Continuous Non-Invasive Arterial Pressure Monitoring (ClearSight System) and Ankle Blood Pressure Measurements as Alternatives to Conventional Arm Blood Pressure.

Seohee Lee,Jinyoung Bae,Karam Nam,Yunseok Jeon,Jaeyeon Chung,Youn Joung Cho

doi:10.3390/jcm9113615

Seohee Lee, Jinyoung Bae + Show 4 more

Open Access

https://doi.org/10.3390/jcm9113615

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Abstract

Measuring blood pressure (BP) via a pneumatic cuff placed around the arm has long been the standard method. However, in clinical situations where BP monitoring at the arm is difficult, the ankle is frequently used instead. We compared continuous non-invasive blood pressure (CNBP) measurements obtained at the finger, ankle BP and arm BP in patients undergoing breast cancer surgery. Arm BP, ankle BP (both obtained with a conventional pneumatic cuff) and CNBP measurements were obtained every 2.5 min during surgery. Correlation and Bland–Altman analyses were performed and differences among measurements were analyzed using a linear mixed model. A total of 245 sets of BP measurements were obtained from 10 patients. All systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP) measurements of ankle BP and CNBP were positively correlated with the arm BP measurements (Spearman rho 0.688–0.836, p < 0.001 for each correlation). The difference between CNBP and arm SBP was significantly smaller (least squares mean (95% confidence interval): −6.03 (−11.40, −0.67)) compared to that between ankle and arm SBP (least squares mean (95% CI): −15.32 (−20.69, −9.96), p = 0.019). However, this significant difference was not observed in DBP and MBP (−1.23 vs. 1.75, p = 0.190 and −3.85 vs. −2.63, p = 0.604, respectively). Ankle SBP measurements showed larger differences from arm SBP measurements than did CNBP SBP measurements in patients undergoing breast cancer surgery. CNBP could serve as a useful alternative to ankle BP when standard arm BP measurements cannot be obtained.

Highlights

Blood pressure (BP) is an essential hemodynamic parameter [1]
BP monitoring using a pneumatic cuff is generally avoided on the surgical-side arm of breast cancer patients due to concerns about lymphedema of the arm [4]
Bland–Altman analysis showed that the mean ± standard deviation (SD) difference (95% limits of agreement) between arm and ankle BP measurements was −15.3 ± 12.4 mmHg (39.7 to 9.2) for systolic blood pressure (SBP), 1.8 ± 6.8 mmHg (−11.6 to 15.2) for diastolic blood pressure (DBP) and −2.6 ± 8.5 mmHg (−19.3 to 14.1) for mean blood pressure (MBP) (Figure 3a,c,e); the respective differences between arm BP and continuous non-invasive blood pressure (CNBP) measurements were −6.0 ± 9.3 mmHg (−24.3 to 12.3), −1.2 ± 7.6 mmHg (−16.1 to 13.7) and −3.8 mmHg ± 8.1 mmHg (−19.7 to 12.1 mmHg) (Figure 3b,d,f)

Summary

Introduction

The gold standard method for BP monitoring is an oscillometric pneumatic cuff around the arm [2,3]. The system uses the volume-clamp method where the changes in cuff pressures to maintain constant arterial transmural pressure are converted to brachial arterial pressure [10]. These procedures are performed throughout the whole cardiac cycle, allowing continuous blood pressure monitoring [10]. We compared arm and leg BP measurements, obtained using a conventional pneumatic cuff, with CNBP measurements obtained using the ClearSight system in patients undergoing breast cancer surgery under general anesthesia

Study Population

Anesthesia

Blood Pressure Monitoring

Results

50 Female

Conclusions