%) for Nexfin®. MAP trending was best during intraoperative ATP positioning for NIBP (97%) and at induction of anesthesia for Nexfin® (97%). Conclusion As compared with IAP, interchangeability of absolute pressure values could neither be shown for NIBP nor Nexfin®, however, NIBP showed poorer overall correlation and precision. Overall trending ability was generally high with Nexfin® surpassing NIBP. Nexfin® may likely render individualized decision-making in the management of different hemodynamic stresses during laparoscopic bariatric surgery, particularly where NIBP cannot be reliably established. Trial registration The non-interventional, observational study was registered retrospectively at (NCT03184285) on June 12, 2017.

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Perioperative non-invasive versus semi-invasive cardiac index monitoring in patients with bariatric surgery – a prospective observational study

Cited by 6 publications

References 49 publications

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

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

Comparison of oscillometric, non-invasive and invasive arterial pressure monitoring in patients undergoing laparoscopic bariatric surgery – a secondary analysis of a prospective observational study

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