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Lakhal K, Audran A, Normand G, Rozec B, Dauvergne JE, Boulain T. Noninvasive Arterial Pressure Measurements at the Lower Leg: Evaluation of the Influence of Patient Position (Semi-Recumbent or Horizontal)-A prospective study. Chest 2024:S0012-3692(24)05136-5. [PMID: 39236997 DOI: 10.1016/j.chest.2024.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 08/20/2024] [Accepted: 08/25/2024] [Indexed: 09/07/2024] Open
Affiliation(s)
- Karim Lakhal
- Department of Anesthesiology and Critical Care, Nantes Université, Laënnec Hospital, University Hospital of Nantes, Nantes, France.
| | - Alexia Audran
- Department of Anesthesiology and Critical Care, Nantes Université, Laënnec Hospital, University Hospital of Nantes, Nantes, France
| | - Gurvan Normand
- Department of Anesthesiology and Critical Care, Nantes Université, Laënnec Hospital, University Hospital of Nantes, Nantes, France
| | - Bertrand Rozec
- Department of Anesthesiology and Critical Care, Nantes Université, Laënnec Hospital, University Hospital of Nantes, Nantes, France; Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes, France
| | - Jérôme E Dauvergne
- Department of Anesthesiology and Critical Care, Nantes Université, Laënnec Hospital, University Hospital of Nantes, Nantes, France; Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes, France
| | - Thierry Boulain
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire d'Orléans, Nantes, France
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Lakhal K, Dauvergne JE, Messet-Charriere H, Nay MA, Kamel T, Muller G, Robert-Edan V, Rozec B, Ehrmann S, Jacquier S, Boulain T. Risk factors for poor performance in finger cuff non-invasive monitoring of arterial pressure: A prospective multicenter study. Anaesth Crit Care Pain Med 2024; 43:101333. [PMID: 38048986 DOI: 10.1016/j.accpm.2023.101333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Compared to the invasive technique, non-invasive monitoring of arterial pressure favors easier and faster implementation while potentially sacrificing some reliability. This may be particularly true for the Clearsight™ system (Edwards Lifesciences), which enables continuous monitoring. We evaluated the risk factors for its poor performance. METHODS Patients with an arterial catheter and stable mean arterial pressure (MAP) over a 5-min period were included. Six pairs of invasive and Clearsight measurements of MAP were collected and the bias between the two techniques was calculated. Poor performance of the Clearsight™ system was defined as either a failure to measure and display MAP or displaying an erroneous MAP (individual bias > 5 mmHg). Fingertip perfusion was assessed using the plethysmographic perfusion index (PI) and the capillary refill time (CRT). RESULTS Among 152 ICU patients (MAP of 81 ± 14 mmHg, norepinephrine in 78 [51%]), 78 (51%) experienced a poor performance of the Clearsight™ system: failure to display MAP in 19 (13%) patients, and erroneous value displayed in 59 (44%). In multivariate analysis, PI ≤ 0.85% (adjusted odds ratio [aOR] = 2.94 [95% confidence interval (95%CI):1.34;6.45]), CRT > 4 s (aOR = 5.28 [95%CI 1.39;20.05]), and the presence of hand edema (aOR = 2.06 [95%CI 1.01;4.21]) were associated with a higher likelihood of poor performance. Cardiac arrhythmia (aOR = 1.39 [95%CI 0.64;3.02]) and other tested variables were not associated with poor performance. CONCLUSIONS Half of the included patients exhibited poor Clearsight™ system performance. Our results caution against using finger cuff arterial pressure monitoring in patients with low PI (≤0.85%), protracted CRT (>4 s), or hand edema. REGISTRATION ClinicalTrials.gov, NCT04269382, Dr. G. Muller, February 13, 2020. https://classic. CLINICALTRIALS gov/ct2/show/NCT04269382.
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Affiliation(s)
- Karim Lakhal
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France.
| | - Jérôme E Dauvergne
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France
| | | | - Mai-Anh Nay
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
| | - Toufik Kamel
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
| | - Grégoire Muller
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France; CRICS-TriggerSep F-CRIN research network, Tours, France; Université de Tours, EA4245, Transplantation, Immunologie, Inflammation, Tours, France
| | - Vincent Robert-Edan
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France
| | - Bertrand Rozec
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France; Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes F-44093, France
| | - Stephan Ehrmann
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France; CRICS-TriggerSep F-CRIN research network, Tours, France; INSERM, Centre d'étude des pathologies respiratoires, U1100 Tours, France; Université de Tours, Tours, France
| | - Sophie Jacquier
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France
| | - Thierry Boulain
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
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Jiang Z, Li S, Wang L, Yu F, Zeng Y, Li H, Li J, Zhang Z, Zuo J. A comparison of invasive arterial blood pressure measurement with oscillometric non-invasive blood pressure measurement in patients with sepsis. J Anesth 2024; 38:222-231. [PMID: 38305914 DOI: 10.1007/s00540-023-03304-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/25/2023] [Indexed: 02/03/2024]
Abstract
PURPOSE This study aimed to compare non-invasive oscillometric blood pressure (NIBP) measurement with invasive arterial blood pressure (IBP) measurement in patients with sepsis. METHODS We conducted a retrospective study to evaluate the agreement between IBP and NIBP using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Paired blood pressure measurements of mean arterial pressure (MAP), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were compared using Bland-Altman analysis and paired Student's t test. We also focus on the effect of norepinephrine (NE) on the agreement between the two methods and the association between blood pressure and mortality during intensive care unit (ICU) stay. RESULTS A total of 96,673 paired blood pressure measurements from 6060 unique patients were analyzed in the study. In Bland-Altman analysis, the bias (± SD, 95% limits of agreement) was 6.21 mmHg (± 12.05 mmHg, - 17.41 to 29.83 mmHg) for MAP, 0.39 mmHg (± 19.25 mmHg, - 37.34 to 38.12 mmHg) for SBP, and 0.80 mmHg (± 12.92 mmHg, - 24.52 to 26.12 mmHg) for DBP between the two techniques. Similarly, large limits of agreement were shown in different groups of NE doses. NE doses significantly affected the agreement between IBP and NIBP. SBP between the two methods gave an inconsistent assessment of patients' risk of ICU mortality. CONCLUSION IBP and NIBP were not interchangeable in septic patients. Clinicians should be aware that non-invasive MAP was clinically and significantly underestimated invasive MAP.
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Affiliation(s)
- Ziqing Jiang
- Candidate of Master's Degree, The First Clinical Medical College, Guangzhou University of Chinese Medicine, Baiyun District, Guangzhou, Guangdong Province, China
| | - Shaoying Li
- Candidate of Master's Degree, The First Clinical Medical College, Guangzhou University of Chinese Medicine, Baiyun District, Guangzhou, Guangdong Province, China
| | - Lin Wang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China
| | - Feng Yu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China
| | - Yanping Zeng
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China
| | - Hongbo Li
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China
| | - Jun Li
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China
| | - Zhanfeng Zhang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China
| | - Junling Zuo
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong Province, China.
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Gore P, Liu H, Bohringer C. Can Currently Available Non-invasive Continuous Blood Pressure Monitors Replace Invasive Measurement With an Arterial Catheter? Cureus 2024; 16:e54707. [PMID: 38529464 PMCID: PMC10961923 DOI: 10.7759/cureus.54707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/27/2024] Open
Abstract
Deviations from normal blood pressure (BP) during general anesthesia have been clearly linked to several adverse outcomes. Measuring BP accurately is therefore critically important for producing excellent outcomes in health care. Normal BP does not necessarily guarantee adequate organ perfusion however and adverse events have occurred even when BP seemed adequate. Invasive blood pressure monitoring has recently evolved beyond merely measuring BP. Arterial line-derived pulse contour analysis is used now to assess both cardiac output and stroke volume variation as indices of adequate intravascular volume. Confirmation of acceptable cardiac output with data derived from invasive intra-arterial catheters has become very important when managing high-risk patients. Newer devices that measure BP continuously and non-invasively in the digital arteries via a finger cuff have also become available. Many clinicians contemplate now if these new devices are ready to replace invasive monitoring with an arterial catheter. Unlike non-invasive devices, intra-arterial catheters allow frequent blood sampling. This makes it possible to assess vital parameters like pH, hemoglobin concentration, ionized calcium, potassium, glucose, and arterial partial pressure of oxygen and carbon dioxide frequently. Non-invasive continuous BP measurement has been found to be unreliable in critically ill patients, the elderly, and patients with calcified arteries. Pulse contour-derived estimates of cardiac output and stroke volume variation have been validated better with data derived from arterial lines than that from the newer finger cuff monitors. Significant advances have been recently made with non-invasive continuous BP monitors. Invasive monitoring with an arterial line however remains the gold standard for measuring BP and assessing pulse contour analysis-derived hemodynamic variables in critically ill patients. In the future, non-invasive continuous BP monitors will likely replace intermittent oscillometers in the operating room and the postoperative period. They will however not eliminate the need for arterial catheterization in critically ill patients.
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Affiliation(s)
- Payton Gore
- Anesthesiology, University of California Davis Medical Center, Sacramento, USA
| | - Hong Liu
- Anesthesiology, University of California Davis Medical Center, Sacramento, USA
| | - Christian Bohringer
- Anesthesiology, University of California Davis Medical Center, Sacramento, USA
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Elsherbiny M, Hasanin A, Kasem S, Abouzeid M, Mostafa M, Fouad A, Abdelwahab Y. Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial. BMC Anesthesiol 2023; 23:329. [PMID: 37789329 PMCID: PMC10546635 DOI: 10.1186/s12871-023-02292-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND We aimed to compare the hemodynamic effect of two ratios of propofol and ketamine (ketofol), namely 1:1 and 1:3 ratios, in rapid-sequence induction of anesthesia for emergency laparotomy. METHODS This randomized controlled study included adult patients undergoing emergency laparotomy under general anesthesia. The patients were randomized to receive either ketofol ratio of 1:1 (n = 37) or ketofol ratio of 1:3 (n = 37). Hypotension (mean arterial pressure < 70 mmHg) was managed by 5-mcg norepinephrine. The primary outcome was total norepinephrine requirements during the postinduction period. Secondary outcomes included the incidence of postinduction hypotension, and the intubation condition (excellent, good, or poor). RESULTS Thirty-seven patients in the ketofol-1:1 and 35 patients in the ketofol 1:3 group were analyzed. The total norepinephrine requirement was less in the ketofol-1:1 group than in the ketofol-1:3 group, P-values: 0.043. The incidence of postinduction hypotension was less in the ketofol-1:1 group (4 [12%]) than in ketofol-1:3 group (12 [35%]), P-value 0.022. All the included patients had excellent intubation condition. CONCLUSION In patients undergoing emergency laparotomy, the use of ketofol in 1:1 ratio for rapid-sequence induction of anesthesia was associated with less incidence of postinduction hypotension and vasopressor consumption in comparison to the 1:3 ratio with comparable intubation conditions. CLINICAL TRIAL REGISTRATION NCT05166330. URL: https://clinicaltrials.gov/ct2/show/NCT05166330 .
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Affiliation(s)
- Mona Elsherbiny
- Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Sahar Kasem
- Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Abouzeid
- Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha Mostafa
- Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Fouad
- Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yaser Abdelwahab
- Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Lakhal K, Dauvergne JE, Kamel T, Messet-Charriere H, Jacquier S, Robert-Edan V, Nay MA, Rozec B, Ehrmann S, Muller G, Boulain T. Noninvasive Monitoring of Arterial Pressure: Finger or Lower Leg As Alternatives to the Upper Arm: A Prospective Study in Three ICUs. Crit Care Med 2023; 51:1350-1362. [PMID: 37232853 DOI: 10.1097/ccm.0000000000005945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES When the upper arm is inaccessible for measurements of arterial pressure (AP), the best alternative site is unknown. We performed a between-site comparison of the agreement between invasive and noninvasive readings of AP taken at the lower leg, the finger, and the upper arm. The risk associated with measurement errors and the trending ability were also assessed. DESIGN Prospective observational study. SETTING Three ICUs. PATIENTS Patients having an arterial catheter and an arm circumference less than 42 cm. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Three triplicates of AP measurements were collected via an arterial catheter (reference AP), a finger cuff system (ClearSight; Edward Lifesciences, Irvine, CA), and an oscillometric cuff (at the lower leg then the upper arm). Trending ability was assessed through an additional set of measurements after a cardiovascular intervention. The default bed backrest angle was respected. Failure to measure and display AP occurred in 19 patients (13%) at the finger, never at other sites. In 130 patients analyzed, the agreement between noninvasive and invasive readings was worse at the lower leg than that observed at the upper arm or the finger (for mean AP, bias ± sd of 6.0 ± 15.8 vs 3.6 ± 7.1 and 0.1 ± 7.4 mm Hg, respectively; p < 0.05), yielding a higher frequency of error-associated clinical risk (no risk for 64% vs 84% and 86% of measurements, respectively, p < 0.0001). According to the International Organization for Standardization (ISO) 81060-2:2018 standard, mean AP measurements were reliable at the upper arm and the finger, not the lower leg. In 33 patients reassessed after a cardiovascular intervention, both the concordance rate for change in mean AP and the ability to detect a therapy-induced significant change were good and similar at the three sites. CONCLUSIONS As compared with lower leg measurements of AP, finger measurements were, when possible, a preferable alternative to upper arm ones.
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Affiliation(s)
- Karim Lakhal
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Jérôme E Dauvergne
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Toufik Kamel
- Service de médecine intensive-réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | | | - Sophie Jacquier
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France
| | - Vincent Robert-Edan
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
| | - Mai-Anh Nay
- Service de médecine intensive-réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France
- Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes, France
| | - Stephan Ehrmann
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France
- CRICS-TriggerSep F-CRIN research network, Tours, France
- INSERM, Centre d'étude des pathologies respiratoires, Tours, France
- Université de Tours, Tours, France
| | - Grégoire Muller
- Service de médecine intensive-réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
- CRICS-TriggerSep F-CRIN research network, Tours, France
- Université de Tours, EA4245, Transplantation, Immunologie, Inflammation, Tours, France
| | - Thierry Boulain
- Service de médecine intensive-réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
- CRICS-TriggerSep F-CRIN research network, Tours, France
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Gamal RM, Mostafa M, Hasanin AM, Khedr SA, Abdelgalil AS, Elshal MM. Evaluation of the accuracy of oscillometric non-invasive blood pressure measurement at the ankle in children during general anesthesia. J Clin Monit Comput 2023; 37:1239-1245. [PMID: 37166693 PMCID: PMC10520206 DOI: 10.1007/s10877-023-01025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Abstract
This study aimed to evaluate the accuracy of oscillometric blood pressure measurement at the ankle in children using invasive blood pressure as reference standard. This prospective observational study included children undergoing noncardiac surgery. Paired radial invasive and ankle non-invasive blood pressure measurements were obtained. Delta blood pressure was calculated as the difference between two consecutive readings. The primary outcome was the mean bias and agreement between the two methods using the Bland-Altman analysis. The ISO standard was fulfilled if the mean bias between the two methods was ≤ 5 ± 8 mmHg. Other outcomes included the trending ability of ankle blood pressure using the four-quadrant plot and the accuracy of ankle measurement to detect hypotension using area under receiver operating characteristic curve (AUC) analysis. We analyzed 683 paired readings from 86 children. The mean bias between the two methods for systolic, diastolic, and mean blood pressure (SBP, DBP, MAP) was - 7.2 ± 10.7, 4.5 ± 12.8, and - 1.8 ± 8.2 mmHg, respectively. The concordance rate of ankle blood pressure was 72%, 71%, and 77% for delta SBP, DBP and MAP, respectively. The AUC (95% confidence interval) for ankle MAP ability to detect hypotension was 0.91 (0.89-0.93) with negative predictive value of 100% at cut-off value ≤ 70 mmHg, We concluded that in pediatric population undergoing noncardiac surgery, ankle blood pressure was not interchangeable with the corresponding invasive readings with the ankle MAP having the least bias compared to SBP and DBP. An ankle MAP > 70 mmHg can exclude hypotension with negative predictive value of 100%.
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Affiliation(s)
- Reham M Gamal
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, 01 Elsarayah street, Elmanyal, Cairo 11559 Egypt
| | - Ahmed M Hasanin
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Suzan Adlan Khedr
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Salah Abdelgalil
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mamdouh Mahmoud Elshal
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
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Calabrese S, Angileri S, Paolicchi O, Mancinelli P, Colosimo D, Ricci Z. Noninvasive vs. invasive arterial pressure during pediatric non cardiac surgery. Minerva Anestesiol 2023; 89:841-842. [PMID: 37158631 DOI: 10.23736/s0375-9393.23.17338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Silvio Calabrese
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy
| | - Sandra Angileri
- Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, IRCCS Meyer Children's University Hospital, Florence, Italy
| | - Olivia Paolicchi
- Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, IRCCS Meyer Children's University Hospital, Florence, Italy
| | - Paola Mancinelli
- Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, IRCCS Meyer Children's University Hospital, Florence, Italy
| | - Denise Colosimo
- Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, IRCCS Meyer Children's University Hospital, Florence, Italy
| | - Zaccaria Ricci
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy -
- Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, IRCCS Meyer Children's University Hospital, Florence, Italy
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9
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Li J, Jia H, Zhou J, Huang X, Xu L, Jia S, Gao Z, Yao K, Li D, Zhang B, Liu Y, Huang Y, Hu Y, Zhao G, Xu Z, Li J, Yiu CK, Gao Y, Wu M, Jiao Y, Zhang Q, Tai X, Chan RH, Zhang Y, Ma X, Yu X. Thin, soft, wearable system for continuous wireless monitoring of artery blood pressure. Nat Commun 2023; 14:5009. [PMID: 37591881 PMCID: PMC10435523 DOI: 10.1038/s41467-023-40763-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023] Open
Abstract
Continuous monitoring of arterial blood pressure (BP) outside of a clinical setting is crucial for preventing and diagnosing hypertension related diseases. However, current continuous BP monitoring instruments suffer from either bulky systems or poor user-device interfacial performance, hampering their applications in continuous BP monitoring. Here, we report a thin, soft, miniaturized system (TSMS) that combines a conformal piezoelectric sensor array, an active pressure adaptation unit, a signal processing module, and an advanced machine learning method, to allow real wearable, continuous wireless monitoring of ambulatory artery BP. By optimizing the materials selection, control/sampling strategy, and system integration, the TSMS exhibits improved interfacial performance while maintaining Grade A level measurement accuracy. Initial trials on 87 volunteers and clinical tracking of two hypertension individuals prove the capability of the TSMS as a reliable BP measurement product, and its feasibility and practical usability in precise BP control and personalized diagnosis schemes development.
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Affiliation(s)
- Jian Li
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Huiling Jia
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Jingkun Zhou
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Xingcan Huang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Long Xu
- School of Mechanical and Aerospace Engineering, Jilin University, 130012, Changchun, China
| | - Shengxin Jia
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Zhan Gao
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Kuanming Yao
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Dengfeng Li
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Binbin Zhang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Yiming Liu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Ya Huang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Yue Hu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Guangyao Zhao
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Zitong Xu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Jiyu Li
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Chun Ki Yiu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Yuyu Gao
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Mengge Wu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- State Key Laboratory of Electronic Thin Films and Integrated Devices, School of Optoelectronic Science and Engineering, University of Electronic Science and Technology of China (UESTC), 610054, Chengdu, China
| | - Yanli Jiao
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Qiang Zhang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Xuecheng Tai
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
- Department of Mathematics, Hong Kong Baptist University, Hong Kong, China
| | - Raymond H Chan
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Yuanting Zhang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Xiaohui Ma
- Department of vascular and endovascular surgery, The first medical center of Chinese PLA General Hospital, 100853, Beijing, China.
| | - Xinge Yu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China.
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China.
- City University of Hong Kong Shenzhen Research Institute, 518057, Shenzhen, China.
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10
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Wan Q, Chen Q, Freithaler MA, Velagala SR, Liu Y, To AC, Mahajan A, Mukkamala R, Xiong F. Toward Real-Time Blood Pressure Monitoring via High-Fidelity Iontronic Tonometric Sensors with High Sensitivity and Large Dynamic Ranges. Adv Healthc Mater 2023; 12:e2202461. [PMID: 36942993 PMCID: PMC11061714 DOI: 10.1002/adhm.202202461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/14/2023] [Indexed: 03/23/2023]
Abstract
Continuous, noninvasive blood pressure (CNIBP) monitoring provides valuable hemodynamic information that renders detection of the early onset of cardiovascular diseases. Wearable mechano-electric pressure sensors that mount on the skin are promising candidates for monitoring continuous blood pressure (BP) pulse waveforms due to their excellent conformability, simple sensing mechanisms, and convenient signal acquisition. However, it is challenging to acquire high-fidelity BP pulse waveforms since it requires highly sensitive sensors (sensitivity larger than 4 × 10-5 kPa-1 ) that respond linearly with pressure change over a large dynamic range, covering the typical BP range (5-25 kPa). Herein, this work introduces a high-fidelity, iontronic-based tonometric sensor (ITS) with high sensitivity (4.82 kPa-1 ), good linearity (R2 > 0.995), and a large dynamic range (up to 180% output change) over a broad working range (0 to 38 kPa). Additionally, the ITS demonstrates a low limit of detection at 40 Pa, a fast load response time (35 ms) and release time (35 ms), as well as a stable response over 5000 load per release cycles, paving ways for potential applications in human-interface interaction, electronic skins, and robotic haptics. This work further explores the application of the ITS in monitoring real-time, beat-to-beat BP by measuring the brachial and radial pulse waveforms. This work provides a rational design of a wearable pressure sensor with high sensitivity, good linearity, and a large dynamic range for real-time CNIBP monitoring.
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Affiliation(s)
- Qingzhou Wan
- Department of Electrical and Computer Engineering University of Pittsburgh, Pittsburgh, PA 15261, United States of America
| | - Qian Chen
- Department of Mechanical Engineering and Materials Science University of Pittsburgh, Pittsburgh, PA 15261, United States of America
| | - Mark A Freithaler
- Department of BioEngineering, University of Pittsburgh, Pittsburgh, PA 15261, United States of America
| | - Sridhar Reddy Velagala
- Department of Electrical and Computer Engineering University of Pittsburgh, Pittsburgh, PA 15261, United States of America
| | - Yihan Liu
- Department of Electrical and Computer Engineering University of Pittsburgh, Pittsburgh, PA 15261, United States of America
| | - Albert C. To
- Department of Mechanical Engineering and Materials Science University of Pittsburgh, Pittsburgh, PA 15261, United States of America
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative, University of Pittsburgh, Pittsburgh, PA 15261, United States of America
| | - Ramakrishna Mukkamala
- Department of BioEngineering, University of Pittsburgh, Pittsburgh, PA 15261, United States of America
| | - Feng Xiong
- Department of Electrical and Computer Engineering University of Pittsburgh, Pittsburgh, PA 15261, United States of America
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11
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Features from the photoplethysmogram and the electrocardiogram for estimating changes in blood pressure. Sci Rep 2023; 13:986. [PMID: 36653426 PMCID: PMC9849280 DOI: 10.1038/s41598-022-27170-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/27/2022] [Indexed: 01/19/2023] Open
Abstract
There is a growing emphasis being placed on the potential for cuffless blood pressure (BP) estimation through modelling of morphological features from the photoplethysmogram (PPG) and electrocardiogram (ECG). However, the appropriate features and models to use remain unclear. We investigated the best features available from the PPG and ECG for BP estimation using both linear and non-linear machine learning models. We conducted a clinical study in which changes in BP ([Formula: see text]BP) were induced by an infusion of phenylephrine in 30 healthy volunteers (53.8% female, 28.0 (9.0) years old). We extracted a large and diverse set of features from both the PPG and the ECG and assessed their individual importance for estimating [Formula: see text]BP through Shapley additive explanation values and a ranking coefficient. We trained, tuned, and evaluated linear (ordinary least squares, OLS) and non-linear (random forest, RF) machine learning models to estimate [Formula: see text]BP in a nested leave-one-subject-out cross-validation framework. We reported the results as correlation coefficient ([Formula: see text]), root mean squared error (RMSE), and mean absolute error (MAE). The non-linear RF model significantly ([Formula: see text]) outperformed the linear OLS model using both the PPG and the ECG signals across all performance metrics. Estimating [Formula: see text]SBP using the PPG alone ([Formula: see text] = 0.86 (0.23), RMSE = 5.66 (4.76) mmHg, MAE = 4.86 (4.29) mmHg) performed significantly better than using the ECG alone ([Formula: see text] = 0.69 (0.45), RMSE = 6.79 (4.76) mmHg, MAE = 5.28 (4.57) mmHg), all [Formula: see text]. The highest ranking features from the PPG largely modelled increasing reflected wave interference driven by changes in arterial stiffness. This finding was supported by changes observed in the PPG waveform in response to the phenylephrine infusion. However, a large number of features were required for accurate BP estimation, highlighting the high complexity of the problem. We conclude that the PPG alone may be further explored as a potential single source, cuffless, blood pressure estimator. The use of the ECG alone is not justified. Non-linear models may perform better as they are able to incorporate interactions between feature values and demographics. However, demographics may not adequately account for the unique and individualised relationship between the extracted features and BP.
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12
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Yang M, Ye Z, Alsaab N, Farhat M, Chen PY. In-Vitro Demonstration of Ultra-Reliable, Wireless and Batteryless Implanted Intracranial Sensors Operated on Loci of Exceptional Points. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2022; 16:287-295. [PMID: 35380967 DOI: 10.1109/tbcas.2022.3164697] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Vital signal monitoring, such as pulse, respiration rate, intra-organ and intra-vascular pressure, can provide important information for determination of clinic diagnosis, treatments, and surgical protocols. Nowadays, micromachined bioimplants, equipped with antennas for converting bio-signals to modulated radio transmissions, may allow remote continuous monitoring of patients' vital signs. Yet, current passive biotelemetry techniques usually suffer from poor signal reproducibility and robustness in light of inevitable misalignment between transmitting and receiving antennas. Here, we seek to address this long-existing challenge and to robustly acquire information from a passive wireless intracranial pressure (or brain pressure) sensor by introducing a novel, high-performance biotelemetry system. In spite of variable inductive links, this biotelemetry system may have absolute accuracy by leveraging the uniqueness of loci of exceptional points (EPs) in non-Hermitian radio-frequency (RF) electronic systems with parity-time (PT) symmetry. Our in-vitro experimental demonstration shows that the proposed intracranial (ICP) monitoring system can provide a sub-mmHg resolution in the ICP range of 0-20 mmHg and ultra-robust wireless data acquisition against the misalignment-induced weakening of inductive link. Our results could provide a practical pathway toward reliable, real-time wireless monitoring of ICP, and other vital signals generated by bio-implants and wearables.
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13
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Miao F, Zhou B, Liu Z, Wen B, Li Y, Tang M. Using noninvasive adjusted pulse transit time for tracking beat-to-beat systolic blood pressure during ventricular arrhythmia. Hypertens Res 2022; 45:424-435. [PMID: 34931020 DOI: 10.1038/s41440-021-00795-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/26/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022]
Abstract
Tracking beat-to-beat blood pressure noninvasively during ventricular arrhythmia (VA) is of great importance but rarely reported. The goal of our study was to investigate the potential utility of the adjusted pulse transit time (APTT) to track beat-to-beat femoral systolic blood pressure (SBP) during VA. Patients who underwent radiofrequency ablation for arrhythmias at Fuwai Hospital were enrolled. Electrocardiograms (ECGs), finger photoplethysmograms, and femoral arterial blood pressure were recorded simultaneously during VA. The APTT was calculated as the ratio between the square of the conventional pulse transit time (cPTT) and the RR interval of the ECG waveform. Forty-five patients were enrolled in our study, and 22,849 beats were collected during their VA. The inverse of the APTT showed a good correlation with femoral SBP during VA (r = 0.70 ± 0.18). The APTT-derived SBP demonstrated acceptable accuracy in terms of the mean difference ± standard deviation (-0.01 ± 10.54 mmHg) from the invasive femoral SBP. The area under the receiver operating characteristic (ROC) curve for the ability of the APTT to detect ≥30% decreases in femoral SBP was 0.903 (95% confidential interval, 0.895-0.911). In addition, the APTT performed better than the cPTT and RR interval in the above analysis (all P < 0.05). Therefore, the APTT has acceptable accuracy in tracking beat-to-beat femoral SBP and could detect substantially decreased femoral SBP. These findings indicate that the APTT may be a promising noninvasive surrogate for invasive femoral SBP during VA. A multiparameter model combining APTT and other parameters is needed to further improve the accuracy.
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Affiliation(s)
- Fen Miao
- Key Laboratory for Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Bin Zhou
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Fuwai Hospital, National Center for Cardiovascular Disease, State Key Lab of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zengding Liu
- Key Laboratory for Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Bo Wen
- Key Laboratory for Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Ye Li
- Key Laboratory for Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Joint Engineering Research Center for Health Big Data Intelligent Analysis Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Min Tang
- Fuwai Hospital, National Center for Cardiovascular Disease, State Key Lab of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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14
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Mahmud S, Ibtehaz N, Khandakar A, Tahir AM, Rahman T, Islam KR, Hossain MS, Rahman MS, Musharavati F, Ayari MA, Islam MT, Chowdhury MEH. A Shallow U-Net Architecture for Reliably Predicting Blood Pressure (BP) from Photoplethysmogram (PPG) and Electrocardiogram (ECG) Signals. SENSORS (BASEL, SWITZERLAND) 2022; 22:919. [PMID: 35161664 PMCID: PMC8840244 DOI: 10.3390/s22030919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 12/10/2022]
Abstract
Cardiovascular diseases are the most common causes of death around the world. To detect and treat heart-related diseases, continuous blood pressure (BP) monitoring along with many other parameters are required. Several invasive and non-invasive methods have been developed for this purpose. Most existing methods used in hospitals for continuous monitoring of BP are invasive. On the contrary, cuff-based BP monitoring methods, which can predict systolic blood pressure (SBP) and diastolic blood pressure (DBP), cannot be used for continuous monitoring. Several studies attempted to predict BP from non-invasively collectible signals such as photoplethysmograms (PPG) and electrocardiograms (ECG), which can be used for continuous monitoring. In this study, we explored the applicability of autoencoders in predicting BP from PPG and ECG signals. The investigation was carried out on 12,000 instances of 942 patients of the MIMIC-II dataset, and it was found that a very shallow, one-dimensional autoencoder can extract the relevant features to predict the SBP and DBP with state-of-the-art performance on a very large dataset. An independent test set from a portion of the MIMIC-II dataset provided a mean absolute error (MAE) of 2.333 and 0.713 for SBP and DBP, respectively. On an external dataset of 40 subjects, the model trained on the MIMIC-II dataset provided an MAE of 2.728 and 1.166 for SBP and DBP, respectively. For both the cases, the results met British Hypertension Society (BHS) Grade A and surpassed the studies from the current literature.
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Affiliation(s)
- Sakib Mahmud
- Department of Electrical Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (S.M.); (N.I.); (A.K.); (A.M.T.); (T.R.); (K.R.I.)
| | - Nabil Ibtehaz
- Department of Electrical Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (S.M.); (N.I.); (A.K.); (A.M.T.); (T.R.); (K.R.I.)
| | - Amith Khandakar
- Department of Electrical Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (S.M.); (N.I.); (A.K.); (A.M.T.); (T.R.); (K.R.I.)
| | - Anas M. Tahir
- Department of Electrical Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (S.M.); (N.I.); (A.K.); (A.M.T.); (T.R.); (K.R.I.)
| | - Tawsifur Rahman
- Department of Electrical Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (S.M.); (N.I.); (A.K.); (A.M.T.); (T.R.); (K.R.I.)
| | - Khandaker Reajul Islam
- Department of Electrical Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (S.M.); (N.I.); (A.K.); (A.M.T.); (T.R.); (K.R.I.)
| | - Md Shafayet Hossain
- Department of Electrical, Electronics and Systems Engineering, Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia; (M.S.H.); (M.T.I.)
| | - M. Sohel Rahman
- Department of CSE, BUET, ECE Building, West Palashi, Dhaka 1205, Bangladesh;
| | - Farayi Musharavati
- Department Mechanical and Industrial Engineering, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Mohamed Arselene Ayari
- Department of Civil and Architectural Engineering, Qatar University, Doha P.O. Box 2713, Qatar;
- Technology Innovation and Engineering Education (TIEE), Qatar University, Doha P.O. Box 2713, Qatar
| | - Mohammad Tariqul Islam
- Department of Electrical, Electronics and Systems Engineering, Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia; (M.S.H.); (M.T.I.)
| | - Muhammad E. H. Chowdhury
- Department of Electrical Engineering, Qatar University, Doha P.O. Box 2713, Qatar; (S.M.); (N.I.); (A.K.); (A.M.T.); (T.R.); (K.R.I.)
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15
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Finnegan E, Davidson S, Harford M, Jorge J, Watkinson P, Young D, Tarassenko L, Villarroel M. Pulse arrival time as a surrogate of blood pressure. Sci Rep 2021; 11:22767. [PMID: 34815419 PMCID: PMC8611024 DOI: 10.1038/s41598-021-01358-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Various models have been proposed for the estimation of blood pressure (BP) from pulse transit time (PTT). PTT is defined as the time delay of the pressure wave, produced by left ventricular contraction, measured between a proximal and a distal site along the arterial tree. Most researchers, when they measure the time difference between the peak of the R-wave in the electrocardiogram signal (corresponding to left ventricular depolarisation) and a fiducial point in the photoplethysmogram waveform (as measured by a pulse oximeter attached to the fingertip), describe this erroneously as the PTT. In fact, this is the pulse arrival time (PAT), which includes not only PTT, but also the time delay between the electrical depolarisation of the heart's left ventricle and the opening of the aortic valve, known as pre-ejection period (PEP). PEP has been suggested to present a significant limitation to BP estimation using PAT. This work investigates the impact of PEP on PAT, leading to a discussion on the best models for BP estimation using PAT or PTT. We conducted a clinical study involving 30 healthy volunteers (53.3% female, 30.9 ± 9.35 years old, with a body mass index of 22.7 ± 3.2 kg/m[Formula: see text]). Each session lasted on average 27.9 ± 0.6 min and BP was varied by an infusion of phenylephrine (a medication that causes venous and arterial vasoconstriction). We introduced new processing steps for the analysis of PAT and PEP signals. Various population-based models (Poon, Gesche and Fung) and a posteriori models (inverse linear, inverse squared and logarithm) for estimation of BP from PTT or PAT were evaluated. Across the cohort, PEP was found to increase by 5.5 ms ± 4.5 ms from its baseline value. Variations in PTT were significantly larger in amplitude, - 16.8 ms ± 7.5 ms. We suggest, therefore, that for infusions of phenylephrine, the contribution of PEP on PAT can be neglected. All population-based models produced large BP estimation errors, suggesting that they are insufficient for modelling the complex pathways relating changes in PTT or PAT to changes in BP. Although PAT is inversely correlated with systolic blood pressure (SBP), the gradient of this relationship varies significantly from individual to individual, from - 2946 to - 470.64 mmHg/s in our dataset. For the a posteriori inverse squared model, the root mean squared errors (RMSE) for systolic and diastolic blood pressure (DBP) estimation from PAT were 5.49 mmHg and 3.82 mmHg, respectively. The RMSEs for SBP and DBP estimation by PTT were 4.51 mmHg and 3.53 mmHg, respectively. These models take into account individual calibration curves required for accurate blood pressure estimation. The best performing population-based model (Poon) reported error values around double that of the a posteriori inverse squared model, and so the use of population-based models is not justified.
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Affiliation(s)
- Eoin Finnegan
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK.
| | - Shaun Davidson
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Mirae Harford
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - João Jorge
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Peter Watkinson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Duncan Young
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Mauricio Villarroel
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
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16
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Kwon Y, Stafford PL, Enfield K, Mazimba S, Baruch MC. Continuous Noninvasive Blood Pressure Monitoring of Beat-By-Beat Blood Pressure and Heart Rate Using Caretaker Compared With Invasive Arterial Catheter in the Intensive Care Unit. J Cardiothorac Vasc Anesth 2021; 36:2012-2021. [PMID: 34666928 DOI: 10.1053/j.jvca.2021.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the accuracy of noninvasively-derived peripheral arterial blood pressure (BP) by the Caretaker device (CT) against invasively measured arterial BP and the fidelity of heart rate variability by CT compared with electrocardiogram (ECG)-derived data. DESIGN Prospective cohort study. PARTICIPANTS Adult surgical and trauma patients admitted to the intensive care unit. SETTING Academic tertiary care medical center. INTERVENTIONS In a prospective manner, beat-by-beat BP by CT was recorded simultaneously with invasive arterial BP measured in patients in the intensive care unit. Invasive arterial BPs were compared with those obtained by the CT system. All comparisons among the CT data, arterial catheter data, and ECG data were postprocessed. MEASUREMENTS AND MAIN RESULTS From 37 enrolled patients, 34 were included with satisfactory data that overlapped between arterial catheter and CT. A total of 87,757 comparative data points were obtained for the 40-minute time window comparisons of the 34 patients, spanning approximately 22.5 hours in total. Systolic BP and diastolic BP correlations (Pearson coefficient), as well as the mean difference (standard deviation), were 0.92 and -0.36 (7.57) mmHg and 0.83 and -2.11 (6.00) mmHg, respectively. The overall interbeat correlation was 0.99, with the mean difference between interbeats obtained with the arterial BP and the CT of -0.056 ms (6.0). CONCLUSIONS This study validated the noninvasive tracking of BP using the CT device, and the pulse decomposition analysis approach is possible within the guidelines of the standard.
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Affiliation(s)
- Younghoon Kwon
- Department of Medicine, University of Washington, Seattle, WA.
| | | | - Kyle Enfield
- Department of Medicine, University of Virginia, Charlottesville, VA
| | - Sula Mazimba
- Department of Medicine, University of Virginia, Charlottesville, VA
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17
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Markakis K, Pagonas N, Georgianou E, Zgoura P, Rohn BJ, Bertram S, Seidel M, Bettag S, Trappe HJ, Babel N, Westhoff TH, Seibert FS. Feasibility of non-invasive measurement of central blood pressure and arterial stiffness in shock. Eur J Clin Invest 2021; 51:e13587. [PMID: 34022074 DOI: 10.1111/eci.13587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients in haemodynamic shock are in need for an intensive care treatment. Invasive haemodynamic monitoring is state of the art for these patients. However, evolved, non-invasive blood pressure monitoring devices offer advanced functions like the assessment of central blood pressure and arterial stiffness. We analysed the feasibility of two oscillometric blood pressure devices in patients with shock. METHODS We performed a monocentre prospective study, enrolling 57 patients admitted to the intensive care unit (ICU), due to septic and/or cardiogenic shock. We assessed invasive and non-invasive peripheral and central blood pressure <24 hours and 48 hours after admission on the ICU. Additional haemodynamic parameters such as pulse wave velocity (PWV), augmentation pressure and augmentation index were obtained through Mobil-o-Graph PWA (IEM) and SphygmoCor XCEL (AtCor Medical). RESULTS A complete haemodynamic assessment was successful in all patients (48) with the Mobil-o-Graph 24 hours PWA and in 29 patients with the SphygmoCor XCEL (P = .001), when cases of death or device malfunction were excluded. Reasons for failure were severe peripheral artery disease, haemodynamic instability, oedema and agitation. Invasive blood pressure showed a sufficient correlation with both devices; however, large differences between invasive and non-invasive techniques were recorded in Bland-Altmann analysis (P < .05 for all parameters). PWV differed between the two devices. CONCLUSION Non-invasive peripheral blood pressure measurement remains a rescue technique. However, non-invasive assessment of arterial stiffness and central blood pressure is possible in patients with septic or cardiogenic shock. Further studies are required to assess their clinical significance for patients in shock.
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Affiliation(s)
- Konstantinos Markakis
- Department of Nephrology, Ruhr-University of Bochum, University Hospital Marien Hospital Herne, Herne, Germany
| | - Nikolaos Pagonas
- Department of Nephrology, Ruhr-University of Bochum, University Hospital Marien Hospital Herne, Herne, Germany.,Department of Cardiology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg, Brandenburg, Germany
| | - Eleni Georgianou
- Second Propedeutic Department of Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiota Zgoura
- Department of Nephrology, Ruhr-University of Bochum, University Hospital Marien Hospital Herne, Herne, Germany
| | - Benjamin J Rohn
- Department of Nephrology, Ruhr-University of Bochum, University Hospital Marien Hospital Herne, Herne, Germany
| | - Sebastian Bertram
- Department of Nephrology, Ruhr-University of Bochum, University Hospital Marien Hospital Herne, Herne, Germany
| | - Maximilian Seidel
- Department of Nephrology, Ruhr-University of Bochum, University Hospital Marien Hospital Herne, Herne, Germany
| | - Sebastian Bettag
- Department of Nephrology, Ruhr-University of Bochum, University Hospital Marien Hospital Herne, Herne, Germany
| | - Hans-Joachim Trappe
- Department of Cardiology, Ruhr-University of Bochum, University Hospital Marien Hospital Herne, Herne, Germany
| | - Nina Babel
- Department of Nephrology, Ruhr-University of Bochum, University Hospital Marien Hospital Herne, Herne, Germany
| | - Timm H Westhoff
- Department of Nephrology, Ruhr-University of Bochum, University Hospital Marien Hospital Herne, Herne, Germany
| | - Felix S Seibert
- Department of Nephrology, Ruhr-University of Bochum, University Hospital Marien Hospital Herne, Herne, Germany
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18
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Ranjit S, Natraj R, Kissoon N, Thiagarajan RR, Ramakrishnan B, Monge García MI. Variability in the Hemodynamic Response to Fluid Bolus in Pediatric Septic Shock. Pediatr Crit Care Med 2021; 22:e448-e458. [PMID: 33750093 DOI: 10.1097/pcc.0000000000002714] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Fluid boluses are commonly administered to improve the cardiac output and tissue oxygen delivery in pediatric septic shock. The objective of this study is to evaluate the effect of an early fluid bolus administered to children with septic shock on the cardiac index and mean arterial pressure, as well as on the hemodynamic response and its relationship with outcome. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS We prospectively collected hemodynamic data from children with septic shock presenting to the emergency department or the PICU who received a fluid bolus (10 mL/kg of Ringers Lactate over 30 min). A clinically significant response in cardiac index-responder and mean arterial pressure-responder was both defined as an increase of greater than or equal to 10% 10 minutes after fluid bolus. MEASUREMENTS AND MAIN RESULTS Forty-two children with septic shock, 1 month to 16 years old, median Pediatric Risk of Mortality-III of 13 (interquartile range, 9-19), of whom 66% were hypotensive and received fluid bolus within the first hour of shock recognition. Cardiac index- and mean arterial pressure-responsiveness rates were 31% and 38%, respectively. We failed to identify any association between cardiac index and mean arterial pressure changes (r = 0.203; p = 0.196). Cardiac function was similar in mean arterial pressure- and cardiac index-responders and nonresponders. Mean arterial pressure-responders increased systolic, diastolic, and perfusion pressures (mean arterial pressure - central venous pressure) after fluid bolus due to higher indexed systemic vascular resistance and arterial elastance index. Mean arterial pressure-nonresponders required greater vasoactive-inotrope support and had higher mortality. CONCLUSIONS The hemodynamic response to fluid bolus in pediatric septic shock was variable and unpredictable. We failed to find a relationship between mean arterial pressure and cardiac index changes. The adverse effects of fluid bolus extended beyond fluid overload and, in some cases, was associated with reduced mean arterial pressure, perfusion pressures and higher vasoactive support. Mean arterial pressure-nonresponders had increased mortality. The response to the initial fluid bolus may be helpful to understand each patient's individualized physiologic response and guide continued hemodynamic management.
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Affiliation(s)
| | | | - Niranjan Kissoon
- The University of British Columbia, The Child and Family Research Institute, and BC Children's Hospital, Vancouver, BC, Canada
| | - Ravi R Thiagarajan
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - M Ignacio Monge García
- Servicio de Cuidados Críticos y Urgencias Hospital SAS de Jerez C/Circunvalación s/n, Jerez de la Frontera, Spain
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Top 10 Pearls for the Recognition, Evaluation, and Management of Maternal Sepsis. Obstet Gynecol 2021; 138:289-304. [PMID: 34237760 PMCID: PMC8288480 DOI: 10.1097/aog.0000000000004471] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/23/2021] [Indexed: 12/13/2022]
Abstract
Maternal sepsis is a leading cause of preventable maternal mortality that requires early recognition, expedient evaluation, and appropriate management. Maternal sepsis is an obstetric emergency and a leading cause of maternal morbidity and mortality. Early recognition in a pregnant or postpartum patient can be a challenge as the normal physiologic changes of pregnancy may mask the signs and symptoms of sepsis. Bedside assessment tools may aid in the detection of maternal sepsis. Timely and targeted antibiotic therapy and fluid resuscitation are critical for survival in patients with suspected sepsis. Once diagnosed, a search for etiologies and early application of source control measures will further reduce harms. If the patient is in septic shock or not responding to initial treatment, multidisciplinary consultation and escalation of care is necessary. Health care professionals should be aware of the unique complications of sepsis in critically ill pregnant and postpartum patients, and measures to prevent poor outcomes in this population. Adverse pregnancy outcomes may occur in association with sepsis, and should be anticipated and prevented when possible, or managed appropriately when they occur. Using a standardized approach to the patient with suspected sepsis may reduce maternal morbidity and mortality.
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Accuracy of oscillometric blood pressure measurement at both arms in the lateral position. Blood Press Monit 2021; 26:364-372. [PMID: 34001758 DOI: 10.1097/mbp.0000000000000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the accuracy of noninvasive blood pressure (NIBP) measurement at the dependent- and nondependent arms in the lateral position, using invasive blood pressure (IBP) as reference. METHODS This prospective observational study included 42 adult patients undergoing surgery in the lateral position. Paired readings of IBP and NIBP were obtained at either arm. The accuracy of both arms in detecting mean arterial pressure (MAP) <70 mmHg was evaluated using the area under the receiver operating characteristic curve (AUC). The agreement between the IBP and NIBP was evaluated using the Bland-Altman and error grid analyses. RESULTS We analyzed 350 and 347 paired readings at the dependent- and nondependent arms. The AUC for detecting hypotension was comparable in both arms. The negative and positive predictive values (95% confidence interval) were 100% (99-100%) and 24% (14-34%), respectively for the dependent arm at cutoff value MAP ≤86 mmHg; and were 99% (96-100%) and 21% (13-30%), respectively for the nondependent arm at cutoff value MAP ≤75 mmHg. The mean bias for MAP was -6.0 ± 9.1 and 6.3 ± 10.1 mmHg; and for systolic blood pressure was 0.3 ± 11.6 and 13.2 ± 12.6 mmHg, in the dependent- and nondependent arm, respectively. Error grid analysis showed that the proportions of paired MAP readings in risk zone A were 71 and 82% in the dependent- and the nondependent arms, respectively. CONCLUSION In the lateral position, the NIBP readings at both arms are not interchangeable with the corresponding IBP readings. However, NIBP measurement at both arms can be used to accurately rule out hypotension.
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Abstract
PURPOSE OF REVIEW To appraise the basic and more advanced methods available for hemodynamic monitoring, and describe the definitions and criteria for the use of hemodynamic variables. RECENT FINDINGS The hemodynamic assessment in critically ill patients suspected of circulatory shock follows a step-by-step algorithm to help determine diagnosis and prognosis. Determination of accurate diagnosis and prognosis in turn is crucial for clinical decision-making. Basic monitoring involving clinical examination in combination with hemodynamic variables obtained with an arterial catheter and a central venous catheter may be sufficient for the majority of patients with circulatory shock. In case of uncertainty of the underlying cause or to guide treatment in severe shock may require additional advanced hemodynamic technologies, and each is utilized for different indications and has specific limitations. Future developments include refining the clinical examination and performing studies that demonstrate better patient outcomes by targeting hemodynamic variables using advanced hemodynamic monitoring. SUMMARY Determination of accurate diagnosis and prognosis for patients suspected of circulatory shock is essential for optimal decision-making. Numerous techniques are available, and each has its specific indications and value.
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22
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Moghadam MC, Masoumi E, Kendale S, Bagherzadeh N. Predicting hypotension in the ICU using noninvasive physiological signals. Comput Biol Med 2020; 129:104120. [PMID: 33387964 DOI: 10.1016/j.compbiomed.2020.104120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022]
Abstract
Hypotension frequently occurs in Intensive Care Units (ICU), and its early prediction can improve the outcome of patient care. Trends observed in signals related to blood pressure (BP) are critical in predicting future events. Unfortunately, the invasive measurement of BP signals is neither comfortable nor feasible in all bed settings. In this study, we investigate the performance of machine-learning techniques in predicting hypotensive events in ICU settings using physiological signals that can be obtained noninvasively. We show that noninvasive mean arterial pressure (NIMAP) can be simulated by down-sampling the invasively measured MAP. This enables us to investigate the effect of BP measurement frequency on the algorithm's performance by training and testing the algorithm on a large dataset provided by the MIMIC III database. This study shows that having NIMAP information is essential for adequate predictive performance. The proposed predictive algorithm can flag hypotension with a sensitivity of 84%, positive predictive value (PPV) of 73%, and F1-score of 78%. Furthermore, the predictive performance of the algorithm improves by increasing the frequency of BP sampling.
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Affiliation(s)
| | - Ehsan Masoumi
- Department of Electrical Engineering and Computer Science, University of California Irvine, Irvine, CA, 92697, USA.
| | - Samir Kendale
- Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
| | - Nader Bagherzadeh
- Department of Electrical Engineering and Computer Science, University of California Irvine, Irvine, CA, 92697, USA.
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Comparison of a noninvasive 3D force sensor-based method and the invasive arterial cannula in postsurgery intensive care patients: a pilot study. Blood Press Monit 2020; 24:310-314. [PMID: 31633517 DOI: 10.1097/mbp.0000000000000407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Improvement in sensing technologies is leading to new, accurate noninvasive monitoring devices. However, noninvasive continuous blood pressure (BP) monitoring still faces many challenges, such as: patient's movement, device accuracy and consistency. In this study, the accuracy of a novel noninvasive BP measuring system based on a three-axis force sensor is compared with the invasive arterial cannula taking 21 simultaneous measurements mostly on elderly, postsurgical participants. For the simultaneously recorded invasive and noninvasive signals, the similarity was high, the average correlation was 0.9001 ± 0.0588. The average differences (±SD) for simultaneously recorded systolic, diastolic and mean arterial pressures were: -9.53 ± 4.69, -0.26 ± 3.06 and 1.25 ± 2.26 mmHg, respectively. The results of diastolic and mean arterial pressure satisfy the criteria set by the Association for the Advancement of Medical Instrumentation. These results suggest that this noninvasive system could be a useful tool in continuous noninvasive BP monitoring, but still requires development.
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24
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Non-invasive measurements of blood pressure in obese patients: Where should I place the cuff? Anaesth Crit Care Pain Med 2020; 39:193-194. [PMID: 32220589 DOI: 10.1016/j.accpm.2020.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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25
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Kaufmann T, Cox EGM, Wiersema R, Hiemstra B, Eck RJ, Koster G, Scheeren TWL, Keus F, Saugel B, van der Horst ICC. Non-invasive oscillometric versus invasive arterial blood pressure measurements in critically ill patients: A post hoc analysis of a prospective observational study. J Crit Care 2020; 57:118-123. [PMID: 32109843 DOI: 10.1016/j.jcrc.2020.02.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/16/2020] [Accepted: 02/21/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim was to compare non-invasive blood pressure measurements with invasive blood pressure measurements in critically ill patients. METHODS Non-invasive blood pressure was measured via automated brachial cuff oscillometry, and simultaneously the radial arterial catheter-derived measurement was recorded as part of a prospective observational study. Measurements of systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP) were compared using Bland-Altman and error grid analyses. RESULTS Paired measurements of blood pressure were available for 736 patients. Observed mean difference (±SD, 95% limits of agreement) between oscillometrically and invasively measured blood pressure was 0.8 mmHg (±15.7 mmHg, -30.2 to 31.7 mmHg) for SAP, -2.9 mmHg (±11.0 mmHg, -24.5 to 18.6 mmHg) for DAP, and -1.0 mmHg (±10.2 mmHg, -21.0 to 18.9 mmHg) for MAP. Error grid analysis showed that the proportions of measurements in risk zones A to E were 78.3%, 20.7%, 1.0%, 0%, and 0.1% for MAP. CONCLUSION Non-invasive blood pressure measurements using brachial cuff oscillometry showed large limits of agreement compared to invasive measurements in critically ill patients. Error grid analysis showed that measurement differences between oscillometry and the arterial catheter would potentially have triggered at least low-risk treatment decisions in one in five patients.
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Affiliation(s)
- Thomas Kaufmann
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Eline G M Cox
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Renske Wiersema
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bart Hiemstra
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ruben J Eck
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Geert Koster
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thomas W L Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Frederik Keus
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Outcomes Research Consortium, Cleveland, OH, USA
| | - Iwan C C van der Horst
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Intensive Care, Maastricht University Medical Center+, Maastricht University, the Netherlands
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Oscillometric versus invasive blood pressure measurement in patients with shock: a prospective observational study in the emergency department. J Clin Monit Comput 2020; 35:387-393. [PMID: 32056094 PMCID: PMC8514358 DOI: 10.1007/s10877-020-00482-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/01/2020] [Indexed: 12/15/2022]
Abstract
In emergency medicine, blood pressure is often measured by an oscillometric device using an upper arm cuff. However, measurement accuracy of this technique in patients suffering from hypotensive shock has not been sufficiently evaluated. We designed a prospective observational study investigating the accuracy of an oscillometric device in hypotensive patients admitted to the resuscitation area of the emergency department. Patients admitted to the resuscitation area of a university hospital, who were equipped with an arterial catheter and found to be hypotensive (mean arterial pressure (MAP) < 60 mmHg) were eligible for the study. Blood pressure was measured simultaneously via upper arm cuff and invasively under routine clinical conditions. After data extraction, Bland–Altman analysis, correlation coefficient and percentage error of mean and systolic blood pressure pairs were performed. We analysed 75 simultaneously obtained blood pressure measurements of 30 patients in hypotension, 11 (37%) were female, median age was 76.5 years (IQR 63–82). Oscillometric MAP was markedly higher than invasive MAP with a mean of the differences of 13 ± 15 mmHg (oscillometric—invasive), 95% limits of agreement − 16 to 41 mmHg, percentage error was 76%. In 64% of readings, values obtained by the upper arm cuff were not able to detect hypotension. Oscillometric blood pressure measurement is not able to reliably detect hypotension in emergency patients. Therefore, direct measurement of blood pressure should be established as soon as possible in patients suffering from shock.
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Pour-Ghaz I, Manolukas T, Foray N, Raja J, Rawal A, Ibebuogu UN, Khouzam RN. Accuracy of non-invasive and minimally invasive hemodynamic monitoring: where do we stand? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:421. [PMID: 31660320 DOI: 10.21037/atm.2019.07.06] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
One of the most important variables in assessing hemodynamic status in the intensive care unit (ICU) is the cardiac function and blood pressure. Invasive methods such as pulmonary artery catheter and arterial line allow monitoring of blood pressure and cardiac function accurately and reliably. However, their use is not without drawbacks, especially when the invasive nature of these procedures and complications associated with them are considered. There are several newer methods of noninvasive and minimally invasive hemodynamic monitoring available. In this manuscript, we will review these different methods of minimally invasive and non-invasive hemodynamic monitoring and will discuss their advantages, drawbacks and limitations.
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Affiliation(s)
- Issa Pour-Ghaz
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Theodore Manolukas
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nathalie Foray
- Department of Medicine - Critical Care, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joel Raja
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Aranyak Rawal
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Uzoma N Ibebuogu
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rami N Khouzam
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
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Noninvasive Determination of Blood Pressure by Heart Sound Analysis Compared With Intra-Arterial Monitoring in Critically Ill Children-A Pilot Study of a Novel Approach. Pediatr Crit Care Med 2019; 20:809-816. [PMID: 31107377 DOI: 10.1097/pcc.0000000000001997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop a novel device to predict systolic and diastolic blood pressure based on measured heart sound signals and evaluate its accuracy in comparison to intra-arterial blood pressure readings. STUDY DESIGN Prospective, observational pilot study. SETTING PICU. PATIENTS Critically ill children (0-18 yr) undergoing continuous blood pressure monitoring via radial artery intra-arterial catheters were enrolled in the study after informed consent. The study included medical, cardiac, and surgical PICU patients. INTERVENTIONS Along with intra-arterial blood pressure, patient's heart sounds were recorded simultaneously by a highly sensitive sensor taped to the chest. Additional hardware included a data acquisition unit and laptop computer. Subsequently, advanced signal processing technologies were used to minimize random interfering signals and extract and separate S1 and S2 signals. A computerized model was then developed using artificial neural network systems to estimate blood pressure from the extracted heart sound analysis. MEASUREMENTS AND MAIN OUTCOMES We found a statistically significant correlation for systolic (r = 0.964; R = 0.928) and diastolic (r = 0.935; R = 0.868) blood pressure readings (n = 491) estimated by the novel heart-sound signal-based method and those recorded by intra-arterial catheters. The mean difference of the individually paired determinations of the blood pressure between the heart-sound-based method and intra-arterial catheters was 0.6 ± 7 mm Hg for systolic blood pressure and -0.06 ± 5 mm Hg for diastolic blood pressure, which was within the recommended range of 5 ± 8 mm Hg for any new blood pressure devices. CONCLUSIONS Our findings provide proof of concept that the heart-sound signal-based method can provide accurate, noninvasive blood pressure monitoring.
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Ricci Z, Brogi J, De Filippis S, Caccavelli R, Morlacchi M, Romagnoli S. Arterial Pressure Monitoring in Pediatric Patients Undergoing Cardiac Surgery: An Observational Study Comparing Invasive and Non-invasive Measurements. Pediatr Cardiol 2019; 40:1231-1237. [PMID: 31222376 DOI: 10.1007/s00246-019-02137-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/15/2019] [Indexed: 10/26/2022]
Abstract
In pediatric cardiac surgery patients, when an artifact due to overdamping or to underdamping is suspected to affect the invasive arterial blood pressure (IABP) measure and waveform, a check against non-invasive blood pressure (NIBP) could be useful. In this study, we aimed to retrospectively analyze the differences between IABP (single site) and NIBP, measured at four limbs in children admitted to pediatric cardiac intensive care unit. Overall, 51 patients were enrolled for a total of 546 measurements. Average differences between IABP and NIBP measurements were relatively high with 42% of differences laying within the benchmark value of ± 5 mmHg. Differences on the measures on one limb vs. the others for systolic, diastolic, and mean arterial pressures were not significant (p = 0.16, 0.98, and 0.89, respectively). The systolic invasive-non-invasive differences were generally negative and diastolic and mean ones were generally positive. Correlations of clinical variables with arterial pressures at different sites were rather weak: age was associated with increased IABP-NIBP differences, whereas heart rate and vasoactive-inotropic score showed inverse correlation with IABP-NIBP deltas. Average systolic, diastolic, and mean IABP-NIBP differences of 45 patients without underdamping artifacts were not significantly different compared to those of 6 patients with underdamping (p = 0.17, 0.84, and 0.08, respectively). In conclusion, a wide bias can be detected in post-cardiac surgery children between IABP and NIBP pressures in more than half of measurements, with underdamping/resonance incidence being relatively low. Measurement of both methods without a limb preference should be considered in cardiac surgery children.
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Affiliation(s)
- Zaccaria Ricci
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children'S Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy.
| | - Jessica Brogi
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children'S Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Sara De Filippis
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children'S Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Rossella Caccavelli
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children'S Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Matteo Morlacchi
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children'S Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Stefano Romagnoli
- Department of Health Science, University of Florence, Largo Brambilla, 3, 50139, Florence, Italy.,Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, 3, 50139, Florence, Italy
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Kim J, Chou E, Le J, Wong S, Chu M, Khine M. Soft Wearable Pressure Sensors for Beat-to-Beat Blood Pressure Monitoring. Adv Healthc Mater 2019; 8:e1900109. [PMID: 31033256 DOI: 10.1002/adhm.201900109] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/01/2019] [Indexed: 01/01/2023]
Abstract
Wrinkled gold thin films on elastomeric substrates are used as robust parallel plate electrodes for soft capacitive pressure sensors. The wrinkled structures create a robust integration with the polymer, allowing repeated normal force to deform the thin film without failure. By incorporating microridged structures that support the counter electrodes to create air cavities within the elastomeric dielectric layer, pressure sensitivity is further increased to 0.148 kPa-1 over a wide dynamic range of up to 10 kPa. The wide dynamic range and pressure sensitivity of the pressure sensor allow for consistent measurements of the pressure exerted by the radial artery located on the wrist. The soft capacitive pressure sensor displays comparable results when tested against an FDA approved device (Clearsight, Edwards Lifesciences, Irvine, CA) measuring beat-to-beat blood pressure. These soft pressure sensors using wrinkled thin films, therefore, illustrate considerable potential to continuously monitor beat-to-beat blood pressure.
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Affiliation(s)
- Joshua Kim
- Department of Materials Science and EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - En‐Fan Chou
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - Jamie Le
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - Sabrina Wong
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - Michael Chu
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - Michelle Khine
- Department of Materials Science and EngineeringUniversity of California Irvine Irvine CA 92697 USA
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
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Seidlerová J, Tůmová P, Rokyta R, Hromadka M. Factors influencing the accuracy of non-invasive blood pressure measurements in patients admitted for cardiogenic shock. BMC Cardiovasc Disord 2019; 19:150. [PMID: 31215405 PMCID: PMC6582540 DOI: 10.1186/s12872-019-1129-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 06/11/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Although invasively measured blood pressure (invBP) is regarded as a "gold standard" in critically ill cardiac patients, the non-invasive BP is still widely used, at least at the initiation of medical care. The erroneous interpretation of BP can lead to clinical errors. We therefore investigated the agreement of both methods with respect to some common clinical situation. METHODS We included 85 patients hospitalized for cardiogenic shock. We measured BP every 6 h for the first 72 h of hospitalization, in all patients. Each set of BP measurements included two invasive (invBP), two auscultatory (auscBP), and two oscillometric (oscBP) BP measurements. InvBP was considered as a gold standard. Mean non-invasive arterial pressure (MAP) was calculated as (diastolic pressure + (pulse pressure ÷ 3)). We used Bland-Altman analysis and we calculated concordance correlation coefficients to assess agreement between different BP methods. RESULTS We obtained 967 sets of BP measurements. AuscMAP and oscMAP were on average only 0.4 ± 8.2 and 1.8 ± 8.5 mmHg higher than invMAP, respectively. On the other hand, auscSBP and oscSBP were on average - 6.1 ± 11.4 and - 4.1 ± 9.8 mmHg lower than invSBP, respectively. However, the mean differences and variability for systolic and diastolic BP variability were large; the 2 standard deviation differences were ± 24 and 18 mmHg. In hypotension, non-invasive BP tended to be higher than invBP while the opposite was true for high BP values. Clinical conditions associated with hypotension generally worsened the accuracy of non-invasive MAP. CONCLUSIONS Mean arterial pressure measured non-invasively appears to be in good agreement with invasive MAP in patients admitted for cardiogenic shock. Several clinical associated with hypotension can affect accuracy of non-invasive measurement. Auscultatory and oscillometric measurements had similar accuracy even in patients with arrhythmia.
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Affiliation(s)
- Jitka Seidlerová
- Internal Department II, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Pavlína Tůmová
- Cardiology Department, University Hospital and Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Pilsen, Czech Republic
| | - Richard Rokyta
- Cardiology Department, University Hospital and Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Pilsen, Czech Republic
| | - Milan Hromadka
- Cardiology Department, University Hospital and Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Pilsen, Czech Republic
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Malinowski CM, Cameron AI, Burnside WM, West SE, Nunamaker EA. Butorphanol-Azaperone-Medetomidine for the Immobilization of Rhesus Macaques ( Macaca mulatta). JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE 2019; 58:346-355. [PMID: 30935442 DOI: 10.30802/aalas-jaalas-18-000088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Maximizing animal wellbeing by minimizing drug-related side effects is a key consideration when choosing pharmaceutical agents for chemical restraint in nonhuman primates. One drug combination that may promote this ideology is butorphanol (27.3 mg/mL), azaperone (9.1 mg/mL), and medetomidine (10.9 mg/mL; BAM). Based on results from a pilot study, 2 doses of BAM (16 and 24 μL/kg IM) were compared in healthy, 3-y-old rhesus macaques. Physiologic parameters and anesthetic quality were assessed and recorded every 5 min. Experimental endpoints were established for hypoxemia (85% or less peripheral oxygen saturation with oxygen supplementation), pulse rate (80 bpm or less for 2 consecutive readings), mean arterial pressure (MAP; 50 mm Hg or less), and hypothermia (97 °F or less); if any endpoint was achieved, medetomidine was reversed by using atipamezole (0.22 mg/kg IM). Both BAM doses resulted in immobilization of all animals with no clinically significant differences between groups. All animals initially exhibited hypoxemia that resolved with oxygen supplementation. Regardless of dose, most macaques (71%) reached established experimental endpoints for bradycardia (62 to 80 bpm) or hypotension (44 to 50 mm Hg MAP). Given the results of this study, our recommendation regarding the use of 16- or 24-μL/kg BAM for immobilizing rhesus macaques is dependent on caution regarding cardiopulmonary parameters and the provision of supplemental oxygen.
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Affiliation(s)
| | - Angus I Cameron
- School of Pure and Applied Sciences, Florida SouthWestern State College, LaBelle, Florida
| | | | - Sylvia E West
- Animal Care Services, University of Florida, Gainesville, Florida
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Lakhal K. Noninvasive Continuous Blood Pressure Monitoring: Are the Intraoperative Episodes of Hypotension in Clear Sight? Anesth Analg 2018; 128:e33-e34. [PMID: 30399020 DOI: 10.1213/ane.0000000000003914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Karim Lakhal
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes, France,
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34
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Meidert AS, Saugel B. Techniques for Non-Invasive Monitoring of Arterial Blood Pressure. Front Med (Lausanne) 2018; 4:231. [PMID: 29359130 PMCID: PMC5766655 DOI: 10.3389/fmed.2017.00231] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/04/2017] [Indexed: 11/13/2022] Open
Abstract
Since both, hypotension and hypertension, can potentially impair the function of vital organs such as heart, brain, or kidneys, monitoring of arterial blood pressure (BP) is a mainstay of hemodynamic monitoring in acutely or critically ill patients. Arterial BP can either be obtained invasively via an arterial catheter or non-invasively. Non-invasive BP measurement provides either intermittent or continuous readings. Most commonly, an occluding upper arm cuff is used for intermittent non-invasive monitoring. BP values are then obtained either manually (by auscultation of Korotkoff sounds or palpation) or automatically (e.g., by oscillometry). For continuous non-invasive BP monitoring, the volume clamp method or arterial applanation tonometry can be used. Both techniques enable the arterial waveform and BP values to be obtained continuously. This article describes the different techniques for non-invasive BP measurement, their advantages and limitations, and their clinical applicability.
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Affiliation(s)
- Agnes S Meidert
- Department of Anaesthesiology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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