Flick M, Bergholz A, Kouz K, Breitfeld P, Nitzschke R, Flotzinger D, Saugel B. A new noninvasive finger sensor (NICCI system) for continuous blood pressure and pulse pressure variation monitoring: A method comparison study in patients having neurosurgery.
Eur J Anaesthesiol 2022;
39:851-857. [PMID:
36155392 DOI:
10.1097/eja.0000000000001754]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND
The NICCI system (Getinge, Gothenburg, Sweden) is a new noninvasive haemodynamic monitoring system using a finger sensor.
OBJECTIVES
We aimed to investigate the performance of the NICCI system to measure blood pressure and pulse pressure variation compared with intra-arterial measurements.
DESIGN
A prospective method comparison study.
SETTING
University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
PATIENTS
Forty-seven neurosurgery patients.
MAIN OUTCOME MEASURES
We performed a method comparison study in 47 neurosurgery patients to compare NICCI blood pressure measurements (BP NICCI ) with intra-arterial blood pressure measurements (BP ART ) (Bland-Altman analysis, four-quadrant plot, error grid analysis) and NICCI pulse pressure variation measurements (PPV NICCI ) with pulse pressure variation calculated manually from the intra-arterial blood pressure waveform (PPV ART ) (Bland-Altman analysis, predictive agreement, Cohen's kappa).
RESULTS
The mean of the differences ± standard deviation (95% limits of agreement) between BP NICCI and BP ART was 11 ± 10 mmHg (-8 to 30 mmHg) for mean blood pressure (MBP), 3 ± 12 mmHg (-21 to 26 mmHg) for systolic blood pressure (SBP) and 12 ± 10 mmHg (-8 to 31 mmHg) for diastolic blood pressure (DBP). In error grid analysis, 54% of BP NICCI and BP ART MBP measurement pairs were classified as 'no risk', 43% as 'low risk', 3% as 'moderate risk' and 0% as 'significant risk' or 'dangerous risk'. The mean of the differences between PPV NICCI and PPV ART was 1 ± 3% (-4 to 6%). The predictive agreement between PPV NICCI and PPV ART was 80% and Cohen's kappa was 0.55.
CONCLUSIONS
The absolute agreement between BP NICCI and BP ART was not clinically acceptable. We recommend not using the current version of the NICCI system for blood pressure monitoring during surgery. The absolute agreement between PPV NICCI and PPV ART was clinically acceptable with moderate predictive agreement regarding pulse pressure variation categories. The NICCI system needs to be further developed and re-evaluated when an improved version is available.
TRIAL REGISTRATION
The study was registered in the German Clinical Trials Register (DRKS00023188) on 2 October 2020.
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