Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland, 4006, Australia.
Faculty of Medicine, The University of Queensland, St Lucia, Queensland, 4067, Australia.
BMC Anesthesiol. 2021 May 18;21(1):152. doi: 10.1186/s12871-021-01374-x.
Measuring blood pressure in patients with obesity is challenging. The ClearSight™ finger cuff (FC) uses the vascular unloading technique to provide continuous non-invasive blood pressure measurements. We aimed to test the agreement of the FC with invasive radial arterial monitoring (INV) in patients with obesity.
Participants had a body mass index (BMI) ≥45 kg/m and underwent laparoscopic bariatric surgery. FC and INV measurements were obtained simultaneously every 5 min on each patient, following induction of anesthesia. Agreement over time was assessed using modified Bland-Altman plots and error grid analysis permitted clinical interpretation of the results. Four-quadrant plots allowed assessment of concordance in blood pressure changes.
The 30 participants had a median (IQR) BMI of 50.2 kg/m (IQR 48.3-55.3). The observed bias (SD, 95% limits of agreement) for systolic blood pressure (SBP) was 14.3 mmHg (14.1, -13.4 - 42.0), 5.2 mmHg (10.9, -16.0 - 26.5) for mean arterial pressure (MAP) and 2.6 mmHg (10.8, -18.6 - 23.8) for diastolic blood pressure (DBP). Error grid analysis showed that the proportion of readings in risk zones A-E were 90.8, 6.5, 2.7, 0 and 0% for SBP and 91.4, 4.3, 4.3, 0 and 0% for MAP, respectively. Discordance occurred in ≤8% of pairs for consecutive change in SBP, MAP and DBP.
The vascular unloading technique was not adequately in agreement with radial arterial monitoring. Evaluation in a larger sample is required before recommending this technique for intraoperative monitoring of patients with BMI ≥45 kg/m.
在肥胖患者中测量血压具有挑战性。ClearSight™ 指套式袖带（FC）采用血管卸载技术提供连续无创血压测量。我们旨在测试 FC 与肥胖患者有创桡动脉监测（INV）的一致性。
参与者的 BMI≥45kg/m2，并接受腹腔镜减重手术。在麻醉诱导后，每位患者每 5 分钟同时获得 FC 和 INV 测量值。使用改良的 Bland-Altman 图评估随时间的一致性，并通过误差网格分析允许对结果进行临床解释。四象限图允许评估血压变化的一致性。
30 名参与者的 BMI 中位数（IQR）为 50.2kg/m2（IQR 48.3-55.3）。收缩压（SBP）的观察偏差（SD，95%一致性界限）为 14.3mmHg（14.1，-13.4-42.0），平均动脉压（MAP）为 5.2mmHg（10.9，-16.0-26.5），舒张压（DBP）为 2.6mmHg（10.8，-18.6-23.8）。误差网格分析显示，SBP 和 MAP 的风险区 A-E 的读数比例分别为 90.8%、6.5%、2.7%、0%和 0%，91.4%、4.3%、4.3%、0%和 0%。SBP、MAP 和 DBP 的连续变化中，差异小于等于 8%的对为 8%。
血管卸载技术与桡动脉监测不一致。在推荐该技术用于 BMI≥45kg/m2 的患者术中监测之前，需要在更大的样本中进行评估。
