Abstract：
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/m2) 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.
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/m2) 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.
摘要：
示波仪,无创血压测量（NIBP）是大多数低、中风险手术的首选血压监测方法。在病态肥胖患者中，然而,它受到几个限制。目的是比较NIBP和非侵入性指套技术（Nexfin®）与金标准侵入性动脉压（IAP）的动脉压监测。
在对前瞻性观察的二次分析中，单中心队列研究，收缩压（SAP），在16个定义的围手术期时间点测量舒张压（DAP）和平均动脉压（MAP），包括体位变化，腹腔镜减肥手术患者的液体推注给药和气腹（PP）。NIBP绝对动脉压，使用相关性和BlandAltman分析比较了Nexfin®和IAP。互换性定义为平均差≤5mmHg(SD≤8mmHg)。计算百分比误差(PE)作为额外的统计估计。对于血液动力学趋势，根据Critchley标准分析了一致性率。
纳入了60名患者（平均体重指数为49.2kg/m2），并最终分析了56名患者的数据。所有时间点的汇总血压值显示NIPB和Nexfin®与IAP的显著正相关。NIBP与IAP的合并PE为37%（SAP），35%（DAP）和30%（MAP），对于Nexfin与IAP23%（SAP），26%(DAP)和22%(MAP)。在NIBP与IAP的麻醉诱导前（r=0.72；PE24％）以及Nexfin®与IAP的术中推注后（r=0.88；PE：17.2％），MAP的相关性最佳，PE最低。MAP趋势的一致性为90%(SAP85%，DAP89%)和91%(SAP90%，DAP86%），适用于Nexfin®。在NIBP的术中ATP定位（97％）和Nexfin®的麻醉诱导（97％）期间，MAP趋势最好。
与IAP相比，对于NIBP和Nexfin®均未显示绝对压力值的互换性,然而,NIBP显示较差的总体相关性和精确度。Nexfin®超过NIBP的总体趋势能力通常较高。Nexfin®可能会在腹腔镜减肥手术中处理不同的血流动力学压力时做出个性化决策。特别是在无法可靠建立NIBP的情况下。
非干预性,观察性研究于2017年6月12日在(NCT03184285)进行回顾性注册.
在对前瞻性观察的二次分析中，单中心队列研究，收缩压（SAP），在16个定义的围手术期时间点测量舒张压（DAP）和平均动脉压（MAP），包括体位变化，腹腔镜减肥手术患者的液体推注给药和气腹（PP）。NIBP绝对动脉压，使用相关性和BlandAltman分析比较了Nexfin®和IAP。互换性定义为平均差≤5mmHg(SD≤8mmHg)。计算百分比误差(PE)作为额外的统计估计。对于血液动力学趋势，根据Critchley标准分析了一致性率。
纳入了60名患者（平均体重指数为49.2kg/m2），并最终分析了56名患者的数据。所有时间点的汇总血压值显示NIPB和Nexfin®与IAP的显著正相关。NIBP与IAP的合并PE为37%（SAP），35%（DAP）和30%（MAP），对于Nexfin与IAP23%（SAP），26%(DAP)和22%(MAP)。在NIBP与IAP的麻醉诱导前（r=0.72；PE24％）以及Nexfin®与IAP的术中推注后（r=0.88；PE：17.2％），MAP的相关性最佳，PE最低。MAP趋势的一致性为90%(SAP85%，DAP89%)和91%(SAP90%，DAP86%），适用于Nexfin®。在NIBP的术中ATP定位（97％）和Nexfin®的麻醉诱导（97％）期间，MAP趋势最好。
与IAP相比，对于NIBP和Nexfin®均未显示绝对压力值的互换性,然而,NIBP显示较差的总体相关性和精确度。Nexfin®超过NIBP的总体趋势能力通常较高。Nexfin®可能会在腹腔镜减肥手术中处理不同的血流动力学压力时做出个性化决策。特别是在无法可靠建立NIBP的情况下。
非干预性,观察性研究于2017年6月12日在(NCT03184285)进行回顾性注册.
