Cuff Size Research Articles

Artificial Urinary Sphincter Placement Before or After Radiation Therapy: Does Timing of Radiation Impact Surgical Complications and Continence?

To evaluate the impact of radiation timing on artificial urinary sphincter (AUS) outcomes. AUS is the gold standard treatment for post-prostatectomy incontinence. Radiation history has been associated with worse outcomes, including higher rates of erosion and infection. The impact of radiation timing-before versus after AUS placement-has been less well studied. Patients undergoing AUS placement over a five-year period were retrospectively reviewed. Salvage prostatectomy patients were excluded. Patients were stratified by radiation timing: radiation prior to AUS placement (pre-AUS) versus after AUS placement (post-AUS). Outcomes included continence rate, improvement in pads per day, complications, and need for further surgery. Of 315 post-prostatectomy AUS patients, 181 underwent radiation treatment. Excluding 42 patients for salvage prostatectomy, 123 patients underwent radiation pre-AUS and 16 post-AUS. Patients were slightly younger in the post-AUS group (p=.020); demographics were otherwise similar. Mean cuff size was similar in both groups. Continence rates were not significantly different (p=.509), nor was difference in pad per day improvement (-3.0 ppd for pre-AUS and -3.8 ppd in the post-AUS group (p=.379)). Over a median follow up of 27.7 months, 1/16 (6.6%) patients experienced device erosion in the post-AUS group, compared to 15/123 (12.2%) pre-AUS (median follow up 15.6 months). No patients in the post-AUS group experienced device infection, compared to 6/123 patients in the pre-AUS group. Revision rates were similar between the two groups (18.8% vs 25.2%, p= 0.761). Patients undergoing AUS placement prior to radiation experienced similar continence improvements and similar complications rates to those who underwent radiation following AUS.

Validation of the A&D BP UA-1100NFC/UA-1100NFC-W, hoseless upper arm-type home blood pressure devices, according to the ISO81060-2:2018/Amd 1:2020 protocol.

The aim of this study was to validate the performance of the A&D UA-1100NFC hoseless devices of two cuff sizes in monitoring blood pressure (BP) in the upper arm according to the International Organization for Standardization (ISO) 81060-2:2018/amendment (Amd) 1:2020 protocol. The accuracy of the UA-1100NFC (for arm circumferences of 22.0-32.0 cm) and the UA-1100NFC-W (for arm circumferences of 22.0-42.0 cm) was assessed using the same-arm sequence protocol as per the ISO 81060-2:2018/Amd 1:2020 standard. Individuals aged >12 years were recruited from the outpatients and volunteers of Jichi Medical University (Tochigi, Japan); 85 participants were included in the final analyses for each device. Both devices performed well against the standard; mean and SD values for the differences between the device-measured and observer-measured SBP and DBP values met both criterion 1 and criterion 2 of the standard [(UA-1100NFC) criterion 1: -3.71 ± 6.82 mmHg and 0.86 ± 6.33 mmHg, respectively; criterion 2: 5.65 mmHg and 5.87 mmHg, respectively; (UA-1100NFC-W) criterion 1: 0.73 ± 7.84 mmHg and 1.72 ± 6.44 mmHg, respectively; criterion 2: 6.49 mmHg and 5.86 mmHg, respectively]. The Bland-Altman plots did not show any systematic variation in the error. Both the UA-1100NFC and UA-1100NFC-W hoseless devices had a high level of accuracy and fulfilled the requirements of the ISO81060-2:2018/Amd 1:2020 validation standard. They are therefore suitable as home BP monitoring tools in patients with hypertension.

BLOOD PRESSURE MEASURING TECHNIQUES AMONG HEALTHCARE PROFESSIONALS IN KSA: A SYSTEMATIC REVIEW

Background: Accurate blood pressure (BP) measurement is critical for the diagnosis and management of hypertension, a leading cause of global morbidity and mortality. However, challenges in measurement techniques and knowledge gaps among healthcare professionals can lead to inaccurate readings, compromising patient care. This systematic review aimed to evaluate the difficulties healthcare professionals face in BP measurement and explore the variability in measurement practices. Methods: A comprehensive search of PubMed, Embase, Cochrane Library, and CINAHL databases was conducted to identify relevant studies. A total of 627 articles were initially identified. After removing 524 irrelevant articles, 103 studies were screened for eligibility. Of these, 60 full-text articles were reviewed, and two studies met the inclusion criteria. Data were synthesized to highlight common challenges and discrepancies in BP measurement practices among healthcare professionals. Results: The two included studies revealed significant challenges in BP measurement. One study identified that 60% of hospital staff in a teaching hospital lacked sufficient knowledge of fundamental BP measurement techniques. Key issues included improper understanding of cuff size, arm positioning, and deflation rates, which led to inconsistent and inaccurate readings. The other one examined BP measurement devices and methods in primary healthcare settings across Saudi Arabia. The study found that mercury sphygmomanometers were most commonly used (69.8%), followed by electronic devices (16.5%) and aneroid manometers (11.8%). However, electronic and aneroid devices were prone to measurement variations, especially in rural areas, emphasizing the need for standardized devices to reduce bias. Conclusion: This review highlights critical gaps in knowledge and variability in BP measurement methods among healthcare professionals, which can adversely impact hypertension management. Addressing these challenges requires targeted educational programs and the adoption of reliable and standardized devices to improve measurement accuracy. Enhancing BP measurement practices is essential for achieving better patient outcomes and reducing the burden of hypertension-related complications.

Blood pressure measurement technique in clinical practice in the NHS Greater Glasgow and Clyde.

Blood pressure (BP) measurement is a common procedure conducted in various disciplines and is widely available on clinical reports. The diagnosis and management of hypertension require reliable measurement of BP in outpatient clinics. Published studies suggest the standardised method for BP measurement is difficult to apply in routine clinical practice. This study aimed to assess the current practice of BP measurement in outpatient clinics in relevant secondary care clinical specialties across the 15 separate hospital sites of the NHS Greater Glasgow and Clyde region (population 1.2 million) compared to the recommended standardised method. An online questionnaire was developed and disseminated to the supervising clinician of each of 268 regular outpatient clinics. The questionnaire focused on the standardised BP method (patient preparation, environment, and BP measurement technique). The questionnaire was returned for 110 clinics. 73 (66.4%) of the participating clinics measure BP routinely and these formed the basis for further analysis. 3 clinics (4.1%) apply all components of the standardised BP method. 5 (6.9%) clinics deliver advice to patients prior to clinic attendance on how to prepare for BP measurement. 61 (83.6%) of participating clinics have a dedicated quiet environment for BP measurement. 50 (68.5%) clinics always place the cuff on bare upper arm and 63.0% use a cuff size appropriate to upper arm circumference. In a wide range of secondary care out-patient clinic settings, we found that BP measurement rarely adheres to the recommended standards. This has important implications for the quality of treatment decisions that are based on BP measurement.

Lower Extremity Blood Flow Restriction Training in Athletes Significantly Improves Strength Related Outcomes in 58% of Studies Compared to Non-BFR Control.

The purpose of this systematic review was to examine the role of lower extremity blood flow restriction (BFR) in the athletic population. This study was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. Searches of level I and II studies were performed on PubMed, Embase, Cochrane databases. Article identification was performed in August of 2024. Studies related to BFR in the lower extremity in athletic populations were included. The data collected included athlete demographics, treatment groups, BFR training protocols, control training protocol, exercises performed, training duration and frequency, cuff type, size, and pressure, muscles targeted, strength improvement, endurance improvement, muscle growth, and sport-specific metrics (speed, jump height, etc.). Twenty studies were identified for inclusion. Significant within-group strength increases from pre- to post-training in the BFR group were reported in 19/20 studies, with at least one strength outcome being significantly increased in the BFR group compared to the control group in 11/19 studies. Outcomes related to muscle size were reported in 14 studies, with 10 of these studies reporting within-group increases for the BFR group in at least one muscle size metric. Sport-specific metrics were reported in ten studies and four studies reported on endurance outcomes and generally favored the BFR group over the control group. Five of six studies comparing low load exercise with BFR to high load exercise without BFR reported comparable outcomes between groups. In this systematic review, we found that 58% of studies reporting on lower extremity BFR use in athletes observed significant strength improvements in the BFR group compared to a non-BFR group. Additionally, when comparing low intensity exercise with BFR to high intensity exercise without BFR, five out of six studies reported either improved or comparable improvements between the BFR and control groups. In general, exercise with and without BFR led to improvements in lower extremity strength, muscle size, endurance outcomes, and sport-specific metrics, and a majority of the included studies reported greater improvements within the BFR group. Level II: Systematic review of Level I and II studies.

How to take and record a manual blood pressure measurement.

Accurate measurement of a patient's blood pressure (BP) is essential to identify hypotension or hypertension and to inform subsequent management and treatment decisions. The auscultatory, or manual, method remains the gold standard for non-invasive BP measurement, so it is vital that nurses are able to undertake this procedure accurately. This article explains how to take and record a manual BP measurement using an aneroid sphygmomanometer and a stethoscope. Nurses and nursing students undertaking this procedure must be equipped with the knowledge and skills to do so proficiently and work within their scope of practice. • BP measurement comprises two pressure readings, systolic and diastolic, which are measured in millimetres of mercury (mmHg) and expressed in documentation as a 'fraction'. • Inaccurate BP measurement, whether overestimation or underestimation, can result in diagnostic errors and incorrect risk assessment and decision-making. • Various factors can influence the accuracy of BP measurement, including patient positioning, cuff size, arm position and correct use of the stethoscope. • It is vital to ensure regular maintenance and recalibration of BP measuring equipment, in accordance with the manufacturer's instructions, to ensure accuracy of readings. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when taking a manual BP measurement. • How you could use this information to educate nursing students or your colleagues on the appropriate steps when taking and recording a manual BP measurement.

Blood Pressure Cuff Sizes for Pregnant Women in the United States: Findings From the National Health and Nutrition Examination Survey.

The use of correctly sized blood pressure (BP) cuffs is important to ensure accurate measurement and effective management of hypertension. The goals of this study were to determine the proportions of pregnant women that would require small, adult, large, and extra-large (XL) cuff sizes, and to examine the demographic characteristics associated with need for a large or XL cuff. This cross-sectional study analyzed 1,176 pregnant women (≥18 years) included in the National Health and Nutrition Examination Survey (NHANES) 1999-2006 cycles. Recommended BP cuff sizes, based on American Heart Association recommendations, were categorized by mid-arm circumference: small adult (≤26 cm), adult (>26 to ≤34 cm), large (>34 to ≤44 cm), and extra-large (XL) (>44 cm). Among US pregnant women, recommended cuff sizes were: 17.9% small adult, 57.0% adult, and 25.1% for large or XL. About 38.5% of non-Hispanic Black, 21.6% of Mexican American and 21.0% of non-Hispanic White pregnant women required a large or XL cuff. About 81.8% of women in the highest quartile for BMI required large or XL cuffs, which was significantly higher than women in other quartiles. Roughly one out of every four pregnant women required large or XL BP cuffs. The requirement for large or XL cuffs was highest among non-Hispanic Black women and women with the highest BMI. For pregnant women, measuring the arm circumference and selecting an appropriately sized cuff is important to facilitate accurate blood pressure monitoring and hypertension management.

Long head of biceps tendon augmentation in rotator cuff repair enhances tendon healing, shoulder function and patient-reported outcomes one-year post-surgery.

The aim is to determine the effect on healing and functionality of patients after 1 year of biceps augmentation of a rotator cuff repair (RCR) compared to RCR plus long head of the biceps (LHB) tenotomy. In addition, to analyse the main factors involved in the recovery after the surgery. A prospective, comparative, non-randomized study (Level of Evidence III) was conducted. Patients with repairable rotator cuff tears were allocated to either the control group, with a double row transosseous equivalent RCR with LHB tenotomy, or the RCR+augmentation with LHB group. Patients were evaluated for radiological (MRI), clinical (cuff size, Patte and Goutallier scales) and functional variables (Constant and American Shoulder and Elbow Surgeons [ASES] scales) before the intervention. At 1-year follow-up cuff healing was confirmed through MRI and functional evaluation with Constant, ASES, simple shoulder test [SST] and Disabilities of the Arm, Shoulder and Hand scales. Seventy-seven patients underwent control or RCR+augmentation with LHB, there were no preoperative differences between the groups. After 1 year of the surgery, re-rupture occurred in 38.5% and 16% of the patients in control and RCR+augmentation with LHB groups, respectively (p = .026). Total functionality was higher (p < .05) in RCR+augmentation with LHB than in the control group: Constant, SST and ASES scales. Among the explored factors involved in healing, re-rupture occurred in 100% of the cases with high fatty degeneration. Besides, higher initial functionality (Constant scale) and RCR+augmentation with LHB increased the odds of healing (odds ratio [OR] = 1.12 [1.04-1.21]; OR = 5 [1, 61], respectively), while higher cuff length had a detrimental effect (OR = 0.92 [0.85-0.99]). RCR+augmentation with LHB achieves a higher healing percentage and a better functional evolution than RCR+LHB tenotomy, 1 year after cuff repair. Fatty degeneration, cuff length and initial functionality are the main factors involved in cuff healing. Level III randomized controlled trial.

Automated Digital Sfigmomanometer Prototype Testing

Abstract Blood pressure is the pressure of blood flow in the arteries generated by the heart. Abnormal blood pressure can lead to hypertension and hypotension. Hypotension, or low blood pressure, has a prevalence of 5% to 34% among individuals aged 17 to 19, and over 50% in the elderly. Hypertension can cause death in patients with heart disease. About 39.7% of people suffer from hypertension, especially those over the age of 60. Blood pressure measurement needs to be done regularly because it has impact such as early detection of blood pressure health conditions and monitoring of health conditions for those already diagnosed with abnormal blood pressure. Unfortunately, only 59% of the population in Indonesia regularly measure their blood pressure. Accurate blood pressure measurement can be performed using an invasive method. Another method is non-invasive, which can be done using a sphygmomanometer that applies the oscillometric method. This method uses pressure oscillations in the cuff influenced by the pulse in the blood vessels. When using this method, several factors need to be considered, such as body position, cuff size, and the technique used during the measurement. In this study, a fully automatic digital sphygmomanometer has been developed with a cuff attached to the device, equipped with a thermal printer to print out the measurement results and classify blood pressure categories. The advantage of the developed prototype is that it has a smaller relative error value, with 1.03% for systolic blood pressure and 1.45% for diastolic blood pressure, and has already been integrated with a thermal printer to directly print the measurement results.

Intraoperative hypotension in children-Measurement and treatment

Intraoperative hypotension is acommon perioperative complication in pediatric anesthesia. Oscillometric blood pressure measurement is therefore an essential part of standard perioperative monitoring in pediatric anesthesia. The optimum measurement site is the upper arm. Attention must be paid to the correct cuff size. Blood pressure should be measured before induction. In children undergoing major surgery or in critically ill children, invasive blood pressure measurement is still the gold standard. Continuous noninvasive measurement methods could be an alternative in the future.Threshold values to define hypotension remain unknown, even in awake children. There are also little data on hypotension thresholds in the perioperative setting. The most reliable measurement parameter for estimating hypotension is the mean arterial pressure. The threshold values for intraoperative hypotension are 40 mm Hg in newborns, 45 mm Hg in infants, 50 mm Hg in young children and 65 mm Hg in adolescents. Treatment should be initiated at adeviation of 10% and intensified at adeviation of 20%.Bolus administration of isotonic balanced crystalloid solutions, vasopressors and/or catecholamines are used as treatment options. Consistent and rapid intervention in the event of hypotension appears to be crucial. So far there is no evidence as to whether this leads to an improvement in outcome parameters.

Arterial hypertension-clinical trials update 2024.

Arterial hypertension remains the most important modifiable cardiovascular risk factor for morbidity and mortality worldwide. This review summarizes and discusses major clinical trials published in 2023 and early 2024 in hypertension research. These trials include new epidemiological data, studies investigating the impact of blood pressure cuff size on blood pressure measurements, benefits of salt substitutes, and novel antihypertensive treatment options, including pharmacotherapy and bariatric surgery in patients with obesity. This summary reviews the major clinical trials published in 2023 and early 2024. AHT arterial hypertension, BP blood pressure, HR hazard ratio, OBP office blood pressure, PRA plasma renin activity, SBP systolic blood pressure.

Abstract MP23: Arm Size Coverage of Popular Over-the-Counter Blood Pressure Devices and Implications in US Adults

Background: Recent findings show the impact of an inappropriate cuff size on blood pressure (BP) reading. Despite the emphasis on the value of home BP monitoring, little is known about the coverage of arm circumference in popular over-the-counter (OTC) devices. Aims: To evaluate the coverage of arm circumference in popular BP devices and quantify the proportion of U.S. adults not eligible for using those devices due to arm size. Methods: We searched a large online retailer, Amazon, for ranks, ratings, and number of sold devices and purchased ten of the most popular OTC devices. We recorded data on the cuff sizes and corresponding aim circumference ranges offered in those devices. Subsequently, using data from the National Health and Nutrition Examination Survey 2015-2020 (13,826 adults), we quantified the number of US adults not eligible to use those popular devices due to arm circumference. Results: Nine devices offered cuff size covering arm circumference from 22-42 cm, and one from 22-40 cm ( Table ). We found that ~22 million US adults (6.7% of US adults) could not use these OTC devices since their arm circumferences were &lt;22 cm (1.0 million [0.3%]) or &gt;42 cm (21.4 million [6.4%]). The proportion of adults not covered by these devices was higher in Blacks (11.7%) than in other racial/ethnic groups (≤6.5%). Conclusions: Despite the emphasis on the importance of home BP monitoring, over 20 million US adults may not be eligible to use popular BP devices due to their arm circumference, and Blacks are more susceptible to this issue than other racial/ethnic groups. Manufacturers of OTC blood pressure devices should address this unrecognized disparity for quality and equitable hypertension diagnosis and management integrating home BP monitoring.

Body position and cuff size influence lower limb arterial occlusion pressure and its predictors: implications for standardizing the pressure applied in training with blood flow restriction.

Background: Arterial occlusion pressure (AOP) is a relevant measurement for individualized prescription of exercise with blood flow restriction (BFRE). Therefore, it is important to consider factors that may influence this measure. Purpose: This study aimed to compare lower limb AOP (LL-AOP) measured with 11cm (medium) and 18cm (large) cuffs, in different body positions, and explore the predictors for each of the LL-AOP measurements performed. This information may be useful for future studies that seek to develop approaches to improve the standardization of pressure adopted in BFRE, including proposals for equations to estimate LL-AOP. Methods: This is a cross-sectional study. Fifty-one healthy volunteers (males, n = 25, females, n = 26; Age: 18-40years old) underwent measurement of thigh circumference (TC), brachial blood pressure, followed by assessments of LL-AOP with medium and large cuffs in positions supine, sitting and standing positions. Results: The large cuff required less external pressure (mmHg) to elicit arterial occlusion in all three-body positions when compared to the medium cuff (p < 0.001). The LL-AOP was significantly lower in the supine position, regardless of the cuff used (p < 0.001). Systolic blood pressure was the main predictor of LL-AOP in the large cuff, while TC was the main predictor of LL-AOP with the medium cuff. Body position influenced strength of the LL-AOP predictors. Conclusion: Our results indicate that LL-AOP and its predictors are substantially influenced by body position and cuff width. Therefore, these variables should be considered when standardizing the pressure prescribed in BFRE.

Three-Dimensional Morphological Analysis of the Suprascapular Notch in Patients with Arthroscopic Rotator Cuff Repair.

The morphology of the suprascapular notch (SSN) and the ossification of the superior transverse suprascapular ligament (STSL) are risk factors for injury of the suprascapular nerve (SN) during arthroscopic shoulder procedures. The purpose of the current study was to compare preoperative clinical and radiologic characteristics between patients with and without STSL ossification and to evaluate SSN morphology in patients who underwent arthroscopic rotator cuff repair using a 3-dimensional (3D) reconstructed model. Patients who underwent arthroscopic rotator cuff repair and were given a computed tomography (CT) scan from March 2018 to August 2019 were included in this study. Patients were divided into 2 groups: those without STSL ossification (group I) and those with STSL ossification (group II). Tear size of the rotator cuff and fatty infiltration of rotator cuff muscles were assessed in preoperative magnetic resonance imaging. The morphology of the SSN was classified following Rengachary's classification. The transverse and vertical diameters of the SSN and the distances from anatomical landmarks to the STSL were measured. All measurements were completed using a 3D CT reconstructed scapula model. A total of 200 patients were included in this study. One hundred seventy-eight patients (89.0%) without STSL ossification were included in group I, and 22 patients (11.0%) with STSL ossification were included in group II. Group II showed a significantly advanced age (61.0 ± 7.4 vs. 71.0 ± 7.3 years, p < 0.001) and a shorter transverse diameter of SSN (10.7 ± 3.1 mm vs. 6.1 ± 3.7 mm, p < 0.001) than group I. In the logistic regression analysis, age was an independent prognostic factor for STSL ossification (odds ratio, 1.201; 95% confidence interval, 1.112-1.296; p < 0.001). Patients in type VI showed significantly shorter transverse diameters than other types (p < 0.001). The patient with type I showed a significantly shorter distance from the articular surface of the glenoid to the SSN than those with other types (p < 0.001). In the 3D morphological analysis, age was the independent factor associated with STSL ossification in patients who underwent arthroscopic rotator cuff repair. Type VI showed significantly shorter transverse diameters than other types. Type I showed a significantly shorter distance from the articular surface of the glenoid to the SSN than other types.

The fragile urethra: Considerations for high-risk patients undergoing artificial urinary sphincter placement

ABSTRACT Background: Prostate cancer is the most common cancer in men, and post-prostate treatment incontinence significantly impacts a patient’s quality of life. The artificial urinary sphincter (AUS) is the gold standard for surgical management of moderate to severe urinary incontinence. Despite this, revision and replacement are common. A subset of patients has a high risk for revision and replacement based on certain historical factors. In this article, we review anatomic factors, etiology, and technique modifications through evaluation of relevant data on AUS placement in this patient population. Materials and Methods: A literature search was conducted to review recent English-language literature using the key search term “artificial urinary sphincter” along with other search terms including “urethral atrophy,” “urethral erosion,” “radiation,” “urethral stricture,” “urethral surgery,” “vesicourethral anastomotic stenosis,” “vesicourethral anastomotic stricture,” “bladder neck contracture,” and “posterior urethral stenosis.” Key Findings: The characteristics of patients with an at-risk or fragile urethra are well known and described in many studies. Primarily, these risks involve changes in urethral blood supply. Various surgical strategies are described for these patients, including transcorporal sphincter cuff placement, changes in cuff size, and potential utilization of tissue transfer or grafting techniques for urethral support. Conclusion: The patient group with a fragile urethra remains a management challenge in individuals experiencing post-prostate treatment incontinence. These patients have recognizable anatomic alterations and changes in urethral blood supply. Many strategies are described to help mitigate the increased risk of early device complications and erosion.

Inter-observer reliability and anatomical landmarks for arm circumference to determine cuff size for blood pressure measurement.

Accurate arm circumference (AC) measurement is required for accurate blood pressure (BP) readings. Standards stipulate measuring arm circumference at the midpoint between the acromion process (AP) and the olecranon process. However, which part of the AP to use is not stipulated. Furthermore, BP is measured sitting but arm circumference is measured standing. We sought to understand how landmarking during AC measurement and body position affect cuff size selection. Two variations in measurement procedure were studied. First, AC was measured at the top of the acromion (TOA) and compared to the spine of the acromion (SOA). Second, standing versus seated measurements using each landmark were compared. AC was measured to the nearest 0.1cm at the mid-point of the upper arm by two independent observers, blinded from each other's measurements. In 51 participants, the mean (±SD) mid-AC measurement using the anchoring landmarks TOA and SOA in the standing position were 32.4cm (±6.18) and 32.1cm (±6.07), respectively (mean difference of 0.3cm). In the seated position, mean arm circumference was 32.2(±6.10) using TOA and 31.1(±6.03) using SOA (mean difference 1.1cm). Kappa agreement for cuff selection in the standing position between TOA and SOA was 0.94 (p<0.001). The landmark on the acromion process can change the cuff selection in a small percentage of cases. The overall impact of this landmark selection is small. However, standardizing landmark selection and body position for AC measurement could further reduce variability in cuff size selection during BP measurement and validation studies.

Effect of varying cuff sizes with identical inner diameter on endotracheal intubation in critically ill adults: A sealed tracheal controlled trial.

The present study aims to determine the impact of different cuff diameters on the cuff pressure of endotracheal tubes (ETTs) when the trachea is adequately sealed. In the present single-center clinical trial, adult patients who underwent cardiothoracic surgery were assigned to use ETTs from 2 brands (GME and GZW). The primary endpoint comprised of the following: cuff diameter, inner diameter of the ETT, manufacturer, and the number of subjects with tracheal leakage when the cuff pressure was 30 cm H2O. A total of 298 patients were assigned into 2 groups, based on the 2 distinct brands of ETTs: experimental group (n = 122, GME brand) and control group (n = 176, GZW brand). There were no significant differences in baseline characteristics. However, the cuff diameter was significantly smaller in the control group, when compared to the experimental group (P = .001), and the incidence of tracheal leakage was significantly higher in the control group (P = .001). Furthermore, the GME brand ETT had a significantly larger cuff diameter, when compared to the GZW brand ETT. The cuff size would mismatch the tracheal area in clinical practice. Therefore, chest computed tomography is recommended to routinely evaluate the tracheal cross-sectional area during anesthesia, in order to ensure the appropriate cuff size selection.

Size Dimension Chart for Reference Cuff Validation and Limitations in Current Recommendations.

International standards used for device validation protocols require that the reference cuff conforms to a width and length that is 37 to 50% and 75 to 100% of the arm circumference, respectively. However, there is no published chart of appropriate width and length dimensions across the range of arm circumferences. The objective of this report was to create a chart that could be used to guide reference cuff selection and compare recommended dimensions with two common cuff systems. Arm circumferences, ranging from 22 to 52 cm were used to create a reference table for width and length requirements. Arm circumferences were grouped following the American Heart Association (AHA) recommendation for cuff sizes. Cuff dimension data was extracted from the website of a cuff system commonly used for validations (the Baum Corporation). Both the AHA recommendations and Baum sizes were compared with the recommended reference dimensions. There were discrepancies in size naming conventions between the Baum Corporation and the AHA cuff systems. Moreover, there were gaps in both systems where the cuff would not be recommended for validation (31-32 cm for Baum and 30-31 cm for the AHA). Neither system had cuffs that could be used for the largest arm circumferences. This chart highlights the need for more than one cuff system in validation studies and the critical need for cuffs that could be used for validation among larger arm circumferences.

OFFICE BP MEASUREMENT USING CONICAL CUFFS IN OBESE CHILDREN AND ADOLESCENTS

Objective: Findings from adult studies suggest that tronco-conical cuffs should be used for accurate blood pressure (BP) measurement in obese individuals with large arm circumference (AC). The aim of the present study was to examine differences in office blood pressure (BP) levels using conical cuffs compared to standard-shaped cylindrical cuffs in obese children and adolescents. Design and method: We performed an observational study enrolling 37 obese children and adolescents consequently recruited from the outpatient clinics of the Obesity Unit at General University Hospital Consortium of Valencia. The device used for the office BP measurements was OMRON HBP-1320 (HBP-1320-E). Middle AC was measured in all participants and the appropriate cuff size was selected among five sizes of conical and three sizes of regular cylindrical cuffs. Results: Mean participants’ age was 11.8±2.5 years, mean BMI was 28.8±3.4 kg/m2, BMI z-score was 2.1 ± 0.3, and mean AC was 30.0±3.6 cm. There was no statistical significance in BP levels measured by cylindrical compared to conical cuffs (mean difference cylindrical-conical cuff was -0.22±6.55 mmHg for SBP, -0.02±0.81 for SBP z-score, -0.70±4.95 mmHg for DBP, and -0.06±0.44 for DBP z-score). The analysis was repeated after excluding participants aged &lt;9 years old, retrieving similar results. A significant positive association was found between the measurements obtained by cylindrical and conical cuffs in both mean and z-score SBP and DBP values (p &lt;0.001). Bland-Altman analysis showed good agreement, with 94.6% of the values for all BP parameters, lying between the limits of agreement. No proportional bias was detected (p &gt;0.05). Conclusions: The use of conical cuffs resulted in similar office BP levels in obese children and adolescents suggesting no advantage in enhancing tolerability and accuracy of office BP measurement in these patients. Although conical cuffs may be considered an alternative for office BP measurements in obese children, their reliability should be confirmed in larger populations and different settings. Acknowledgments: This abstract is based on the work of the COST Action HyperChildNET (CA19115), with the support of COST (European Cooperation in Science and Technology) and the Horizon 2020 Framework Program of the European Union.

Comparative study between cuff sizes in the determination of systolic blood pressure, by non-invasive methods in anesthetized dogs

The measurement of systolic blood pressure (SBP) is a variable of paramount importance in clinical routine, obtained and measured according to published guidelines for dogs. The study evaluated the influence of cuff size on the determination of systolic blood pressure (SBP) values in dogs, comparing two non-invasive methods. Eighteen healthy dogs of different breeds and ages were used, clinically evaluated and undergoing elective surgeries. SBP was measured using vascular Doppler and high-definition oscillometric methods during the anesthetic period, using both ideal-sized cuffs and smaller cuffs. The dogs were divided into groups, Group 1 composed of dogs with ideal cuff no. 2, Group 2 dogs with ideal cuff no. 3 and Group 3 ideal cuff no The results showed that smaller cuffs significantly overestimated the mean SBP values compared to the ideal cuff values, regardless of the method used. It was concluded that cuffs with a lower than ideal number overestimate SBP values in anesthetized dogs, regardless of the non-invasive method used.