Comparison of oscillometric, non-invasive and invasive arterial pressure monitoring in patients undergoing laparoscopic bariatric surgery – a secondary analysis of a prospective observational study
Abstract Background Oscillometric, non-invasive blood pressure measurement (NIBP) is the first choice of blood pressure monitoring in the majority of low and moderate risk surgeries. In patients with morbid obesity, however, it is subject to several limitations. The aim was to compare arterial press...
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| Format: | Article |
| Language: | English |
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BMC
2022-03-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-022-01619-3 |
| _version_ | 1819049215731433472 |
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| author | Jonathan Hansen Markus Pohlmann Jan H. Beckmann Phil Klose Matthias Gruenewald Jochen Renner Ulf Lorenzen Gunnar Elke |
| author_facet | Jonathan Hansen Markus Pohlmann Jan H. Beckmann Phil Klose Matthias Gruenewald Jochen Renner Ulf Lorenzen Gunnar Elke |
| author_sort | Jonathan Hansen |
| collection | DOAJ |
| description | Abstract Background Oscillometric, non-invasive blood pressure measurement (NIBP) is the first choice of blood pressure monitoring in the majority of low and moderate risk surgeries. In patients with morbid obesity, however, it is subject to several limitations. The aim was to compare arterial pressure monitoring by NIBP and a non-invasive finger-cuff technology (Nexfin®) with the gold-standard invasive arterial pressure (IAP). Methods In this secondary analysis of a prospective observational, single centre cohort study, systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP) were measured at 16 defined perioperative time points including posture changes, fluid bolus administration and pneumoperitoneum (PP) in patients undergoing laparoscopic bariatric surgery. Absolute arterial pressures by NIBP, Nexfin® and IAP were compared using correlation and Bland Altman analyses. Interchangeability was defined by a mean difference ≤ 5 mmHg (SD ≤8 mmHg). Percentage error (PE) was calculated as an additional statistical estimate. For hemodynamic trending, concordance rates were analysed according to the Critchley criterion. Results Sixty patients (mean body mass index of 49.2 kg/m2) were enrolled and data from 56 finally analysed. Pooled blood pressure values of all time points showed a significant positive correlation for both NIPB and Nexfin® versus IAP. Pooled PE for NIBP versus IAP was 37% (SAP), 35% (DAP) and 30% (MAP), for Nexfin versus IAP 23% (SAP), 26% (DAP) and 22% (MAP). Correlation of MAP was best and PE lowest before induction of anesthesia for NIBP versus IAP (r = 0.72; PE 24%) and after intraoperative fluid bolus administration for Nexfin® versus IAP (r = 0.88; PE: 17.2%). Concordance of MAP trending was 90% (SAP 85%, DAP 89%) for NIBP and 91% (SAP 90%, DAP 86%) for Nexfin®. MAP trending was best during intraoperative ATP positioning for NIBP (97%) and at induction of anesthesia for Nexfin® (97%). Conclusion As compared with IAP, interchangeability of absolute pressure values could neither be shown for NIBP nor Nexfin®, however, NIBP showed poorer overall correlation and precision. Overall trending ability was generally high with Nexfin® surpassing NIBP. Nexfin® may likely render individualized decision-making in the management of different hemodynamic stresses during laparoscopic bariatric surgery, particularly where NIBP cannot be reliably established. Trial registration The non-interventional, observational study was registered retrospectively at ( NCT03184285 ) on June 12, 2017. |
| first_indexed | 2024-12-21T11:28:37Z |
| format | Article |
| id | doaj.art-72b65c094edb4d19b094405cb771434f |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-21T11:28:37Z |
| publishDate | 2022-03-01 |
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| series | BMC Anesthesiology |
| spelling | doaj.art-72b65c094edb4d19b094405cb771434f2022-12-21T19:05:36ZengBMCBMC Anesthesiology1471-22532022-03-0122111210.1186/s12871-022-01619-3Comparison of oscillometric, non-invasive and invasive arterial pressure monitoring in patients undergoing laparoscopic bariatric surgery – a secondary analysis of a prospective observational studyJonathan Hansen0Markus Pohlmann1Jan H. Beckmann2Phil Klose3Matthias Gruenewald4Jochen Renner5Ulf Lorenzen6Gunnar Elke7Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-HolsteinDepartment of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-HolsteinDepartment of General and Abdominal Surgery, University Medical Center Schleswig-HolsteinDepartment of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-HolsteinDepartment of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-HolsteinDepartment of Anesthesiology and Intensive Care Medicine, Municipal Hospital KielDepartment of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-HolsteinDepartment of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-HolsteinAbstract Background Oscillometric, non-invasive blood pressure measurement (NIBP) is the first choice of blood pressure monitoring in the majority of low and moderate risk surgeries. In patients with morbid obesity, however, it is subject to several limitations. The aim was to compare arterial pressure monitoring by NIBP and a non-invasive finger-cuff technology (Nexfin®) with the gold-standard invasive arterial pressure (IAP). Methods In this secondary analysis of a prospective observational, single centre cohort study, systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP) were measured at 16 defined perioperative time points including posture changes, fluid bolus administration and pneumoperitoneum (PP) in patients undergoing laparoscopic bariatric surgery. Absolute arterial pressures by NIBP, Nexfin® and IAP were compared using correlation and Bland Altman analyses. Interchangeability was defined by a mean difference ≤ 5 mmHg (SD ≤8 mmHg). Percentage error (PE) was calculated as an additional statistical estimate. For hemodynamic trending, concordance rates were analysed according to the Critchley criterion. Results Sixty patients (mean body mass index of 49.2 kg/m2) were enrolled and data from 56 finally analysed. Pooled blood pressure values of all time points showed a significant positive correlation for both NIPB and Nexfin® versus IAP. Pooled PE for NIBP versus IAP was 37% (SAP), 35% (DAP) and 30% (MAP), for Nexfin versus IAP 23% (SAP), 26% (DAP) and 22% (MAP). Correlation of MAP was best and PE lowest before induction of anesthesia for NIBP versus IAP (r = 0.72; PE 24%) and after intraoperative fluid bolus administration for Nexfin® versus IAP (r = 0.88; PE: 17.2%). Concordance of MAP trending was 90% (SAP 85%, DAP 89%) for NIBP and 91% (SAP 90%, DAP 86%) for Nexfin®. MAP trending was best during intraoperative ATP positioning for NIBP (97%) and at induction of anesthesia for Nexfin® (97%). Conclusion As compared with IAP, interchangeability of absolute pressure values could neither be shown for NIBP nor Nexfin®, however, NIBP showed poorer overall correlation and precision. Overall trending ability was generally high with Nexfin® surpassing NIBP. Nexfin® may likely render individualized decision-making in the management of different hemodynamic stresses during laparoscopic bariatric surgery, particularly where NIBP cannot be reliably established. Trial registration The non-interventional, observational study was registered retrospectively at ( NCT03184285 ) on June 12, 2017.https://doi.org/10.1186/s12871-022-01619-3Blood pressureFinger-cuffNon-invasive monitoringNexfinClear sightObesity |
| spellingShingle | Jonathan Hansen Markus Pohlmann Jan H. Beckmann Phil Klose Matthias Gruenewald Jochen Renner Ulf Lorenzen Gunnar Elke Comparison of oscillometric, non-invasive and invasive arterial pressure monitoring in patients undergoing laparoscopic bariatric surgery – a secondary analysis of a prospective observational study BMC Anesthesiology Blood pressure Finger-cuff Non-invasive monitoring Nexfin Clear sight Obesity |
| title | Comparison of oscillometric, non-invasive and invasive arterial pressure monitoring in patients undergoing laparoscopic bariatric surgery – a secondary analysis of a prospective observational study |
| title_full | Comparison of oscillometric, non-invasive and invasive arterial pressure monitoring in patients undergoing laparoscopic bariatric surgery – a secondary analysis of a prospective observational study |
| title_fullStr | Comparison of oscillometric, non-invasive and invasive arterial pressure monitoring in patients undergoing laparoscopic bariatric surgery – a secondary analysis of a prospective observational study |
| title_full_unstemmed | Comparison of oscillometric, non-invasive and invasive arterial pressure monitoring in patients undergoing laparoscopic bariatric surgery – a secondary analysis of a prospective observational study |
| title_short | Comparison of oscillometric, non-invasive and invasive arterial pressure monitoring in patients undergoing laparoscopic bariatric surgery – a secondary analysis of a prospective observational study |
| title_sort | comparison of oscillometric non invasive and invasive arterial pressure monitoring in patients undergoing laparoscopic bariatric surgery a secondary analysis of a prospective observational study |
| topic | Blood pressure Finger-cuff Non-invasive monitoring Nexfin Clear sight Obesity |
| url | https://doi.org/10.1186/s12871-022-01619-3 |
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