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A Comparison of Noninvasive Blood Pressure Measurement on the Wrist with Invasive Arterial Blood Pressure Monitoring in Patients Undergoing Bariatric Surgery

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Abstract

Background

In morbidly obese patients, oscillometric blood pressure measurements with an upper-arm cuff are often difficult to perform. The alternative method, invasive blood pressure monitoring, can be difficult to place and is associated with risks. A wrist-mounted blood pressure-monitoring device, the Vasotrac, provides accurate blood pressure measurements in lean patients. Even in the obese, wrist morphology remains relatively unchanged. We thus assessed the degree to which blood pressure measurements with the Vasotrac on the wrist and cuff measurements agree with invasive arterial blood pressure monitoring.

Methods

We evaluated 22 morbidly obese patients undergoing bariatric surgery lasting 3.8 ± 1.1 h. Intraoperative blood pressure was simultaneously measured using the Vasotrac mounted on one wrist; an arterial catheter was inserted in the opposite radial artery, and an oscillometric cuff was positioned on the upper arm. Preoperative patient comfort was evaluated on a scale from 1 to 10, with 10 being most uncomfortable, just after the first oscillometric cuff inflation. Values from the Vasotrac and arterial catheter were recorded at 5-s intervals. Bias, precision, and clinically acceptable agreement were calculated between the two continuous monitoring devices and between the arterial catheter and the cuff measurements, with the arterial catheter providing the reference value.

Results

The patients’ age was 44.3 ± 9.5 years (mean ± SD), body mass index was 66.7 ± 13.8 kg/m2, and arm circumference was 48.6 ± 7.5 cm. Patients found the Vasotrac more comfortable than the oscillometric device [1.7 ± 1.8 vs 5.3 ± 0.5 (P = 0.009)]. A total of 40,411 pairs of values from the Vasotrac and arterial catheter were recorded. Lin’s concordance correlation coefficient (95% CI) for mean arterial blood pressure measured between the arterial line and the Vasotrac was 0.74 (0.67, 0.82). The bias (mean error) was −0.25 mmHg; however, the Bland–Altman limits where 95% of individual pressure differences are expected to fall was (−20, 20) mmHg. The precisions for diastolic and systolic pressures were even worse.

Conclusion

The Vasotrac was more comfortable than an oscillometric device. Although the average accuracy was good, individual mean Vasotrac and noninvasive blood pressure pressures often differed considerably from arterial values. These results suggest that the Vasotrac monitor should not be substituted for an arterial catheter in super-obese patients.

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References

  1. WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i–xii, 1–253.

    Google Scholar 

  2. Sinha R, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002;346(11):802–10.

    Article  CAS  Google Scholar 

  3. Angulo P, Lindor KD. Treatment of non-alcoholic steatohepatitis. Best Pract Res Clin Gastroenterol. 2002;16(5):797–810.

    Article  CAS  Google Scholar 

  4. Drazen JM. Sleep apnea syndrome. N Engl J Med. 2002;346(6):390.

    Article  Google Scholar 

  5. Kenchaiah S, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347(5):305–13.

    Article  Google Scholar 

  6. Bur A, et al. Accuracy of oscillometric blood pressure measurement according to the relation between cuff size and upper-arm circumference in critically ill patients. Crit Care Med. 2000;28(2):371–6.

    Article  CAS  Google Scholar 

  7. Feher MD, et al. Fat arms, obesity and choice of blood pressure cuff size in diabetic patients. Br J Clin Pract. 1995;49(6):286–7.

    CAS  PubMed  Google Scholar 

  8. Schwartz WJ 3rd, et al. Blood pressure monitoring during pregnancy. Accuracy of portable devices designed for obese patients. J Reprod Med. 1996;41(8):581–5.

    PubMed  Google Scholar 

  9. Singer AJ, Hollander JE. Blood pressure. Assessment of interarm differences. Arch Intern Med. 1996;156(17):2005–8.

    Article  CAS  Google Scholar 

  10. Belani K, et al. A new noninvasive method to measure blood pressure: results of a multicenter trial. Anesthesiology. 1999;91(3):686–92.

    Article  CAS  Google Scholar 

  11. Cua CL, et al. A comparison of the Vasotrac with invasive arterial blood pressure monitoring in children after pediatric cardiac surgery. Anesth Analg. 2005;100(5):1289–94, table of contents.

    Article  Google Scholar 

  12. Hager H, Reddy D, Kurz A. Perfusion index—a valuable tool to assess changes in peripheral perfusion caused by sevoflurane? Anesthesiology. 2003;99:A593.

    Google Scholar 

  13. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.

    Article  CAS  Google Scholar 

  14. Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8(2):135–60.

    Article  CAS  Google Scholar 

  15. Lin L, Torbeck LD. Coefficient of accuracy and concordance correlation coefficient: new statistics for methods comparison. PDA J Pharm Sci Technol. 1998;52(2):55–9.

    CAS  PubMed  Google Scholar 

  16. Efron B, Halloran E, Holmes S. Bootstrap confidence levels for phylogenetic trees. Proc Natl Acad Sci U S A. 1996;93(14):7085–90.

    Article  CAS  Google Scholar 

  17. Findlay JY, et al. Vasotrac arterial blood pressure and direct arterial blood pressure monitoring during liver transplantation. Anesth Analg. 2006;102(3):690–3.

    Article  Google Scholar 

  18. Scheer B, Perel A, Pfeiffer UJ. Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care. 2002;6(3):199–204.

    Article  Google Scholar 

  19. David Hill MBBS, et al. Accuracy of radial artery blood pressure determination in children undergoing controlled hypotensive anesthesia in the prone position with the Vasotrac. 2002 ASA Meeting Abstracts, 2002.

  20. Kumar Belani M, Komanduri V, Poliac M. radial artery blood pressure monitoring in children with the Vasotrac—a preliminary report. 2000 ASA Meeting Abstracts, 2000.

  21. Maja Sostaric MD, et al. Comparison of the Vasotrac BP monitor with the arm cuff methods. 2000 ASA Meeting Abstracts, 2000.

  22. Thomas Hartmann MD, et al. Assessment of the Vasotrac Blood pressure monitor during deliberate hypotension. 2000 ASA Meeting Abstracts, 2000.

  23. Bowdle TA. Complications of invasive monitoring. Anesthesiol Clin North America. 2002;20(3):571–88.

    Article  Google Scholar 

  24. Hynson JM, et al. Thermoregulatory and anesthetic-induced alterations in the differences among femoral, radial, and oscillometric blood pressures. Anesthesiology. 1994;81(6):1411–21.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and General Intensive Care, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1180, Vienna, Austria

    Helmut Hager

  2. Department of Anesthesiology, Washington University, St. Louis, MO, USA

    Goutham Mandadi & Debra Pulley

  3. Department of Surgery, Washington University, St. Louis, MO, USA

    J. Chris Eagon

  4. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA

    Edward Mascha & Andrea Kurz

  5. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Edward Mascha & Benjamin Nutter

Authors
  1. Helmut Hager
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  2. Goutham Mandadi
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  3. Debra Pulley
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  4. J. Chris Eagon
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  5. Edward Mascha
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  6. Benjamin Nutter
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  7. Andrea Kurz
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Corresponding author

Correspondence to Helmut Hager.

Additional information

This study was financially supported by the Clinical Research Division of the Department of Anesthesiology, Washington University, St. Louis, MO. None of the authors have personal financial interest related to this research.

Medwave (Arden Hills, MN, USA) provided the Vasotrac monitor.

Summary Statement: A novel wrist-mounted device, the Vasotrac, showed moderate agreement at best with invasive arterial blood pressure monitoring.

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Hager, H., Mandadi, G., Pulley, D. et al. A Comparison of Noninvasive Blood Pressure Measurement on the Wrist with Invasive Arterial Blood Pressure Monitoring in Patients Undergoing Bariatric Surgery. OBES SURG 19, 717–724 (2009). https://doi.org/10.1007/s11695-008-9607-7

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  • DOI: https://doi.org/10.1007/s11695-008-9607-7

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