Key result
Continuous noninvasive arterial pressure monitoring using the vascular unloading technique did not meet criteria for interchangeability with invasive measurements, showing a mean arterial pressure bias of 1.73 mmHg and a standard deviation of 18.76 mmHg.
Why the study?
Age-related and comorbid vascular alterations in elderly surgical patients increase the risk of hemodynamic complications and may limit the accuracy of modern noninvasive arterial pressure monitoring devices.
Does continuous noninvasive monitoring of arterial pressure using the vascular unloading technique provide interchangeable measurements compared to invasive radial artery monitoring in elderly comorbid patients?
Observational (n=60)
No
Does continuous noninvasive monitoring of arterial pressure using the vascular unloading technique provide interchangeable measurements compared to invasive radial artery monitoring in elderly comorbid patients?
Noninvasive arterial pressure monitoring using the vascular unloading technique does not meet criteria for interchangeability with invasive radial artery monitoring in elderly comorbid patients.
Answers are grounded in this paper and cite their sources.
Does not support interchangeability for clinical decisions in elderly comorbid patients; leaves open need for further validation studies.
BACKGROUND AND AIMS: Elderly patients aged ≥65 years represent a growing population in the perioperative field, particularly orthopedic and vascular surgery. The higher degree of age-related or comorbid-dependent vascular alterations renders these patients at risk for hemodynamic complications and likely denote a possible limitation for modern, non-invasive arterial pressure monitoring devices. The aim was to compare vascular unloading technique-derived to invasive measurements of systolic (SAP), diastolic (DAP), and mean arterial pressure (MAP) in elderly perioperative patients. METHODS: This prospective observational study included patients aged ≥65 years scheduled for orthopedic and patients ≥50 years with peripheral artery disease Fontaine stage ≥ II scheduled for vascular surgery, respectively. Invasive radial artery and non-invasive finger-cuff (Nexfin system) arterial pressures were recorded before and after induction of general anesthesia and during surgery. Correlation, Bland-Altman, and concordance analyses were performed. Measurements of arterial pressure were also compared during intraoperative hypotension (MAP <70 mm Hg) and hypertension (MAP >105 mm Hg). RESULTS: Sixty patients with orthopedic (N = 25, mean (SD) age 77 (5) years) and vascular surgery (N = 35, age 69 [10] years) were enrolled. Seven hundred data pairs of all patients were analysed and pooled bias and percentage error were: SAP: 14.43 mm Hg, 43.79%; DAP: -2.40 mm Hg, 53.78% and MAP: 1.73 mm Hg, 45.05%. Concordance rates were 84.01% for SAP, 77.87% for DAP, and 86.47% for MAP. Predefined criteria for interchangeability of absolute and trending values could neither be reached in the overall nor in the subgroup analyses orthopedic vs vascular surgery. During hypertension, percentage error was found to be lowest for all pressure values, still not reaching predefined criteria. CONCLUSION: Arterial pressure monitoring with the vascular unloading technique did not reach criteria of interchangeability for absolute and trending values. Nevertheless, the putatively beneficial use of noninvasive arterial pressure measurements should be further evaluated in the elderly perioperative patient.
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Klose et al. (2020) conducted an observational in Elderly patients undergoing orthopedic or vascular surgery (n=60). Continuous noninvasive arterial pressure monitoring (Nexfin) vs. Invasive radial arterial line was evaluated on Interchangeability of absolute and trending arterial pressure values (AAMI criterion of mean difference ≤5 mmHg and SD ≤8 mmHg) (Bias 1.73 mmHg (SD 18.76) for MAP). Continuous noninvasive arterial pressure monitoring using the vascular unloading technique did not meet criteria for interchangeability with invasive measurements, showing a mean arterial pressure bias of 1.73 mmHg and a standard deviation of 18.76 mmHg.
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