Key result
The NICCI noninvasive blood pressure monitor provided continuous readings with a systolic bias of 2 mm Hg compared to arterial cannulation, but wide limits of agreement prevented it from meeting strict ANSI/AAMI accuracy standards.
Why the study?
Intermittent blood pressure measurement remains standard during anesthesia or procedural sedation, but continuous noninvasive devices like the NICCI system may improve early identification of hemodynamic compromise.
Does the NICCI system provide accurate continuous noninvasive blood pressure measurements compared to an arterial cannula in adolescents during intraoperative care?
Observational (n=44)
No
Does the NICCI system provide accurate continuous noninvasive blood pressure measurements compared to an arterial cannula in adolescents during intraoperative care?
Mean Difference: 2 (95% CI -23–31)
The NICCI system provides clinically relevant continuous noninvasive beat-to-beat blood pressure measurement in adolescents during surgery, despite not meeting strict ANSI/AAMI SP10 accuracy criteria.
Requires cautious interpretation of NICCI readings in surgical adolescents; leaves open further validation before routine adoption.
Background: The intermittent measurement of blood pressure (BP) remains the standard of care during anesthesia or procedural sedation. To improve the early identification of hemodynamic compromise, various noninvasive BP devices have been developed which provide a continuous BP reading. The current study evaluates the accuracy of a novel continuous BP device, the NICCI system, in adolescents weighing 40 - 80 kg. Methods: During intraoperative anesthetic care, BP readings (systolic, diastolic, and mean) were captured from the arterial cannula and the NICCI device every second. Results: The study cohort included 44 pediatric patients undergoing major orthopedic, cardiac, and neurosurgical procedures. A total of 383,126 pairs of systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) values from the arterial cannula and the NICCI device were analyzed. The absolute difference for SBP, DBP, and MAP values from the NICCI monitor and the arterial cannula were 10 ± 8, 9 ± 7, and 9 ± 7 mm Hg, respectively. The difference between the BP values from the NICCI and the arterial cannula was ≤ 10 mm Hg for 60% of the SBP readings, 67% of the DBP readings, and 56% of the MAP readings. Using Bland-Altman analysis, the bias was 2, 3, and 4 mm Hg for the SBP, DBP, and MAP. Conclusions: Although there were technical limitations related to patient size that affected its ability to meet the strict accuracy criteria set by the American National Standards Institute/Association for the Advancement of Medical Instrumentation standards for noninvasive BP measurement (ANSI/AAMI SP10), the NICCI system provided a continuous noninvasive beat-to-beat BP measurement which was clinically relevant during a significant portion of intraoperative care.
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Owusu‐Bediako et al. (2022) conducted an observational in Hemodynamic monitoring during major surgery (n=44). NICCI noninvasive continuous blood pressure monitor vs. Invasive intra-arterial cannula was evaluated on Systolic blood pressure agreement (Bland-Altman bias) (Bias 2 mm Hg, 95% CI -23 to 31). The NICCI noninvasive blood pressure monitor provided continuous readings with a systolic bias of 2 mm Hg compared to arterial cannulation, but wide limits of agreement prevented it from meeting strict ANSI/AAMI accuracy standards.
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