Heeney Natalie D, Habib Fajish, Brar Garveen K, Krahn Gordon, Campbell David A, Sanatani Shubhayan, Claydon Victoria E
Departments of Biomedical Physiology and Kinesiology.
Department of Paediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.
Blood Press Monit. 2019 Jun;24(3):137-145. doi: 10.1097/MBP.0000000000000374.
Continuous beat-to-beat blood pressure monitoring permits the rapid detection of blood pressure fluctuations for cardiovascular reflex testing and clinical haemodynamic monitoring. In adults, this can be achieved noninvasively with high accuracy, using finger blood pressure monitoring with volume clamp photoplethysmography. However, data are lacking on the validity of finger blood pressure monitoring in children compared to the gold standard - invasive intra-arterial blood pressure monitoring.
We aimed to evaluate the accuracy of novel noninvasive index and middle finger arterial pressure (FinAP) measurements in children.
Using prototype paediatric finger cuffs, we compared: mean differences, bias and limits of agreement (Bland-Altman analyses); cumulative percentage differences [clinical grade A-D (based on the percentage of heartbeats in agreement with the standard)]; and waveform morphology (regression analysis and smoothing) between both raw FinAP (Finapres NOVA) and reconstructed finger-brachial arterial pressure (reBAP) compared to intra-arterial blood pressure measurements.
Eighteen children were tested (aged 3-13 years; 12 male), with data from 13 included in the analysis. The bias for reBAP for the middle finger was 1.8±6.9, 0.3±6.1 and 0.4±5.3 mmHg for systolic, diastolic and mean arterial pressure, with clinical grades of C, B and A, respectively. reBAP improved numerical accuracy, but reduced waveform morphological agreement.
Middle finger arterial measurements with waveform reconstruction provide an acceptable surrogate for invasive intra-arterial recording in children. Finger blood pressure monitoring is a novel comfortable, convenient and accurate alternative approach for noninvasive beat-to-beat blood pressure monitoring in children.
连续逐搏血压监测能够快速检测血压波动，用于心血管反射测试和临床血流动力学监测。在成人中，使用容积钳光电容积脉搏波描记法进行手指血压监测可高精度地无创实现这一点。然而，与金标准——有创动脉内血压监测相比，儿童手指血压监测的有效性数据尚缺。
我们旨在评估新型无创指标和中指动脉压（FinAP）测量在儿童中的准确性。
我们使用儿科手指袖带原型，比较了原始FinAP（Finapres NOVA）和重建的指肱动脉压（reBAP）与动脉内血压测量之间的平均差异、偏差和一致性界限（布兰德-奥特曼分析）；累积百分比差异[临床A-D级（基于与标准一致的心跳百分比）]；以及波形形态（回归分析和平滑）。
对18名儿童（年龄3至13岁；12名男性）进行了测试，分析纳入了其中13名儿童的数据。中指reBAP的收缩压、舒张压和平均动脉压偏差分别为1.8±6.9、0.3±6.1和0.4±5.3 mmHg，临床分级分别为C级、B级和A级。reBAP提高了数值准确性，但降低了波形形态一致性。
采用波形重建的中指动脉测量为儿童有创动脉内记录提供了可接受的替代方法。手指血压监测是一种用于儿童无创逐搏血压监测的新型舒适、便捷且准确的替代方法。
