Abstract
Background: Continuous blood pressure (BP) measurement in intensive care units is based on arterial line (AL) transducers, sometimes associated with clinical complications. Our objective was to evaluate continuous BP measurements obtained from a non-invasive, wireless photoplethysmography (PPG)-based device using two distinct configurations (wristwatch and chest-patch monitors) compared to an AL.Methods: In this prospective evaluation study, comparison of the PPG-based devices to the AL was conducted in 10 patients immediately following cardiac surgery. Pulse rate (PR), systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were recorded using both the AL and the PPG-based devices simultaneously for an average of 432 ± 290 min starting immediately after cardiac surgery. Bland-Altman plots and Pearson's correlations were used to assess the accuracy and degree of agreement between techniques.Results: A total of ~4,000 data points were included in the final analysis. AL measurements for PR, SBP, DBP and MAP were significantly (p < 0.001) and strongly correlated with both the wristwatch (r = 0.99, r = 0.94, r = 0.93 and r = 0.96, respectively) and the chest-patch (r = 0.99, r = 0.95, r = 0.93 and r = 0.95, respectively) monitors. Both configurations showed a marginal bias of <1 mmHg for BP measurements and <1 beat/min for PR [95% limits of agreement −3,3 beat/min; BP measurements: (−6)–(−10), 6–10 mmHg] compared to AL measurements.Conclusion: The PPG-based devices offer a high level of accuracy for cardiac-related parameters compared to an AL in post-cardiac surgery patients. Such devices could provide advanced monitoring capabilities in a variety of clinical settings, including immediate post-operative and intensive care unit settings.Clinical Trial Registration:www.clinicaltrials.gov, NCT03603860.
Highlights
Post-operative hypotension and hypertension commonly occur after cardiac surgery and are associated with severe outcomes including acute kidney injury, cerebrovascular accidents, myocardial injury and death [1,2,3,4]
arterial line (AL) measurements for Pulse rate (PR), systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) were significantly (p < 0.001) and strongly correlated with both the wristwatch (r = 0.99, r = 0.94, r = 0.93 and r = 0.96, respectively) and the chest-patch (r = 0.99, r = 0.95, r = 0.93 and r = 0.95, respectively) monitors
The frequency of post-operative blood pressure (BP) measurement is inversely correlated with hypotension occurrence, and early interventions aimed at adjusting BP are important for improving clinical outcomes [5]
Summary
Post-operative hypotension and hypertension commonly occur after cardiac surgery and are associated with severe outcomes including acute kidney injury, cerebrovascular accidents, myocardial injury and death [1,2,3,4]. Albeit providing accurate and continuous BP measurements, the AL is an invasive method with several potential adverse effects and complications [6] It requires operation by skilled personnel and has a cumbersome setting with monitors, cables and wires connected to the patient [7,8,9,10]. Such technology would assist in early identification of medical emergencies and would enable retrospective investigation of BP when needed, leading to improved patient care [11,12,13]. Our objective was to evaluate continuous BP measurements obtained from a non-invasive, wireless photoplethysmography (PPG)-based device using two distinct configurations (wristwatch and chest-patch monitors) compared to an AL
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