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Ackerman-Banks CM, Bhinder J, Eder M, Heerdt P, Sugeng L, Testani J, Alian A, Lipkind H, Velazquez E, Reddy U, Chou JC. Continuous non-invasive hemodynamic monitoring in early onset severe preeclampsia. Pregnancy Hypertens 2023; 34:27-32. [PMID: 37783090 DOI: 10.1016/j.preghy.2023.09.003] [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: 04/06/2023] [Revised: 08/17/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES Continuous hemodynamic monitoring offers the opportunity to individualize management in severe preeclampsia (PEC). We compared cardiac output (CO) and total peripheral resistance (TPR) measured by bioreactance (NICOM), Clearsite™ Fingercuff [CS), and 3D-echocardiography (3DE). STUDY DESIGN This prospective observational study included 12 pregnant patients with early PEC. CO and TPR were measured simultaneously by NICOM, CS, and 3DE antepartum and 1-2 days postpartum. Using 3DE as the standard, CS and NICOM interchangeability, precision, accuracy, and correlation were assessed. RESULTS Compared to 3DE-CO, CS-CO was highly correlated (R2 = 0.70, p = <0.0001) with low percentage error (PE 29%) which met criteria for interchangeablity. CS-TPR had strong correlation (R2 = 0.81, p = <0.0001) and low PE (29%). While CS tended to slightly overestimate CO (bias + 2.05 ±1.18 L/min, limit of agreement (LOA) -0.20 to 4.31) and underestimate TPR (bias -279 ±156 dyes/sec/cm5; LOA -580 to 18.4) these differences were unlikely to be clinically significant. Thus CS could be interchangeable with 3DE for CO and TPR. NICOM-CO had only moderate correlation with 3DE-CO (R2 = 0.29, p = 0.01) with high PE (52%) above threshold for interchangeability. NICOM-CO had low mean bias (-1.2 ±1.68 L/min) but wide 95% LOA (-4.41 to 2.14) suggesting adequate accuracy but low precision in relation to 3DE-CO. NICOM-TPR had poor correlation with 3DE-TPR (R2 = 0.32, p = 0.001) with high PE (67%), relatively low mean bias (238 ±256), and wide 95% LOA (-655 to 1131). NICOM did not meet the criteria for interchangeable with 3DE for CO and TPR. CONCLUSIONS Clearsite Fingercuff, but not NICOM, has potential to be clinically useful for CO and TPR monitoring in severe preeclampsia.
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Affiliation(s)
| | - Jasjit Bhinder
- Department of Cardiology, Northwell Health, Manhasset, NY, United States.
| | - Maxwell Eder
- Department of Cardiology, Yale School of Medicine, New Haven, CT, United States.
| | - Paul Heerdt
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States.
| | - Lissa Sugeng
- Department of Cardiology, Northwell Health, Manhasset, NY, United States.
| | - Jeffrey Testani
- Department of Cardiology, Yale School of Medicine, New Haven, CT, United States.
| | - Aymen Alian
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States.
| | - Heather Lipkind
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York City, NY, United States.
| | - Eric Velazquez
- Department of Cardiology, Yale School of Medicine, New Haven, CT, United States.
| | - Uma Reddy
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York City, NY, United States.
| | - Josephine C Chou
- Department of Cardiology, University of Colorado, Aurora, CO, United States.
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Bonnin P, Constans B, Duhamel A, Kyheng M, Ducloy-Bouthors AS, Estevez MG, Tavernier B, Gaudet A. Accuracy and trending ability of finger plethysmographic cardiac output monitoring in late pregnancy. Can J Anaesth 2022; 69:1340-1348. [PMID: 35927539 DOI: 10.1007/s12630-022-02297-y] [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: 11/04/2021] [Revised: 03/22/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Individuals in late pregnancy are at risk of significant hemodynamic variations, especially during Cesarean delivery. Although non-invasive monitoring might enable the early detection of variations in cardiac output (CO), clinical validation is lacking. METHODS In a prospective, single-center study, we measured CO simultaneously with finger plethysmography and transthoracic echocardiography in 100 third-trimester pregnant individuals in the supine and left lateral decubitus (LLD) positions. RESULTS A Bland-Altman analysis revealed a mean (standard deviation) bias of 1.36 (1.04) L·min-1 in the supine position (95% limits of agreement, -0.68 to 3.4 L·min-1; percent error, 26.6%), indicating overestimation by finger plethysmography. The intra-class correlation coefficient was 0.43 (95% confidence interval [CI], 0.33 to 0.51). Regarding the changes in CO induced by the supine-to-LLD transition, the concordance rate in a four-quadrant plot was 98.3% (95% CI, 91.1 to 99.9%). CONCLUSION Our study showed a poor reliability of finger plethysmography for static measurement of CO. Nevertheless, finger plethysmography had a reasonably high concordance rate for the detection of CO changes secondary to positional changes in late-pregnant individuals. STUDY REGISTRATION DATE: www. CLINICALTRIALS gov (NCT03735043); registered 8 November 2018.
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Affiliation(s)
- Paul Bonnin
- CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France
| | - Benjamin Constans
- CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France
- Centre Hospitalier de Seclin-Carvin, Service d'Anesthésie, Seclin, France
| | - Alain Duhamel
- Université de Lille, CHU Lille, ULR 2694 METRICS- Evaluation des technologies de santé et des pratiques médicales, Lille, France
- CHU Lille, Unité de Méthodologie, Biostatistiques et Data Management, Lille, France
| | - Maéva Kyheng
- Université de Lille, CHU Lille, ULR 2694 METRICS- Evaluation des technologies de santé et des pratiques médicales, Lille, France
- CHU Lille, Unité de Méthodologie, Biostatistiques et Data Management, Lille, France
| | | | | | - Benoit Tavernier
- CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France
- Université de Lille, CHU Lille, ULR 2694 METRICS- Evaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Alexandre Gaudet
- CHU Lille, Pôle d'Anesthésie-Réanimation, Lille, France.
- Department of Intensive Care Medicine, Critical Care Centre, CHU Lille, 59000, Lille, France.
- Université de Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Lille, France.
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Helmer P, Helf D, Sammeth M, Winkler B, Hottenrott S, Meybohm P, Kranke P. The Use of Non-Invasive Continuous Blood Pressure Measuring (ClearSight®) during Central Neuraxial Anaesthesia for Caesarean Section—A Retrospective Validation Study. J Clin Med 2022; 11:jcm11154498. [PMID: 35956113 PMCID: PMC9369920 DOI: 10.3390/jcm11154498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/23/2022] Open
Abstract
The close monitoring of blood pressure during a caesarean section performed under central neuraxial anaesthesia should be the standard of safe anaesthesia. As classical oscillometric and invasive blood pressure measuring have intrinsic disadvantages, we investigated a novel, non-invasive technique for continuous blood pressure measuring. Methods: In this monocentric, retrospective data analysis, the reliability of continuous non-invasive blood pressure measuring using ClearSight® (Edwards Lifesciences Corporation) is validated in 31 women undergoing central neuraxial anaesthesia for caesarean section. In addition, patients and professionals evaluated ClearSight® through questioning. Results: 139 measurements from 11 patients were included in the final analysis. Employing Bland–Altman analyses, we identified a bias of −10.8 mmHg for systolic, of −0.45 mmHg for diastolic and of +0.68 mmHg for mean arterial blood pressure measurements. Pooling all paired measurements resulted in a Pearson correlation coefficient of 0.7 for systolic, of 0.67 for diastolic and of 0.75 for mean arterial blood pressure. Compensating the interindividual differences in linear regressions of the paired measurements provided improved correlation coefficients of 0.73 for systolic, of 0.9 for diastolic and of 0.89 for mean arterial blood pressure measurements. Discussion: Diastolic and mean arterial blood pressure are within an acceptable range of deviation from the reference method, according to the Association for the Advancement of Medical Instrumentation (AAMI) in the patient collective under study. Both patients and professionals prefer ClearSight® to oscillometric blood pressure measurement in regard of comfort and handling.
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Affiliation(s)
- Philipp Helmer
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany; (P.H.); (D.H.); (M.S.); (B.W.); (S.H.); (P.M.)
| | - Daniel Helf
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany; (P.H.); (D.H.); (M.S.); (B.W.); (S.H.); (P.M.)
| | - Michael Sammeth
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany; (P.H.); (D.H.); (M.S.); (B.W.); (S.H.); (P.M.)
- Department of Applied Sciences, Coburg University, Friedrich-Streib-Str. 2, 96450 Coburg, Germany
| | - Bernd Winkler
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany; (P.H.); (D.H.); (M.S.); (B.W.); (S.H.); (P.M.)
| | - Sebastian Hottenrott
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany; (P.H.); (D.H.); (M.S.); (B.W.); (S.H.); (P.M.)
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany; (P.H.); (D.H.); (M.S.); (B.W.); (S.H.); (P.M.)
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany; (P.H.); (D.H.); (M.S.); (B.W.); (S.H.); (P.M.)
- Correspondence:
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Boisselle MÈ, Zaphiratos VV, Fortier A, Richebé P, Loubert C. Comparison of carbetocin as a bolus or an infusion with prophylactic phenylephrine on maternal heart rate during Cesarean delivery under spinal anesthesia: a double-blinded randomized controlled trial. Can J Anaesth 2022; 69:715-725. [PMID: 35352277 DOI: 10.1007/s12630-022-02227-y] [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: 07/15/2021] [Revised: 12/07/2021] [Accepted: 12/18/2021] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Carbetocin, an oxytocin analog, given as a postpartum hemorrhage prophylaxis in elective Cesarean deliveries, frequently causes tachycardia and hypotension. Phenylephrine infusion has been shown to prevent spinal anesthesia-induced hypotension. The goal of this study was to evaluate if a slow infusion of carbetocin would reduce maternal heart rate variation and hemodynamic disturbances compared with a rapid bolus in parturients receiving a prophylactic phenylephrine infusion during elective Cesarean delivery. METHODS In this double-blinded randomized controlled trial, 70 healthy parturients were allocated to either a bolus group or an infusion group. At cord clamping, participants in the bolus group received carbetocin 100 µg as a rapid intravenous bolus, while participants in the infusion group received carbetocin 100 µg over 10 min. The primary outcome was the variation in maternal heart rate from baseline during the 20 min following cord clamping. Secondary outcomes included blood pressure, cardiac output, and stroke volume variations during the study period, measured with the ClearSight™ hemodynamic monitor. RESULTS Maximum heart rate variation was not different between the groups: bolus group, mean (standard deviation) 29.8 (25.2)% vs infusion group, 27.2 (23.3)%; P = 0.67. The increase in heart rate occurred significantly earlier in the bolus group than in the infusion group (median [interquartile range] time, 105 [69-570] sec vs 485 [255-762] sec; P = 0.02; group × time interaction: two-way repeated measures ANOVA, P = 0.04). There was no significant difference in maximum variations for the other hemodynamic parameters between the groups. CONCLUSION Carbetocin infused over ten minutes did not reduce the magnitude of maternal heart rate variation but delayed its occurrence. This finding could be relevant to the anesthesiologist caring for parturients in whom a slight increase in maternal heart rate is clinically undesirable. STUDY REGISTRATION www. CLINICALTRIALS gov (NCT03404544); registered 19 January 2018.
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Affiliation(s)
- Marie-Ève Boisselle
- Department of Anesthesiology, Centre hospitalier affilié universitaire régional - Trois-Rivières, University of Montreal, Trois-Rivières, QC, Canada
| | - Valérie Vasiliki Zaphiratos
- Department of Anesthesiology and Pain Medicine, CEMTL - Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada
| | - Annik Fortier
- Montreal Health Innovations Coordinating Center (MHICC), Montreal, QC, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, CEMTL - Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada
| | - Christian Loubert
- Department of Anesthesiology and Pain Medicine, CEMTL - Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada.
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Duclos G, Granier S, Hili A, Blanc J, Einav S, Leone. M, Zieleskiewicz L. Performance of non-invasive stroke volume variation during passive leg raise as a predictor of hypotension following induction of spinal anesthesia for elective cesarean delivery: a single cohort study. Int J Obstet Anesth 2021; 50:103251. [DOI: 10.1016/j.ijoa.2021.103251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 12/03/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
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Hypotension Prediction Index with non-invasive continuous arterial pressure waveforms (ClearSight): clinical performance in Gynaecologic Oncologic Surgery. J Clin Monit Comput 2021; 36:1325-1332. [PMID: 34618291 PMCID: PMC8496438 DOI: 10.1007/s10877-021-00763-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/29/2021] [Indexed: 12/23/2022]
Abstract
Intraoperative hypotension (IOH) is common during major surgery and is associated with a poor postoperative outcome. Hypotension Prediction Index (HPI) is an algorithm derived from machine learning that uses the arterial waveform to predict IOH. The aim of this study was to assess the diagnostic ability of HPI working with non-invasive ClearSight system in predicting impending hypotension in patients undergoing major gynaecologic oncologic surgery (GOS). In this retrospective analysis hemodynamic data were downloaded from an Edwards Lifesciences HemoSphere platform and analysed. Receiver operating characteristic curves were constructed to evaluate the performance of HPI working on the ClearSight pressure waveform in predicting hypotensive events, defined as mean arterial pressure < 65 mmHg for > 1 min. Sensitivity, specificity, positive predictive value and negative predictive value were computed at a cutpoint (the value which minimizes the difference between sensitivity and specificity). Thirty-one patients undergoing GOS were included in the analysis, 28 of which had complete data set. The HPI predicted hypotensive events with a sensitivity of 0.85 [95% confidence interval (CI) 0.73-0.94] and specificity of 0.85 (95% CI 0.74-0.95) 15 min before the event [area under the curve (AUC) 0.95 (95% CI 0.89-0.99)]; with a sensitivity of 0.82 (95% CI 0.71-0.92) and specificity of 0.83 (95% CI 0.71-0.93) 10 min before the event [AUC 0.9 (95% CI 0.83-0.97)]; and with a sensitivity of 0.86 (95% CI 0.78-0.93) and specificity 0.86 (95% CI 0.77-0.94) 5 min before the event [AUC 0.93 (95% CI 0.89-0.97)]. HPI provides accurate and continuous prediction of impending IOH before its occurrence in patients undergoing GOS in general anesthesia.
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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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Lee SW, Lee S, Kim H, Kim YJ, Kim M, Choi JH. Accuracy of noninvasive continuous arterial pressure monitoring using ClearSight during one-lung ventilation. Medicine (Baltimore) 2021; 100:e25152. [PMID: 33726000 PMCID: PMC7982160 DOI: 10.1097/md.0000000000025152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/23/2021] [Indexed: 01/05/2023] Open
Abstract
Noninvasive continuous arterial pressure monitoring may be clinically useful in patients who require continuous blood pressure monitoring in situations where arterial catheter placement is limited. Many previous studies on the accuracy of the noninvasive continuous blood pressure monitoring method reported various results. However, there is no research on the effectiveness of noninvasive arterial pressure monitoring during one-lung ventilation. The purpose of this study was to compare arterial blood pressure obtained through invasive method and noninvasive method by using ClearSight during one-lung ventilation.In this retrospective observational study, a total of 26 patients undergoing one-lung ventilation for thoracic surgery at a single institution between March and July 2019 were recruited. All patients in this study were cannulated on their radial artery to measure continuously invasive blood pressures and applied ClearSight on the ipsilateral side of the cannulated arm. We compared and analyzed the agreement and trendability of blood pressure recorded with invasive and noninvasive methods during one-lung ventilation.Blood pressure and pulse rate showed a narrower limit of agreement with a percentage error value of around 30%. In addition, the tracking ability of each measurement could be determined by the concordance rate, all of which were below acceptable limits (92%).In noninvasive arterial blood pressure monitoring using ClearSight, mean blood pressure and pulse rate show acceptable agreement with the invasive method.
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Affiliation(s)
- Sang-Wook Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul
| | - Sangho Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul
| | - Hyungtae Kim
- Department of Medicine, Graduate School, Kyung Hee University
| | - Yun-Jong Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital
| | - Mihyeon Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital
| | - Jeong-Hyun Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
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Heesen M, Girard T, Klimek M. Noradrenaline - at best it is not worse. A comparison with phenylephrine in women undergoing spinal anaesthesia for caesarean section. Anaesthesia 2021; 76:743-747. [PMID: 33406274 DOI: 10.1111/anae.15363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/01/2022]
Affiliation(s)
- M Heesen
- Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland
| | - T Girard
- Department of Anaesthesia, University Hospital Basel, Basel, Switzerland
| | - M Klimek
- Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Omenås IN, Tronstad C, Rosseland LA. Accuracy and trending abilities of finger plethysmographic blood pressure and cardiac output compared to invasive measurements during caesarean delivery in healthy women: an observational study. BMC Anesthesiol 2020; 20:157. [PMID: 32593297 PMCID: PMC7320595 DOI: 10.1186/s12871-020-01078-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background In women presenting for caesarean section under spinal anesthesia, continuous measurement of circulatory aspects, such as blood pressure and cardiac output, is often needed. At present, invasive techniques are used almost exclusively. Reliable non-invasive monitoring would be welcome, as it could be safer, less uncomfortable, and quick and easy to apply. We aimed to evaluate whether a non-invasive, finger plethysmographic device, the ccNexFin monitor, can replace invasively measured blood pressure in the radial artery, and whether cardiac output measurements from this device can be used interchangeably with measurements from the mini-invasive LiDCO monitor currently in use at our institution. Methods Simultaneous invasive measurements were compared to ccNexFin in 23 healthy women during elective caesarean section under spinal anesthesia. We used Bland Altman statistics to assess agreement, and polar plot methodology to judge trending abilities with pre-defined limits. Results Mean arterial and systolic pressures showed biases (invasive – ccNexFin) of − 4.3 and 12.2 mmHg, with limits of agreement of − 15.9 – 7.4 and − 11.1 – 35.6, respectively. The ccNexFin trending abilities were within the suggested limits for mean pressure but insufficient for systolic pressure compared to invasive measurements. Cardiac output had a small bias of 0.2 L/min, but wide limits of agreement of − 2.6 – 3.0. The ccNexFin trending abilities compared to the invasive estimated values (LiDCO) were unsatisfactory. Conclusions We consider the ccNexFin monitor to have sufficient accuracy in measuring mean arterial pressure. The limits of agreement for systolic measurements were wider, and the trending ability compared to invasive measurements was outside the recommended limit. The ccNexFin is not reliable for cardiac output measurements or trend in pregnant women for caesarean delivery under spinal anesthesia. Trial registration Registered May 23, 2013, at ClinicalTrials.gov under number NCT01861132.
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Affiliation(s)
- Ivar N Omenås
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Christian Tronstad
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
| | - Leiv Arne Rosseland
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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