Abstract
Purpose
A novel design is proposed to measure the Arterial Blood Pressure (BP) using the vascular unloading technique controlling the pressure cuff acting on the air pump speed instead of a servo valve. The BP monitoring in a continuous way allows identifying the hypertension or hypotension states in order to avoid damage of vital organs such as the heart and brain in critically ill patients. Depending on the clinical evaluation, this procedure can be done invasively using an arterial catheter, or noninvasively using, for example, the volume clamp method or vascular unloading technology. In the last case, the finger BP is monitored by a photoplethysmography device coupled to an inflatable cuff controlled by a servo valve to keep constant the diameter of the artery. The cost of commercial devices using this operation principle is relatively high in comparison with noninvasive intermittent BP monitors.
Method
A prototype was built based on the Arduino platform, and tested based on the International Protocol of Validation of BP Measurement Instruments in adults. As a result, a low-cost device (components cost around EUR 150) was built.
Results
From the Bland–Altman analysis, the mean and standard deviation (SD) were determined as 5.09 ± 12.27 for the Systolic BP, − 1.72 ± 12.56 for the Diastolic BP, and 0.68 ± 11.08 for the Mean BP.
Conclusion
Similar results were reported for commercial devices that employ the vascular unload technique controlling the cuff pressure through a servo valve. Then, the proposed device is a low-cost alternative to measure BP with results similar to commercial devices.
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References
Aagadeesh AM, Singh NG, Mahankali S. A comparison of a continuous noninvasive arterial pressure (CNAPTM) monitor with an invasive arterial blood pressure monitor in the cardiac surgical ICU. Ann Card Anaesth. 2012;15(3):180.
Akkerman J, Diepeveen M, Ganzevoort W, Van Montfrans GA, Westerhof BE, Wolf H. Continuous non-invasive blood pressure monitoring, a validation study of Nexfin in a pregnant population, hypertens. Pregnancy. 2009;28(2):230–42. https://doi.org/10.1080/10641950802601260.
Ameloot K et al., Validation study of Nexfin® continuous non-invasive blood pressure monitoring in critically ill adult patients, Minerva. Anestesiol 2014;80(12):1294–301. Available: http://www.ncbi.nlm.nih.gov/pubmed/24705004. Accessed 5 Mar 2019.
Araghi A, Bander JJ, Guzman JA. Arterial blood pressure monitoring in overweight critically ill patients: invasive or noninvasive? Crit Care. 2006;10(2):R64. https://doi.org/10.1186/cc4896.
Balzer F, et al. Comparison of the non-invasive Nexfin® monitor with conventional methods for the measurement of arterial blood pressure in moderate risk orthopaedic surgery patients. J Int Med Res. 2016;44(4):832–43. https://doi.org/10.1177/0300060516635383.
Boehmer RD. Continuous, real-time, noninvasive monitor of blood pressure: Peňaz methodology applied to the finger. J Clin Monit. 1987;3(4):282–7. https://doi.org/10.1007/BF03337384.
Chen Y, Chen J. Development of a noninvasive instantaneous blood pressure measurement device based on volume-compensation method and study of its control algorithm. J Instrum. 2020;15(08):P08012. https://doi.org/10.1088/1748-0221/15/08/P08012.
EeftinckSchattenkerk DW, et al. Nexfin noninvasive continuous blood pressure validated against Riva-Rocci/Korotkoff. Am J Hypertens. 2009;22(4):378–83. https://doi.org/10.1038/ajh.2008.368.
Fortin J, et al. Continuous non-invasive blood pressure monitoring using concentrically interlocking control loops. Comput Biol Med. 2006;36(9):941–57. https://doi.org/10.1016/j.compbiomed.2005.04.003.
Fortin J, et al. A novel art of continuous noninvasive blood pressure measurement. Nat Commun. 2021;12(1):1–14. https://doi.org/10.1038/s41467-021-21271-8.
Heusdens JF, et al. Validation of non-invasive arterial pressure monitoring during carotid endarterectomy. Br J Anaesth. 2016;117(3):316–23. https://doi.org/10.1093/bja/aew268.
Imholz B. Fifteen years’ experience with finger arterial pressure monitoring: assessment of the technology: assessment of the tecnology. Cardiovasc Res. 1998;38(3):605–16. https://doi.org/10.1016/S0008-6363(98)00067-4.
ISO 81060–2:2013. Non-invasive sphygmomanometers–Part 2: clinical investigation of automated measurement type ANSI/AAMI Association for the Advancement of Medical Instrumentation 2013 ISO 81060-2/ANSI-AAMI. 2nd ed. Arlington: AAMI.
Jeleazcov C, et al. Precision and accuracy of a new device (CNAPTM) for continuous non-invasive arterial pressure monitoring: assessment during general anaesthesia. Br J Anaesth. 2010;105(3):264–72. https://doi.org/10.1093/bja/aeq143.
Kim SH, et al. Accuracy and precision of continuous noninvasive arterial pressure monitoring compared with invasive arterial pressure: A Systematic Review and Meta-analysis. Anesthesiol. 2014;120(5):1080–97. https://doi.org/10.1097/ALN.0000000000000226.
Lakhal K, et al. The CNAPTM finger cuff for noninvasive beat-to-beat monitoring of arterial blood pressure: An Evaluation in Intensive Care Unit Patients and a Comparison with 2 Intermittent Devices. Anesth Analg. 2016;123(5):1126–35. https://doi.org/10.1213/ANE.0000000000001324.
Lakhal K, Ehrman S, Boulain T. Noninvasive BP monitoring in the critically ill: time to abandon the arterial catheter? Chest. 2018;153(4):1023–39. https://doi.org/10.1016/J.CHEST.2017.10.030.
Martina JR, et al. Noninvasive arterial blood pressure waveforms in patients with continuous-flow left ventricular assist devices. ASAIO J. 2014;60(2):154–61. https://doi.org/10.1097/MAT.0000000000000033.
Meidert AS, Saugel B. Techniques for non-invasive monitoring of arterial blood pressure. Front Med. 2018. p. 4. https://doi.org/10.3389/fmed.2017.00231.
Molhoek GP, et al. Evaluation of the Penàz servo-plethysmo-manometer for the continuous, non-invasive measurement of finger blood pressure. Basic Res Cardiol. 1984;79(5):598–609. https://doi.org/10.1007/BF01910489.
Mukaka MM. A guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012;24(3):69–71.
Myles PS, Cui J. I. Using the Bland-Altman method to measure agreement with repeated measures. Br J Anaesth. 2007;99(3):309–11. https://doi.org/10.1093/bja/aem214.
O’Brien E, et al. European Society of Hypertension International Protocol revision 2010 for the validation of blood pressure measuring devices in adults. Blood Press Monit. 2010;15(1):23–38. https://doi.org/10.1097/MBP.0b013e3283360e98.
Rogge DE. Continuous noninvasive arterial pressure monitoring in obese patients during bariatric surgery. Anesth Analg. 2019;128(3):477–83. https://doi.org/10.1213/ANE.0000000000003943.
Schramm P, et al. Noninvasive hemodynamic measurements during neurosurgical procedures in sitting position. J Neurosurg Anesthesiol. 2017;29(3):251–7. https://doi.org/10.1097/ANA.0000000000000300.
Stergiou GS, et al. A universal standard for the validation of blood pressure measuring devices. J Hypertens. 2018;36(3):472–8. https://doi.org/10.1097/HJH.0000000000001634.
Wang Z, Chen G, Lu K, Zhu Y, Chen Y. Investigation of the accuracy of a noninvasive continuous blood pressure device in different age groups and its ability in detecting hypertension and hypotension: an observational study. BMC Anesthesiol. 2019;19(1):223. https://doi.org/10.1186/s12871-019-0899-z.
Weaver MG. Differences in blood pressure levels obtained by auscultatory and oscillometric methods. Arch Pediatr Adolesc Med. 1990;144(8):911. https://doi.org/10.1001/archpedi.1990.02150320075031.
Acknowledgements
This study was approved by the Medical Ethics Committee of the University of Pernambuco (Protocol No 94530418.0.0000.5192). The authors would like to thank the Polytechnic School of the University of Pernambuco for the instrumental/technical support.
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This article involves the blood pressure measurements of various human subjects. Ethical approval was taken from the Medical Ethics Committee of the University of Pernambuco, before performing the measurements. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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de Lorena, A.E.S., de Lima, R.A. & Malagón, L.A.G. Low-cost noninvasive continuous blood pressure monitor. Res. Biomed. Eng. 38, 559–570 (2022). https://doi.org/10.1007/s42600-022-00207-1
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DOI: https://doi.org/10.1007/s42600-022-00207-1