Cuff Pressure Research Articles

ANALISIS SISTEM KERJA DAN PENGARUH NON INVASIVE BLOOD PRESSURE PADA PATIENT MONITOR

Patient Monitor is a device that monitors physiological conditions in the form of NIBP (Non-Ivasive Blood Pressure) blood pressure, temperature, respiration, SPO2 and the shape of the heart pulse continuously. The purpose of this study was to find out how the system works and the use of Non Iinvasive Blood Pressure is good in order to get maximum results. This research is a descriptive and qualitative method, namely by analyzing the Work System and the Effect of Noun Invasive Blood Pressure measurement on the Patient Monitor. The results obtained are the NIBP working system on the patient monitor device consisting of power supply, motor, air valve, microprocessor, display. The blood pressure measurement system uses a cuff with air pressure generated by a motor. The conclusion of this study is that the NIBP works using a pneumatic system, namely using air pressure, where the cuff is inflated until the pressure reaches a maximum above systolic pressure, where the arteries are effectively blocked. Then the cuff pressure is reduced to a constant level, the pressure traducer provides an analog signal to the digital hardware during the process of obtaining the systolic, diastolic and mean pressures.

Chronic post-thoracotomy pain after lung cancer surgery: a prospective study of preoperative risk factors.

The objective of this longitudinal cohort study was to investigate if preoperative pain mechanisms, anxiety, and depression increase risk of developing chronic post-thoracotomy pain (CPTP) after lung cancer surgery. Patients with suspected or confirmed lung cancer undergoing surgery by either video-assisted thoracoscopic surgery or anterior thoracotomy were recruited consecutively. Preoperative assessments were conducted by: quantitative sensory testing (QST) (brush, pinprick, cuff pressure pain detection threshold, cuff pressure tolerance pain threshold, temporal summation and conditioned pain modulation), neuropathic pain symptom inventory (NPSI), and the Hospital Anxiety and Depression Scale (HADS). Clinical parameters in relation to surgery were also collected. Presence of CPTP was determined after six months and defined as pain of any intensity in relation to the operation area on a numeric rating scale form 0 (no pain) to 10 (worst pain imaginable). A total of 121 patients (60.2 %) completed follow-up and 56 patients (46.3 %) reported CPTP. Development of CPTP was associated with higher preoperative HADS score (p=0.025), higher preoperative NPSI score (p=0.009) and acute postoperative pain (p=0.042). No differences were observed in relation to preoperative QST assessment by cuff algometry and HADS anxiety and depression sub-scores. High preoperative HADS score preoperative pain, acute postoperative pain intensity, and preoperative neuropathic symptoms were was associated with CPTP after lung cancer surgery. No differences in values of preoperative QST assessments were found. Preoperative assessment and identification of patients at higher risk of postoperative pain will offer opportunity for further exploration and development of preventive measures and individualised pain management depending on patient risk profile.

Troponin and NT-proBNP in the prediction of impaired myocardial deformation after STEMI

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): University of Medicine and Pharmacy “Iuliu Hațieganu” Cluj- Napoca. Introduction One adverse consequence that may follow an ST-elevation myocardial infarction (STEMI) is left ventricular (LV) remodeling. The majority of evidence indicates speckle-tracking echocardiography and global longitudinal strain may identify early changes in deformation after MI, while circumferential strain (GCS) is less extensively studied. However, since strain is thought to be afterload-dependent, the global work index (GWI), a novel afterload-incorporating parameter recently evolved. Objective The aim of this study was to determine whether the levels of high-sensitive troponin and NT-proBNP, two variables known to be of prognostic significance in STEMI, might indicate whether GCS and GWI are more impaired after STEMI. Material and methods 60 patients with STEMI and preserved LVEF who underwent PCI were included in the study. Using a Vivid E95 scanner, early echocardiography (2–4 days) was performed, and the EchoPac BT13 software (GE Vingmed ultrasound) was used for analysis. Both conventional and deformation parameters were assessed. GWI was determined by using pressure-strain loops (strain and estimated LV pressure from the peak arterial brahial cuff pressure). ROC curves were used to determine the optimal cut-off values of Troponin and NT-proBNP to predict the values below the median for each of the studied parameters (GCS and GWI). Results The mean age of the patients was of 68±13 years and 55% were male. The majority of the patients presented with anterior MI (n=29, 48.3%), followed by inferior MI (n=25, 42%). Patients frequently reported hypertension (n=45,75%), while others had dyslipidemia (n=15, 25%), diabetes (n=8, 13.3%), and smoking (n=23, 38.3%) as cardiovascular risk factors. The median values of NT-proBNP were 600 [280–1930] pg/mL and 0.52 mg/dL [0.16–1.6] for troponin, respectively. Mean values of GCS were −11.6 ± 5.1% and of GWI were 927 ± 403 mmHg%. We analysed the ROC curves of troponin and NT-proBNP to predict values below the median of −10% for GCS and of 937mmHg% for GWI (Fig.1). We found that troponin values > 0.612 mg/dL (AUC 0.674, 95% CI 0.541 to 0.790, p = 0.014, Se 66%, Sp 71%) and NT-proBNP values > 715 pg/mL (AUC 0.678, 95 %CI 0.545 to 0.793, p = 0.0117, Se 59%, Sp 74%) were able to predict more impaired GWI. Interestingly, only troponin values > 0.315 mg/dL, a threshold that was lower than in the case of GWI, were able to predict more impaired GCS (AUC 0.755, 95% CI 0.627 to 0.857, p<0.0001, Se 91%, Sp 58%). Conclusion High sensitive troponin and NT-proBNP may indicate more impaired myocardial mechanics after STEMI. Both GCS and GWI, a parameter integrating strain and afterload, may provide additional information In the early stages of remodeling following MI.

Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery

Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery

Pressure changes in the endotracheal tube cuff in otorhinolaryngologic surgery: a prospective observational study.

Inflation of the endotracheal tube cuff is needed for providing ventilation. Cuff pressure should be maintained inside the appropriate range to prevent critical airway complications. The purpose of this study is to evaluate the pressure changes in the endotracheal tube cuff during otorhinolaryngologic surgery. This single-center observational study was conducted at Severance Hospital in Korea between April 2020 and November 2020. Patients aged >20 years scheduled to undergo otorhinolaryngological surgical procedures were enrolled. Patients undergoing planned tracheostomy and those who were slated for uncuffed endotracheal tube use were excluded. Intubation was performed after the induction of general anesthesia. A pressure transducer was connected to the pilot balloon of the endotracheal tube, and cuff pressure was continuously monitored until extubation. If the cuff pressure was not appropriate for more than 5 min, it was adjusted to the appropriate range by injecting or removing air. The percentage of time for which the cuff pressure remained within the appropriate range was calculated and defined as the time in the therapeutic range (TTR). The presumed cause for the rise or fall in cuff pressure was identified. In total 199 patients, alterations in cuff pressure outside the appropriate range occurred in 191 patients (96.0%). The mean TTR was 79.7% (SD 25.0%), and head and neck surgery had the lowest mean TTR of 69.0% compared to ear and nose surgeries (94.2 and 82.1%, respectively). Sixty-eight patients (34.2%) demonstrated inadequate endotracheal tube cuff pressure for more than 20% of the total anesthesia time. Twenty-six patients (13.1%) demonstrated optimal endotracheal tube cuff pressure for less than 50% of the total anesthesia time. The causative factors inducing inappropriate cuff pressure were found to vary, including positional changes, surgical procedure, anatomical manipulation, and anesthetic procedure. In otorhinolaryngologic surgery, cuff pressure increased or decreased outside the appropriate range due to various factors. Therefore, we suggest close continuous monitoring of cuff pressure during anesthesia for otorhinolaryngologic surgery. clinicaltrials.gov, identifier NCT03938493.

Towards continuous non-invasive blood pressure measurements-interpretation of the vasculature response to cuff inflation.

Blood pressure (BP) surrogates, such as pulse transit time (PTT) or pulse arrival time (PAT), have been intensively explored with the goal of achieving cuffless, continuous, and accurate BP inference. In order to estimate BP, a one-point calibration strategy between PAT and BP is typically used. Recent research focuses on advanced calibration procedures exploiting the cuff inflation process to improve calibration robustness by active and controlled modulation of peripheral PAT, as measured via plethysmograph (PPG) and electrocardiogram (ECG) combination. Such methods require a detailed understanding of the mechanisms behind the vasculature's response to cuff inflation; for this, a model has recently been developed to infer the PAT-BP calibration from measured cuff-induced vasculature changes. The model, while promising, is still preliminary and only partially validated; in-depth analysis and further developments are still needed. Therefore, this work aims to improve our understanding of the cuff-vasculature interaction in this model; we seek to define potential opportunities and to highlight which aspects may require further study. We compare model behaviors with clinical data samples based on a set of observable characteristics relevant for BP inference and calibration. It is found that the observed behaviors are qualitatively well represented with the current simulation model and complexity, with limitations regarding the prediction of the onset of the distal arm dynamics and behavior changes at high cuff pressures. Additionally, a sensitivity analysis of the model's parameter space is conducted to show the factors that influence the characteristics of its observable outputs. It was revealed that easily controllable experimental variables, such as lateral cuff length and inflation rate, have a significant impact on cuff-induced vasculature changes. An interesting dependency between systemic BP and cuff-induced distal PTT change is also found, revealing opportunities for improved methods for BP surrogate calibration. However, validation via patient data shows that this relation does not hold for all patients, indicating required model improvements to be validated in follow up studies. These results provide promising directions to improve the calibration process featuring cuff inflation towards accurate and robust non-invasive blood pressure estimation.

CAN RECORDING KOROTKOFF SOUNDS DURING BRACHIAL CUFF INFLATION PROVIDE MORE ACCURATE NON-INVASIVE ESTIMATES OF INTRA-ARTERIAL BLOOD PRESSURE?

Objective: We have previously demonstrated that recording onset and termination of Korotkoff sounds as markers of systolic (SBP) and diastolic (DBP) during brachial cuff deflation results in underestimation of true SBP. In this study we explore whether recording Korotkoff sounds during cuff inflation provides more accurate non-invasive estimates of intra-arterial blood pressure (IABP). Design and method: Experiments were carried out on 15 participants, (14 males, 64.3 ± 10.4 years; one female, 86 yo), undergoing coronary angiography. A conventional (oscillometric) BP cuff, with a microphone for Korotkoff sounds, was placed on the upper arm. The cuff was inflated at rate of approximately 2.5mm Hg/sec and deflated at the same rate. Inflation and deflation cycles were randomised and separated by 2 - 3 minutes. IABP was measured below the cuff with a fluid-filled catheter inserted via the radial artery and an external transducer. Korotkoff sounds were processed electronically, and custom algorithms identified the cuff pressure (CP) at which the first and last Korotkoff sounds were heard. Results: Systolic (SBP), and diastolic (DBP) pressure were 147.7.6 ± 12.7 and 70.7 ± 9.7mmHg. The CP at which the brachial artery closes during rapid (∼20mmHg/sec) cuff inflation (132.0 ± 17.1) was similar to that of slow (2.5mmHg/sec) inflation (132.0 ± 16.3 mmHg). However, peak Korotkoff sound energy was significantly reduced (P = 0.003) from 0.19 ± 0.1 to 0.15 ± 0.09 RMS volts and the Korotkoff sounds were often observed to disappear prematurely before brachial artery closure. Difference between intra-arterial SBP and CP at the last recorded Korotkoff sound (27.5 ± 9.3 mmHg) during cuff inflation was significantly higher (P = 0.0025) than during slow cuff deflation (18.9 ± 8.3 mmHg). In contrast, DBP recorded at first onset of the Korotkoff sounds (70.5 ± 11.1 mmHg) was consistently similar to intra-arterial DBP (70.7 ± 9.7 mmHg). Conclusions: SBP estimates derived from the last Korotkoff sound recorded as the cuff inflates generates greater errors than when Korotkoff sounds are first recorded as the cuff deflates. In contrast, the estimate of DBP derived from the first onset of the Korotkoff sound as the cuff inflates, appears to reflect accurately the true intra-arterial DBP.

KOROTKOFF SOUNDS DO NOT PROVIDE AN ACCURATE ESTIMATE OF SYSTOLIC AND DIASTOLIC PRESSURE IN SPHYGMOMANOMETRY AND CANNOT BE USED AS A CALIBRATION STANDARD FOR NIBP DEVICES

Objective: Noninvasive blood pressure (NIBP) devices are calibrated against validated auscultation sphygmomanometers using Korotkoff sounds. This study aimed to investigate the timing of Korotkoff sounds in relation to pulse appearance in the brachial artery and values of intra-arterial blood pressure. Design and method: Experiments were carried out on 15 participants, (14 males, 64.3 ±10.4 years; one female, 86 yo), undergoing coronary angiography. A conventional (oscillometric) BP cuff, with a microphone for Korotkoff sounds, was placed on the upper arm. Intra-arterial brachial artery pressure (IABP) was measured below the cuff with a fluid-filled catheter inserted via the radial artery and an external transducer. Finger photoplethysmography was used to measure brachial pulse wave velocity (PWV). Korotkoff sounds were processed electronically and custom algorithms identified the cuff pressure (CP) at which the first and last Korotkoff sounds were heard. PWV and max slope of the IABP pressure pulse were recorded to estimate arterial stiffness. Results: The brachial artery closed at a CP of 132.0±17.1 mmHg. Systolic (SBP), and diastolic (DBP) pressure were 147.6±14.3 and 72.7±10.1mmHg; mean pressure (MP, 100.1±10.4 mmHg) was similar to MP derived from the peak of the oscillogram (98.5±13.6 mmHg). Difference between IABP and CP recorded at first and last occurrence of Korotkoff sounds were, SBP: 18.9±8.3 (range 2-29) mmHg, DBP: 4.0±4.3 (range -1.6 -12.4) mmHg. Multiple linear regression showed that differences increase with arterial stiffness and can be compensated for using a prediction equation for calculation of true SBP (tSBP) using heart rate (HR) and Korotkoff derived systolic (SBPk) and diastolic (DBPk), at least over the limited age range for this study cohort. Conclusions: SBP and DBP derived from the onset and termination of Korotkoff sounds can underestimate IABP by up to 29 mmHg. Since Korotkoff sounds are the recommended method mandated by the universal standard for the validation of blood pressure measuring devices, these errors are propagated through to all NIBP measurement devices irrespective of whether they use auscultatory or oscillometric methods thus explaining the well known differences recorded between NIBP measurements and intra-arterial BP measurements.

IMPACT OF OSCILLOMETRIC MEASUREMENT ARTEFACTS IN AMBULATORY BLOOD PRESSURE MONITORING ON ESTIMATES OF AVERAGE BLOOD PRESSURE AND OF ITS VARIABILITY: A PILOT STUDY

Objective: Ambulatory blood pressure monitoring (ABPM) plays an important role in the diagnosis of hypertension. However, methodological factors and the measurement conditions affect the results and may lead to incorrect classification of the patient. We performed a pilot study to evaluate the impact of oscillometric measurement artefacts on ABPM-derived variables. Methods: Four classes of artefacts have been detected: motor activity artefacts, cuff errors, cardiovascular arousals, and arrhythmias. These artefacts were identified via simultaneous recording of actigraphy, cuff pressure, and an ECG. The data consisted of uncorrected measurements (all data), corrected measurements (all artefact free data), and artefact affected data. Design and method: A total of 30 individuals (9 female / 21 male, aged between 36 and 86 years, mean: 65.5 (SD: 9.5) were included in the study. The 24h average blood pressure (BP) was higher in artefacts-affected measurements compared the artefact-free measurements both for systolic (4.6 mmHg) and diastolic (1.3 mmHg) measurements. Further, artefact-affected systolic BP (SBP) was 6.4 mmHg higher than artefact-free measurements during daytime. On average, nocturnal measurements showed no artefact-depended differences. However, individual comparisons yielded that 23% of the subjects crossed the threshold for BP classification for either 24-h, daytime or nocturnal hypertension when comparing uncorrected and artefact-free measurements. Dipping classification changed in 24% of subjects. BP variability was 21% and 12% higher for SPB and DBP, respectively, during daytime when comparing uncorrected and artefact-free measurements. These differences were even higher (27% for SBP and 21% for DPB) when focussing on night-time BP variability. Conclusions: The study reveals that measurement artefacts are frequently present during cuff-based ABPM and do relevantly affect measurement outcome. Exclusion of measurement artefacts is a promising approach to improving cuff-based ABPM accuracy.

RESULTS OF SIMULTANEOUS LEFT AND RIGHT UPPER ARM 24-HOUR AMBULATORY BLOOD PRESSURE MEASUREMENT: A WAKE UP-CALL FOR BETTER HYPERTENSION MANAGEMENT

Objective: Cuff-based 24-hour ambulatory blood pressure (BP) measurement is considered as the gold standard for hypertension diagnosis and treatment monitoring, its clinical value being ubiquitously accepted. This study wants to quantify the measurement discrepancies in simultaneous and synchronized 24-hour ambulatory BP measurements on both arms. Identifying and understanding measurement uncertainties could improve future hypertension management and further stimulate research on alternative, cuff-less systems with adequate measurement precision. Methods: We conducted simultaneous 24-hour ambulatory BP measurements on both arms in 52 healthy young adults. Broadly used and validated cuff-devices (BoSo TM-2430) were synchronized to start BP measurement within one second of each other. Further, we recorded cuff-pressures of both cuff-based devices and the hydrostatic pressure differences between both cuffs throughout the recording. We then scored pressure curves for disturbances (e.g., pressure spikes during deflation) and were able to correct measurements for hydrostatic differences between the arms. This enabled us to not only quantify the extent of measurement inaccuracy but to describe its origins and possible countermeasures. Design and method: Measured BP levels from left and right arm showed limits of agreement in the Bland Altman Plot of > 33 mmHg for systolic and > 30 mmHg for diastolic values over 24 h. Daytime values deviated more than nocturnal values (systolic: > 35 mmHg vs. > 27 mmHg systolic, and diastolic: > 32 mmHg vs. > 24 mmHg, respectively). Linear regression retrieved R2 = 0.39 (p < 0.001) for systolic and R2 = 0.20 (p < 0.001) for diastolic values. Exclusion of artefactual cuff pressure curves improved limits of agreement to > 23 mmHg for systolic and > 19mmHg for diastolic measurements. Subsequently, it improved correlation coefficients to R2 = 0.54 (p < 0.001) for systolic and R2 = 0.35 (p < 0.001) for diastolic values. Correction of hydrostatic differences between the arms had a negligible effect on limits of agreement and strength of correlation. Results: Comparison of synchronized 24-hour BP measurements obtained on both arms showed large measurement uncertainties with possible implications on clinical grading of hypertension and dipping pattern. Exclusion of artefactual cuff pressure curves, not detected by the conventional software of BP devices, mitigates the effect but cannot eliminate worrying discrepancies. These results strongly support the need to further investigate the clinical implications of BP measurement uncertainty. They should further stimulate research on alternative means of BP measurement which might overcome some of the problems related to cuff-based BP monitoring.

Measurement of tracheal tube cuff pressure and the incidence of postoperative sore throat

Measurement of tracheal tube cuff pressure and the incidence of postoperative sore throat

Left ventricular strain and myocardial work in apical hypertrophic cardiomyopathy.

Apical hypertrophic cardiomyopathy (ApHCM) is recognized for its associated cardiovascular morbidity. Herein we describe left ventricular (LV) function and mechanics over long-term follow-up in ApHCM. A retrospective study of 98 consecutive ApHCM patients was performed (mean age: 64±15 years, 46% female) using 2D and speckle-tracking echocardiography. LV function and mechanics were characterized by global longitudinal strain (GLS), segmental strain, and myocardial work indices. Myocardial work was calculated by integrating longitudinal strain and blood pressure as estimated by the brachial artery cuff pressure, to generate an LV pressure-strain loop with adjusted ejection and isovolumetric periods. Composite complications were defined as all-cause mortality, sudden death, myocardial infarction, and/or stroke. Mean LV ejection fraction measured 67%±11% and GLS was -11.7%±3.9%. Global work index (GWI) was 1,073±349 mmHg%, constructive work was 1,379±449 mmHg%, wasted work was 233±164 mmHg%, and work efficiency was 82%±8%. In 72 patients with follow-up echocardiography, at a median of 3.9 years there was progressive impairment in GLS (-11.9% vs. -10.7%; P=0.006), GWI (1,105 vs. 989 mmHg%; P=0.02), and global constructive work (1,432 vs. 1,312 mmHg%; P=0.03), without change in wasted work or work efficiency. Atrial fibrillation (β=0.37; P<0.001), mitral annular e' velocity (β=-0.32; P=0.001), and glomerular filtration rate (β=-0.2; P=0.03) were independently associated with follow-up GLS; atrial fibrillation (β=-0.27; P=0.01) and glomerular filtration rate (β=0.23; P=0.04) were also associated with follow-up GWI. Global wasted work >186 mmHg% was predictive of composite complications (AUC =0.7, 95% CI: 0.53-0.82, sensitivity 93%, specificity 41%). ApHCM is associated with preserved LV ejection fraction but abnormal LV GLS and work indices, with progressive impairment. Important clinical and echocardiographic measures are independently predictive of long-term follow-up LV GLS, GWI and adverse events.

Effect of continuous measurement and adjustment of endotracheal tube cuff pressure on postoperative sore throat in patients undergoing gynecological laparoscopic surgery: study protocol for a randomized controlled trial

BackgroundPostoperative sore throat (POST) is a common postoperative complication after endotracheal tube removal. There are still no effective preventive methods for POST. The aim of this trial is to confirm whether maintaining intraoperative cuff pressure below the tracheal capillary perfusion pressure could effectively reduce the incidence of POST among patients undergoing gynecological laparoscopic surgery.MethodsThis study is a single-center, randomized, parallel-controlled, superiority trial with a 1:1 allocation ratio. Sixty patients whose age is between 18 and 65 years and scheduled for gynecological laparoscopic surgery will be randomized to the cuff pressure measurement and adjustment (CPMA) group and the only cuff pressure measurement without adjustment group (control group). The primary endpoint is the incidence of sore throat at rest within 24 h after extubation. The secondary endpoints include the incidence of cough, the incidence of hoarseness, the incidence of postoperative nausea and vomiting (PONV), POST, and pain intensity within 24 h after extubation. Blocked randomization will be conducted with a computer-generated central randomization online service. The blind method will be applied to subjects, data collectors, outcome evaluators, and statisticians. Outcome assessments will be performed at 0 h and 24 h post-extubation.DiscussionThis randomized controlled study hypothesizes that cuff pressure is the primary influencing factor of POST. By continuous monitoring of endotracheal tube cuff pressure and maintaining it within the range of 18–22 mmHg compared with only continuous measurement without adjustment, it aims to prove that continuous measurement and adjustment of endotracheal tube cuff pressure could be effective in reducing the incidence of POST in gynecological laparoscopic surgery patients. The result of this study could be used as a reference for future multicenter studies to confirm the effect of cuff pressure on POST and provides a scientific theoretical basis for preventing POST to further support comfort medicine.Trial registrationChinese Clinical Trial Registry ChiCTR2200064792. Registered on 18 October 2022. This protocol (version 1.0, 16 March 2022) was approved by the Ethics Committee of Beijing Chaoyang Hospital.

Behavior of Endotracheal Tube Cuff Pressure During a Routine Control Maneuver With Different Manometers.

The main functions of the endotracheal tube (ETT) cuff are to prevent aspiration and to allow pressurization of the respiratory system. For this purpose, it is essential to maintain adequate pressure inside the cuff, thus reducing the risks for the patient. It is regularly checked using a manometer and is considered the best alternative. The objective of this study was to evaluate the cuff pressure behavior of different ETTs during the simulation of an inflation maneuver using different manometers. A bench study was performed. Four brands of 8-mm internal diameter single lumen with a Murphy eye ETT with cuff and 3 different brands of manometers were used. In addition, a pulmonary mechanics monitor was connected to the inside of the cuff through the body of the distal end of the ETT. A total of 528 measurements were made on the 4 ETTs. During the complete procedure (connection and disconnection), there was a significant pressure drop of 7 ± 1.4 cm H2O from the initial pressure (Pinitial) (P < .001), of which 6 ± 1.4 cm H2O was lost during connection (difference between Pinitial and Pconnection). The Preconnection value was 19.1 ± 1.6 cm H2O, showing a significant total pressure drop of 11 ± 1.6 cm H2O (difference between Pinitial and Preconnection) (P < .001). The Pfinal mean was 29.6 ± 1.3 cm H2O. Significant differences were found between manometers according to the time of measurement. A similar phenomenon was evidenced when analyzing different ETTs. Significant pressure changes occur secondary to ETT cuff measurement, which has important implications for patient safety.

The value of inquiring patients about local discomfort during blood pressure measurement for fibromyalgia detection. A cross-sectional study

BackgroundFibromyalgia overlaps and/or mimics other rheumatic diseases and may be a confounding factor in the clinimetric assessment of these illnesses. Allodynia is a distinctive fibromyalgia feature that can be elicited during routine blood pressure measurement. For epidemiological purposes fibromyalgia can be diagnosed using the 2016 Wolfe et al. criteria questionnaire. No physical examination is required. ObjectiveTo evaluate the role of a straightforward question formulated during routine blood pressure measurement for fibromyalgia detection in a rheumatology outpatient clinic. Patients and methodsAll adult patients attending our Rheumatology outpatient clinic were invited to participate. While awaiting their medical consultation, they filled-out the 2016 Wolfe et al. FM diagnostic criteria questionnaire. During the ensuing routine physical examination, the physician advanced the following guideline: “I am going to take your blood pressure; tell me if the cuff's pressure causes pain”. Then, blood pressure cuff was inflated to 170 mm/Hg. Sphygmomanometry induced allodynia was defined as any local discomfort caused by blood pressure measurement. If a patient voiced any uneasiness, a follow-up dichotomic question was formulated “did it hurt much or little”. Sphygmomanometry-induced allodynia was correlated with the presence of fibromyalgia according to the 2016 Wolfe diagnostic criteria. ResultsFour hundred and ninety-one patients were included in the study; most of them (84%) were female. The female cohort displayed the following features: Twenty five percent had fibromyalgia. Twenty seven percent had sphygmomanometry-induced allodynia. In women, sphygmomanometry-evoked allodynia had 63% sensitivity and 84% specificity for fibromyalgia diagnosis. The area under curve was 0.751. Moreover, having “much” local pain elicitation during blood pressure testing had 23% sensitivity and 96% specificity for fibromyalgia diagnosis. Men behaved differently; 15% fulfilled the fibromyalgia diagnostic criteria, but only 2% had sphygmomanometry induced allodynia. ConclusionsInquiring female patients about local discomfort during routine blood pressure measurement is a simple and efficient procedure for fibromyalgia detection. This undemanding approach could be implemented in all clinical settings. There is marked sexual dimorphism in the link between sphygmomanometry-induced allodynia and fibromyalgia diagnosis. The presence of fibromyalgia is almost certain in those individuals having substantial pain elicitation during blood pressure measurement.

Use of AG Cuffill Syringe for Monitoring of Changes in ETT Cuff Pressure in Prone Position Under GA: (Cross Sectional Study)

Use of AG Cuffill Syringe for Monitoring of Changes in ETT Cuff Pressure in Prone Position Under GA: (Cross Sectional Study)

Assessment of remote ischemic conditioning delivery with optical sensor in acute ischemic stroke: Randomised clinical trial protocol.

Remote ischemic conditioning (RIC) is delivered by a blood pressure cuff over the limb, raising pressure 50 mmHg above the systolic blood pressure, to a maximum of 200 mmHg. The cuff is inflated for five minutes and then deflated for five minutes in a sequential ischemia-reperfusion cycle 4-5 times per session. Elevated pressure in the limb may be associated with discomfort and consequently reduced compliance. Continuous assessment of relative blood concentration and oxygenation with a tissue reflectance spectroscopy (a type of optical sensor device) placed over the forearm during the RIC sessions of the arm will allow us to observe the effect of inflation and deflation of the pressure cuff. We hypothesize, in patients with acute ischemic stroke (AIS) and small vessel disease, RIC delivered together with a tissue reflectance sensor will be feasible. The study is a prospective, single-center, randomized control trial testing the feasibility of the device. Patients with AIS within 7 days from symptoms onset; who also have small vessel disease will be randomized 2:1 to intervention or sham control arms. All patients randomized to the intervention arm will receive 5 cycles of ischemia/reperfusion in the non-paralyzed upper limb with a tissue reflectance sensor and patients in the sham control arm will receive pressure by keeping the cuff pressure at 30 mmHg for 5 minutes. A total of 51 patients will be randomized, 17 in the sham control arm and 34 in the intervention arm. The primary outcome measure will be the feasibility of RIC delivered for 7 days or at the time of discharge. The secondary device-related outcome measures are fidelity of RIC delivery and the completion rate of intervention. The secondary clinical outcome includes a modified Rankin scale, recurrent stroke and cognitive assessment at 90 days. RIC delivery together with a tissue reflectance sensor will allow insight into the blood concentration and blood oxygenation changes in the skin. This will allow individualized delivery of the RIC and improve compliance. ClinicalTrials.gov Identifier: NCT05408130, June 7, 2022.

An Innovative Single Staged Surgical Repair of Benign Tracheoesophageal Fistula - A Case Report.

The online version contains supplementary material available at 10.1007/s12070-022-03382-w.

Predictors of Arterial Occlusion Pressure in the Lower-Body Across Commonly Used Cuff Widths

For implementation of exercise with blood flow restriction (BFR), cuff pressures should be based on arterial occlusion pressure (AOP). Limb circumference and blood pressure have been identified as predictors of AOP and used to set appropriate exercising cuff pressures. However, it is unclear whether these predictors are consistent across BFR cuffs of varying width. Our purpose was to compare predictors of lower-body AOP in a variety of commonly utilized cuff widths. We hypothesized that limb circumference would be a stronger predictor when using narrower cuffs while blood pressure would be a stronger predictor when using wider cuffs.Healthy normotensive adults (women=44, men=76; age:23±4yrs; BMI:25±4) underwent measurements of thigh circumference (TC) and systolic (SBP) and diastolic blood pressure (DBP). Lower-body AOP was assessed (via Doppler ultrasound) in the post-tibial artery in a seated position with an 11, 13, and 18cm wide pneumatic cuff. Models of hierarchical linear regression were constructed to predict AOP in each of the cuffs using TC, SBP, and DBP as predictor variables. A linear mixed effects model including AOP as the outcome variable was fit. The model included fixed effects of TC, SBP, DBP, cuff width, TC x cuff width, SBP x cuff width, and DBP x cuff width, and a random intercept for participants.AOP was 188±28, 170±20, and 152±15mmHg, for the 11, 13, and 18cm cuff, respectively. For the 11cm cuff, TC (β = 0.66, part = 3.46), SBP (β = 0.17, part = 0.48), and DBP (β = 0.21, part = 3.46) were significant predictors that explained 74% of AOP variability. For the 13cm cuff, TC (β = 0.56, part = 2.06), SBP (β = 0.25, part = 0.48), and DBP (β = 0.22, part = 0.59) were significant predictors that explained 69% of AOP variability. In the 18cm cuff, TC (β = 0.35, part = 0.10) and SBP (β = 0.48, part = 0.72) were significant predictors that explained 57% of the AOP variability. There were significant main effects of TC, SBP, DBP, and cuff width on AOP, and significant interactions of TC x cuff width and SBP x cuff width (all P&lt;0.05). Results indicated that when using a narrow cuff, AOP was largely based on TC and when using a wider cuff, AOP was based mostly on SBP. Differences are likely due to wider cuffs transmitting pressures more efficiently into underlying soft tissues, thereby reducing the influence of TC on AOP and shifting greater influence towards blood pressure. Our results support and expand on previous work in a small sample (n=12) reporting that AOP depends more on TC as cuff width decreases. Together, these data provide evidence that cuff width should be considered when selecting factors to estimate AOP and establish appropriate pressures during lower-body BFR exercise. This work was supported by the Michigan Tech Health Research Institute This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Novel Smart Assistance System for Arteriosclerosis Evaluation.

Arteriosclerosis is a cardiovascular disease that can cause calcification, sclerosis, stenosis, or obstruction of blood vessels and may further cause abnormal peripheral blood perfusion or other complications. In clinical settings, several approaches, such as computed tomography angiography and magnetic resonance angiography, can be used to evaluate arteriosclerosis status. However, these approaches are relatively expensive and require an experienced operator and often the injection of a contrast agent. In this study, a novel smart assistance system based on near-infrared spectroscopy was proposed that can noninvasively assess blood perfusion and thus indicate arteriosclerosis status. In this system, a wireless peripheral blood perfusion monitoring device simultaneously monitors changes in hemoglobin parameters and the cuff pressure applied by a sphygmomanometer. Several indexes extracted from changes in hemoglobin parameters and cuff pressure were defined and can be used to estimate blood perfusion status. A neural network model for arteriosclerosis evaluation was constructed using the proposed system. The relationship between the blood perfusion indexes and arteriosclerosis status was investigated, and the neural network model for arteriosclerosis evaluation was validated. Experimental results indicated that the differences in many blood perfusion indexes for different groups were significant and that the neural network model could effectively evaluate arteriosclerosis status (accuracy = 80.26%). By using a sphygmomanometer, the model can be employed for simple arteriosclerosis screening and blood pressure measurements. The model offers real-time noninvasive measurement, and the system is relatively inexpensive and easy to operate.