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Comparison of non-invasive blood pressure monitoring using modified arterial applanation tonometry with intra-arterial measurement

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Abstract

Intermittent non-invasive blood pressure measurement with tourniquets is slow, can cause nerve and skin damage, and interferes with other measurements. Invasive measurement cannot be safely used in all conditions. Modified arterial tonometry may be an alternative for fast and continuous measurement. Our aim was to compare arterial tonometry sensor (BPro®) with invasive blood pressure measurement to clarify whether it could be utilized in the postoperative setting. 28 patients who underwent elective surgery requiring arterial cannulation were analyzed. Patients were monitored post-operatively for 2 h with standard invasive monitoring and with a study device comprising an arterial tonometry sensor (BPro®) added with a three-dimensional accelerometer to investigate the potential impact of movement. Recordings were collected electronically. The results revealed inaccurate readings in method comparison between the devices based on recommendations by Association for the Advancement of Medical Instrumentation (AAMI). On a Bland–Altman plot, the bias and precision between these two methods was 19.8 ± 16.7 (Limits of agreement − 20.1 to 59.6) mmHg, Spearman correlation coefficient r = 0.61. For diastolic pressure, the difference was 4.8 ± 7.7 (LoA − 14.1 to 23.6) mmHg (r = 0.72), and for mean arterial pressure it was 11.18 ± 11.1 (LoA − 12.1 to 34.2) mmHg (r = 0.642). Our study revealed inaccurate agreement (AAMI) between the two methods when measuring systolic and mean blood pressures during post-operative care. The readings for diastolic pressures were inside the limits recommended by AAMI. Movement increased the failure rate significantly (p < 0.001). Thus, arterial tonometry is not an appropriate replacement for invasive blood pressure measurement in these patients.

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References

  1. Campbell NR, Chockalingam A, Fodor JG, McKay DW. Accurate, reproducible measurement of blood pressure. CMAJ. 1990;143:19–24.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Bause GS, Weintraub AC, Tanner GE. Skin avulsion during oscillometry. J Clin Monit. 1986;2:262–3.

    Article  CAS  PubMed  Google Scholar 

  3. Lin CC, Jawan B, de Villa MV, Chen FC, Liu PP. Blood pressure cuff compression injury of the radial nerve. J Clin Anesth. 2001;13:306–8.

    Article  CAS  PubMed  Google Scholar 

  4. Slogoff S, Keats AS, Arlund C. On the safety of radial artery cannulation. Anesthesiology. 1983;59:42–7.

    Article  CAS  PubMed  Google Scholar 

  5. Chim H, Bakri K, Moran SL. Complications related to radial artery occlusion, radial artery harvest, and arterial lines. Hand Clin. 2015;31:93–100.

    Article  PubMed  Google Scholar 

  6. Komori T, Eguchi K, Hoshide S, Williams B, Kario K. Comparison of wrist-type and arm-type 24-h blood pressure monitoring devices for ambulatory use. Blood Press Monit. 2013;18:57–62.

    Article  PubMed  Google Scholar 

  7. Nair D, Tan SY, Gan HW, Lim SF, Tan J, Zhu M, Gao H, Chua NH, Peh WL, Mak KH. The use of ambulatory tonometric radial arterial wave capture to measure ambulatory blood pressure: the validation of a novel wrist-bound device in adults. J Hum Hypertens. 2008;22:220–2.

    Article  CAS  PubMed  Google Scholar 

  8. Ng KG, Ting CM, Yeo JH, Sim KW, Peh WL, Chua NH, Chua NK, Kwong F. Progress on the development of the MediWatch ambulatory blood pressure monitor and related devices. Blood Press Monit. 2004;9:149–65.

    Article  PubMed  Google Scholar 

  9. Harju J, Vehkaoja A, Lindroos V, Kumpulainen P, Liuhanen S, Yli-Hankala A, Oksala N. Determination of saturation, heart rate, and respiratory rate at forearm using a Nellcor\texttrademark forehead SpO2-saturation sensor. J Clin Monit Comput. 2016. Doi:10.1007/s10877-016-9940-7.

    PubMed  Google Scholar 

  10. Shrivastava A, Gupta V. Methods for the determination of limit of detection and limit of quantitation of the analytical methods. Chron Young Sci. 2011;2:21–5.

    Article  Google Scholar 

  11. Non-invasive sphygmomanometers—Part 2: Clinical investigation of Automated Measurement type, ANSI/ AAMI/ ISO 81060–2:2013. Arlington: Association for the Advancement of Medical instrumentation; 2013, pp 1–22.

  12. Zou GY. Confidence interval estimation for the Bland–Altman limits of agreement with multiple observations per individual. Stat Methods Med Res. 2013;22:630–42.

    Article  CAS  PubMed  Google Scholar 

  13. Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8:135–60.

    Article  CAS  PubMed  Google Scholar 

  14. Ilies C, Bauer M, Berg P, Rosenberg J, Hedderich J, Bein B, Hinz J, Hanss R. Investigation of the agreement of a continuous non-invasive arterial pressure device in comparison with invasive radial artery measurement. Br J Anaesth. 2012;108:202–10.

    Article  CAS  PubMed  Google Scholar 

  15. Saugel B, Grothe O, Wagner JY. Tracking changes in cardiac output: statistical considerations on the 4-quadrant plot and the polar plot methodology. Anesth Analg. 2015;121:514–24.

    Article  PubMed  Google Scholar 

  16. Cecconi M, Rhodes A, Poloniecki J, Della Rocca G, Grounds RM. Bench-to-bedside review: the importance of the precision of the reference technique in method comparison studies–with specific reference to the measurement of cardiac output. Crit Care. 2009;13:201.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Saugel B, Meidert AS, Hapfelmeier A, Eyer F, Schmid RM, Huber W. Non-invasive continuous arterial pressure measurement based on radial artery tonometry in the intensive care unit: a method comparison study using the T-Line TL-200pro device. Br J Anaesth. 2013;111:185–90.

    Article  CAS  PubMed  Google Scholar 

  18. Meidert AS, Huber W, Hapfelmeier A, Schofthaler M, Muller JN, Langwieser N, Wagner JY, Schmid RM, Saugel B. Evaluation of the radial artery applanation tonometry technology for continuous noninvasive blood pressure monitoring compared with central aortic blood pressure measurements in patients with multiple organ dysfunction syndrome. J Crit Care. 2013;28:908–12.

    Article  PubMed  Google Scholar 

  19. Meidert AS, Huber W, Muller JN, Schofthaler M, Hapfelmeier A, Langwieser N, Wagner JY, Eyer F, Schmid RM, Saugel B. Radial artery applanation tonometry for continuous non-invasive arterial pressure monitoring in intensive care unit patients: comparison with invasively assessed radial arterial pressure. Br J Anaesth. 2014;112:521–8.

    Article  CAS  PubMed  Google Scholar 

  20. Janelle GM, Gravenstein N. An accuracy evaluation of the T-Line Tensymeter (continuous noninvasive blood pressure management device) versus conventional invasive radial artery monitoring in surgical patients. Anesth Analg. 2006;102:484–90.

    Article  PubMed  Google Scholar 

  21. Kim SH, Lilot M, Sidhu KS, Rinehart J, Yu Z, Canales C, Cannesson M. Accuracy and precision of continuous noninvasive arterial pressure monitoring compared with invasive arterial pressure: a systematic review and meta-analysis. Anesthesiology. 2014;120:1080–97.

    Article  PubMed  Google Scholar 

  22. Theilade S, Joergensen C, Persson F, Lajer M, Rossing P. Ambulatory tonometric blood pressure measurements in patients with diabetes. Diabetes Technol Ther. 2012;14:453–6.

    Article  PubMed  Google Scholar 

  23. Briet M, Boutouyrie P, Laurent S, London GM. Arterial stiffness and pulse pressure in CKD and ESRD. Kidney Int. 2012;82:388–400.

    Article  PubMed  Google Scholar 

  24. Ott C, Haetinger S, Schneider MP, Pauschinger M, Schmieder RE. Comparison of two noninvasive devices for measurement of central systolic blood pressure with invasive measurement during cardiac catheterization. J Clin Hypertens (Greenwich). 2012;14:575–9.

    Article  Google Scholar 

  25. Garcia-Ortiz L, Recio-Rodriguez JI, Canales-Reina JJ, Cabrejas-Sanchez A, Gomez-Arranz A, Magdalena-Belio JF, Guenaga-Saenz N, Agudo-Conde C, Gomez-Marcos MA, EVIDENT Group. Comparison of two measuring instruments, B-pro and SphygmoCor system as reference, to evaluate central systolic blood pressure and radial augmentation index. Hypertens Res. 2012;35:617–23.

    Article  PubMed  Google Scholar 

  26. Wax DB, Rubin P, Neustein S. A comparison of transmittance and reflectance pulse oximetry during vascular surgery. Anesth Analg. 2009;109:1847–9.

    Article  PubMed  Google Scholar 

  27. van Egmond J, Hasenbos M, Crul JF. Invasive v. non-invasive measurement of arterial pressure. Comparison of two automatic methods and simultaneously measured direct intra-arterial pressure. Br J Anaesth. 1985;57:434–44.

    Article  PubMed  Google Scholar 

  28. Mignini MA, Piacentini E, Dubin A. Peripheral arterial blood pressure monitoring adequately tracks central arterial blood pressure in critically ill patients: an observational study. Crit Care. 2006;10:R43.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ, Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on high blood pressure research. Hypertension. 2005;45:142.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors wish to thank Finnish Cultural Foundation, Pirkanmaa Regional Fund (4/2014 J.H.), The Finnish Society of Anaesthesiologists and Paulo Foundation (12/2015 J.H.) for grants, as well as the Medieta Oy (Helsinki, Finland), for providing the study device.

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Authors and Affiliations

  1. Department of Anaesthesia, Tampere University Hospital, PL2000, 33521, Tampere, Finland

    Jarkko Harju & Arvi Yli-Hankala

  2. Tampere University of Technology, Tampere, Finland

    Antti Vehkaoja & Pekka Kumpulainen

  3. CamsoS Consulting Ltd., Helsinki, Finland

    Stefano Campadello

  4. Medical School, University of Tampere, Tampere, Finland

    Ville Lindroos, Arvi Yli-Hankala & Niku Oksala

  5. Department of Surgery, Tampere University Hospital, Tampere, Finland

    Niku Oksala

Authors
  1. Jarkko Harju
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  2. Antti Vehkaoja
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  3. Pekka Kumpulainen
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  4. Stefano Campadello
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  5. Ville Lindroos
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  6. Arvi Yli-Hankala
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  7. Niku Oksala
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Corresponding author

Correspondence to Jarkko Harju.

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Conflict of interest

NO has been a shareholder on former company Medieta. Antti Vehkaoja, Pekka Kumpulainen and Stefano Campadello have been former employees on former company Medieta. Jarkko Harju, Ville Lindroos and Arvi Yli-Hankala declare no conflicts of interest.

Ethical approval

This study was approved by the Pirkanmaa Hospital district ethics committee. All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee, as well as with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Clinical trial registration: NCT02357511

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Harju, J., Vehkaoja, A., Kumpulainen, P. et al. Comparison of non-invasive blood pressure monitoring using modified arterial applanation tonometry with intra-arterial measurement. J Clin Monit Comput 32, 13–22 (2018). https://doi.org/10.1007/s10877-017-9984-3

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  • DOI: https://doi.org/10.1007/s10877-017-9984-3

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