September 26, 2022Journal of Clinical AnesthesiaOpen Access

Clinical agreement of a novel algorithm to estimate radial artery blood pressure from the non-invasive finger blood pressure

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Non-cardiac surgery requiring invasive radial arterial monitoring (n=33). Intervention: Novel algorithm estimating radial artery blood pressure (BPRad_hat) vs. Original algorithm estimating brachial blood pressure (BPBra_hat). Primary outcome: Agreement (bias) of diastolic arterial blood pressure (DAP) compared to invasive radial measurement (Bias 0.7 mmHg, p=<0.001).

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Key result

A novel algorithm estimating radial blood pressure from finger measurements showed better agreement with invasive diastolic pressure than the original brachial algorithm (bias 0.7 vs 6.4 mmHg).

Why the study?

To determine whether a new algorithm estimating radial blood pressure from non-invasive finger blood pressure shows better agreement with invasive radial blood pressure than the original one, and whether it can be used safely in the operating room.

Does a novel algorithm estimating radial artery blood pressure from non-invasive finger blood pressure improve agreement with invasive radial blood pressure compared to the original brachial algorithm in non-cardiac surgery patients?

Comparison

New algorithm vs original algorithm compared with invasive radial BP

Design

Observational study

Authors

EKEline KhoApple (Israel)BSBjörn J. P. van der SterErasmus MC WVWard H. van der VenApple (Israel)

Discussion

Member takes

Implication

No practice change indicated yet; leaves open clinical utility pending outcome trials in non-cardiac surgery.

Study Design

Type

Observational (n=33)

Multicenter

Structured PICO

Population

33 adult patients scheduled for non-cardiac surgery requiring invasive radial arterial monitoring, with a mean age of 65 years and 51.5% female, monitored during surgery.

Intervention

Novel algorithm estimating radial artery blood pressure (̂BPRad) from non-invasive finger blood pressure (ClearSight)

Comparator

Original algorithm estimating brachial artery blood pressure (̂BPBra) from non-invasive finger blood pressure

Outcome

Agreement of systolic, mean, and diastolic arterial blood pressure (SAP, MAP, DAP) with invasive radial blood pressure (BPRad) assessed with Bland-Altman, trend analysis, and error grid analysessurrogate

Main Result

Mean Difference: 0.7

Absolute Event Rate: 0.7% vs 6.4%

p-value: p=<0.001

A novel algorithm estimating radial blood pressure from non-invasive finger blood pressure shows good agreement with invasive radial blood pressure and slightly improves upon the traditional brachial estimation algorithm.

Limitations

Invasive radial artery measurements can be overdamped or underdamped, affecting accuracy.
Non-invasive BP was measured ipsilaterally in 85% of patients, potentially introducing contralateral differences.
The number of zones in the error grid analyses influences clinical interpretation.
Single-center study with a relatively small sample size.
Invasive and non-invasive signals could be affected over time by artefacts like overdamping or sensor misalignment
Non-invasive blood pressure was measured ipsilateral to the invasive line in 85% of patients, potentially missing contralateral differences
The number of zones implemented in the error grid analyses influences the clinical interpretation

Cite This Study

Kho et al. (2022) conducted an observational in Non-cardiac surgery requiring invasive radial arterial monitoring (n=33). Novel algorithm estimating radial artery blood pressure (BPRad_hat) vs. Original algorithm estimating brachial blood pressure (BPBra_hat) was evaluated on Agreement (bias) of diastolic arterial blood pressure (DAP) compared to invasive radial measurement (Bias 0.7 mmHg, p=<0.001). A novel algorithm estimating radial blood pressure from finger measurements showed better agreement with invasive diastolic pressure than the original brachial algorithm (bias 0.7 vs 6.4 mmHg).

synapsesocial.com/papers/6a2214146be264275d4e9446 https://doi.org/10.1016/j.jclinane.2022.110976

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Clinical agreement of a novel algorithm to estimate radial artery blood pressure from the non-invasive finger blood pressure

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Clinical agreement of a novel algorithm to estimate radial artery blood pressure from the non-invasive finger blood pressure

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider