Institute for Anesthesia and Intensive Care Medicine, Spital Thurgau Frauenfeld, Frauenfeld, Switzerland.
Clinic for Orthopedic Surgery and Traumatology, Spital Thurgau Frauenfeld, Frauenfeld, Switzerland.
BMC Anesthesiol. 2020 Oct 24;20(1):271. doi: 10.1186/s12871-020-01185-6.
The beach chair position that is commonly used in shoulder surgery is associated with relative hypovolemia, which leads to a reduction in arterial blood pressure. The effects of patient positioning on the accuracy of non-invasive continuous blood pressure monitoring with the ClearSight™ system (CS-BP; Edwards Lifesciences, Irvine CA, USA) have not been studied extensively. Our research aim was to assess agreement levels between CS-BP measurements with traditional blood pressure monitoring techniques.
For this prospective self-controlled study, we included 20 consecutively treated adult patients undergoing elective shoulder surgery in the beach chair position. We performed Bland-Altman analyses to determine agreement levels between blood pressure values from CS-BP and standard non-invasive (NIBP) methods. Perioperative measurements were done in both the supine (as reference) and beach chair surgical positions. Additionally, we compared invasive blood pressure (IBP) measurements with both the non-invasive methods (CS-BP and NIBP) in a sub-group of patients (n = 10) who required arterial blood pressure monitoring.
We analyzed 229 data points (116 supine, 113 beach chair) from the entire cohort; per patient measurements were based on surgical length (range 3-9 supine, 2-10 beach chair). The mean difference (±SD; 95% limits of agreement) in the mean arterial pressure (MAP) between CS-BP and NIBP was - 0.9 (±11.0; - 24.0-22.2) in the beach chair position and - 4.9 mmHg (±11.8; - 28.0-18.2) when supine. In the sub-group, the difference between CS-BP and IBP in the beach chair position was - 1.6 mmHg (±16.0; - 32.9-29.7) and - 2.8 mmHg (±15.3; - 32.8-27.1) in the supine position. Between NIBP and IBP, we detected a difference of 3.0 mmHg (±9.1; - 20.8-14.7) in the beach chair position, and 4.6 mmHg (±13.3; - 21.4-30.6) in the supine position.
We found clinically acceptable mean differences in MAP measurements between the ClearSight™ and non-invasive oscillometric blood pressure systems when patients were in either the supine or beach chair position. For all comparisons of the monitoring systems and surgical positions, the standard deviations and limits of agreement were wide.
This study was prospectively registered at the German Clinical Trial Register (www.DRKS.de; DRKS00013773 ). Registered 26/01/2018.
在肩部手术中常用的沙滩椅体位与相对低血容量有关，这会导致动脉血压降低。患者体位对 ClearSight™系统（CS-BP；爱德华生命科学公司，美国欧文市）进行的非侵入性连续血压监测的准确性的影响尚未得到广泛研究。我们的研究目的是评估 CS-BP 测量值与传统血压监测技术之间的一致性水平。
在这项前瞻性自身对照研究中，我们纳入了 20 例连续接受沙滩椅体位择期肩部手术的成年患者。我们进行 Bland-Altman 分析以确定 CS-BP 和标准非侵入性（NIBP）方法之间的血压值的一致性水平。在仰卧位（作为参考）和沙滩椅手术位进行围手术期测量。此外，我们还在需要动脉血压监测的患者亚组（n=10）中比较了有创血压（IBP）测量值与非侵入性方法（CS-BP 和 NIBP）。
我们分析了整个队列的 229 个数据点（116 个仰卧位，113 个沙滩椅位）；每位患者的测量值基于手术时间（范围 3-9 个仰卧位，2-10 个沙滩椅位）。在沙滩椅位时，CS-BP 和 NIBP 之间的平均动脉压（MAP）的平均差值（±SD；95%一致性界限）为-0.9（±11.0；-24.0-22.2），仰卧位时为-4.9mmHg（±11.8；-28.0-18.2）。在亚组中，沙滩椅位时 CS-BP 和 IBP 之间的差值为-1.6mmHg（±16.0；-32.9-29.7），仰卧位时为-2.8mmHg（±15.3；-32.8-27.1）。在 NIBP 和 IBP 之间，我们在沙滩椅位时检测到 3.0mmHg（±9.1；-20.8-14.7）的差异，在仰卧位时检测到 4.6mmHg（±13.3；-21.4-30.6）的差异。
当患者处于仰卧位或沙滩椅位时，我们发现 ClearSight™ 和非侵入性振荡血压系统之间 MAP 测量值的平均差异具有临床可接受性。对于所有监测系统和手术体位的比较，标准偏差和一致性界限都很宽。
本研究前瞻性地在德国临床试验注册处（www.DRKS.de；DRKS00013773）注册。注册于 2018 年 1 月 26 日。
