Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany.
Department of General and Abdominal Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany.
BMC Anesthesiol. 2022 Mar 28;22(1):83. doi: 10.1186/s12871-022-01619-3.
Oscillometric, non-invasive blood pressure measurement (NIBP) is the first choice of blood pressure monitoring in the majority of low and moderate risk surgeries. In patients with morbid obesity, however, it is subject to several limitations. The aim was to compare arterial pressure monitoring by NIBP and a non-invasive finger-cuff technology (Nexfin®) with the gold-standard invasive arterial pressure (IAP).
In this secondary analysis of a prospective observational, single centre cohort study, systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP) were measured at 16 defined perioperative time points including posture changes, fluid bolus administration and pneumoperitoneum (PP) in patients undergoing laparoscopic bariatric surgery. Absolute arterial pressures by NIBP, Nexfin® and IAP were compared using correlation and Bland Altman analyses. Interchangeability was defined by a mean difference ≤ 5 mmHg (SD ≤8 mmHg). Percentage error (PE) was calculated as an additional statistical estimate. For hemodynamic trending, concordance rates were analysed according to the Critchley criterion.
Sixty patients (mean body mass index of 49.2 kg/m) were enrolled and data from 56 finally analysed. Pooled blood pressure values of all time points showed a significant positive correlation for both NIPB and Nexfin® versus IAP. Pooled PE for NIBP versus IAP was 37% (SAP), 35% (DAP) and 30% (MAP), for Nexfin versus IAP 23% (SAP), 26% (DAP) and 22% (MAP). Correlation of MAP was best and PE lowest before induction of anesthesia for NIBP versus IAP (r = 0.72; PE 24%) and after intraoperative fluid bolus administration for Nexfin® versus IAP (r = 0.88; PE: 17.2%). Concordance of MAP trending was 90% (SAP 85%, DAP 89%) for NIBP and 91% (SAP 90%, DAP 86%) for Nexfin®. MAP trending was best during intraoperative ATP positioning for NIBP (97%) and at induction of anesthesia for Nexfin® (97%).
As compared with IAP, interchangeability of absolute pressure values could neither be shown for NIBP nor Nexfin®, however, NIBP showed poorer overall correlation and precision. Overall trending ability was generally high with Nexfin® surpassing NIBP. Nexfin® may likely render individualized decision-making in the management of different hemodynamic stresses during laparoscopic bariatric surgery, particularly where NIBP cannot be reliably established.
The non-interventional, observational study was registered retrospectively at ( NCT03184285 ) on June 12, 2017.
在大多数低危和中危手术中，振动脉冲式、非侵入性血压测量（NIBP）是血压监测的首选方法。然而，对于病态肥胖患者，它受到多种限制。本研究旨在比较振动脉冲式血压测量法（NIBP）和非侵入性指套式血压技术（Nexfin®）与金标准有创动脉压（IAP）的测量效果。
本研究为前瞻性观察性单中心队列研究的二次分析，在接受腹腔镜减重手术的患者中，在 16 个定义的围手术期时间点测量收缩压（SAP）、舒张压（DAP）和平均动脉压（MAP），包括体位变化、输液负荷和人工气腹（PP）。使用相关分析和 Bland Altman 分析比较 NIBP、Nexfin®和 IAP 的绝对动脉压。以平均差值≤5mmHg（SD≤8mmHg）定义可互换性。计算百分比误差（PE）作为额外的统计估计。为了进行血流动力学趋势分析，根据 Critchley 标准分析一致性率。
共纳入 60 例患者（平均体重指数为 49.2kg/m²），最终对 56 例患者的数据进行了分析。所有时间点的 pooled 血压值与 NIBP 和 Nexfin®与 IAP 均呈显著正相关。与 IAP 相比，NIBP 的 pooled PE 为 37%（SAP）、35%（DAP）和 30%（MAP），Nexfin 的 pooled PE 为 23%（SAP）、26%（DAP）和 22%（MAP）。NIBP 与 IAP 相比，麻醉诱导前 MAP 的相关性最好，PE 最低（r=0.72；PE 24%），Nexfin®与 IAP 相比，术中输液负荷后 MAP 的相关性最好（r=0.88；PE：17.2%）。NIBP 的 MAP 趋势一致性为 90%（SAP 85%，DAP 89%），Nexfin®的 MAP 趋势一致性为 91%（SAP 90%，DAP 86%）。NIBP 的 MAP 趋势最佳在术中 ATP 定位时（97%），Nexfin®在麻醉诱导时（97%）。
与 IAP 相比，NIBP 和 Nexfin®的绝对压力值均不可互换，然而，NIBP 的相关性和精度均较差。Nexfin®总体趋势能力较高，优于 NIBP。Nexfin®可能在腹腔镜减重手术期间管理不同的血流动力学压力方面提供个性化决策，特别是在无法可靠建立 NIBP 时。
非干预性、观察性研究于 2017 年 6 月 12 日在（NCT03184285）上进行了回顾性注册。
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