Abstract
BackgroundClearSight is a noninvasive arterial blood pressure monitor, but it remains unknown whether it is affected by the state of perfusion to the fingers. We investigated whether the lower perfusion index (PI) measured with a pulse oximeter, which reflects finger perfusion, would affect the agreement between arterial pressures measured with ClearSight versus those obtained with an arterial catheter.MethodsPaired arterial pressure data (ClearSight and arterial catheter-based pressures) and PI values were prospectively obtained from 30 patients undergoing major abdominal surgery. The primary outcome was standard deviation (SD) of the bias (precision) of blood pressure between ClearSight and arterial catheter. The ratio of the adjusted SD of the bias between PI≤1 and PI>1 was calculated using the linear mixed-effects model. The secondary outcomes were the bias and the limits of agreement (LOA) between the two devices (repeated measures Bland-Altman analysis).ResultsWe analyzed 6312 paired data points. The adjusted SD of bias in PI ≤1 compared with those in PI >1 was 1.4-fold (95% confidence interval: 1.3- to 1.4-fold) for systolic arterial pressure, 1.5-fold (95% confidence interval: 1.3- to 1.6-fold) for diastolic arterial pressure, and 1.3-fold (95% confidence interval: 1.2- to 1.5-fold) for mean arterial pressure. The bias (LOA) were as follows: systolic arterial pressure in the PI ≤1 and PI >1 groups, -3.5 (-35.4 to 28.4) mmHg and 2.2 (-19.9 to 24.3) mmHg, respectively; diastolic arterial pressure in the PI ≤1 and PI >1 groups, 13.1 (-5.1 to 31.3) mmHg and 9.0, (-2.6 to 20.6) mmHg, respectively; and mean arterial pressure in the PI ≤1 and PI >1 groups, 8.7 (-11.3 to 28.7) mmHg and 7.6 (-6.2 to 21.3) mmHg, respectively.ConclusionsPI ≤1 was associated with a large SD of the bias between the devices. The PI value could be a real-time indicator of ClearSight precision.
Highlights
Invasive arterial blood pressure measurement with an arterial catheter (IAP) is the gold standard for continuous and accurate monitoring of arterial blood pressure, but this technique carries the risk of complications such as arterial occlusion, pseudoaneurysm, local infection, or hematoma [1]
We investigated whether the lower perfusion index (PI) measured with a pulse oximeter, which reflects finger perfusion, would affect the agreement between arterial pressures measured with ClearSight versus those obtained with an arterial catheter
The PI value could be a real-time indicator of ClearSight precision
Summary
Invasive arterial blood pressure measurement with an arterial catheter (IAP) is the gold standard for continuous and accurate monitoring of arterial blood pressure, but this technique carries the risk of complications such as arterial occlusion, pseudoaneurysm, local infection, or hematoma [1]. ClearSight (Edwards Lifesciences, Irvine, CA, USA), which consists of a cuff placed around a finger, is a noninvasive, continuous arterial blood pressure monitoring device. Based on the assumption that the transmural pressure is zero at this clamped finger artery diameter, the cuff pressure is considered equal to the finger arterial pressure. This “unloaded” state is checked by Physiocal calibration, which is automatically performed to maintain the appropriate diameter of the finger arteries [2]. ClearSight is a noninvasive arterial blood pressure monitor, but it remains unknown whether it is affected by the state of perfusion to the fingers. We investigated whether the lower perfusion index (PI) measured with a pulse oximeter, which reflects finger perfusion, would affect the agreement between arterial pressures measured with ClearSight versus those obtained with an arterial catheter
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