Investigation of the agreement of a continuous non-invasive arterial pressure device in comparison with invasive radial artery measurement

Abstract

Arterial pressure (AP) monitoring should be accurate, easy to use, free of risks, and ideally continuous. The continuous non-invasive arterial pressure (CNAP) device is non-invasive and provides continuous pressure readings. This study was performed to compare the agreement of CNAP and invasive AP monitoring. Ninety patients undergoing surgery under general anaesthesia were enrolled. Invasive pressure monitoring was established at the radial artery. CNAP monitoring using a finger sensor recording was begun before induction of anaesthesia. Statistical analysis was conducted with the Bland-Altman method for comparisons of repeated measures. We obtained 16 843 valid pressure readings from 85 patients. Mean (sd) bias during maintenance of anaesthesia was: systolic AP: 4.2 (16.5) mm Hg; mean AP (MAP): -4.3 (10.4) mm Hg; and diastolic AP: -5.8 (6) mm Hg. The results of a subgroup analysis of patients who had a mean intra-arterial pressure of <70 mm Hg were as follows: systolic pressure: -0.3 (9.7) mm Hg; mean pressure: -6.8 (7.6) mm Hg; and diastolic pressure: -7.9 (7.2) mm Hg. Bias and percentage error during the induction period were greater in both the main and subgroup analyses, probably due to recalibration being omitted after induction. The CNAP monitor showed an acceptable agreement and was interchangeable with invasive pressure monitoring for MAP during normotensive conditions. During induction of anaesthesia and when the AP was low, the agreement was less good and interchangeability was not achieved. These results suggest that CNAP is not statistically equivalent to invasive monitoring during all periods of anaesthesia but may be a useful additional AP monitor.