Key result
The NICCI monitor provided continuous noninvasive blood pressure measurements with a bias of 4 mm Hg and 95% limits of agreement of -23 to +31 mm Hg for systolic blood pressure compared to an arterial cannula in pediatric patients.
Why the study?
Continuous blood pressure monitoring via arterial cannula can be technically challenging or linked to adverse events, prompting evaluation of the accuracy of the noninvasive continuous NICCI monitor in pediatric patients.
Does the NICCI monitor provide accurate continuous noninvasive blood pressure readings compared to an arterial cannula in pediatric patients weighing 10-40 kg during surgery?
Observational (n=24)
No
Does the NICCI monitor provide accurate continuous noninvasive blood pressure readings compared to an arterial cannula in pediatric patients weighing 10-40 kg during surgery?
Mean Difference: 4 (95% CI -23–31)
The NICCI monitor provides continuous noninvasive blood pressure measurements within clinically useful limits during a significant portion of anesthetic care in pediatric patients weighing 10-40 kg, though technical limitations remain.
Wide agreement limits caution against replacing arterial monitoring with NICCI in children; leaves open need for further validation before broader use.
Background: In specific clinical scenarios or with patient comorbid conditions, continuous blood pressure (BP) monitoring may be required as it can be expected to provide superior physiologic monitoring to intermittent techniques. However, continuous BP monitoring requires an arterial cannula (AC) placement, which may be time-consuming, technically challenging, or associated with adverse events. 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 monitor (NM), in pediatric patients weighing 10 - 40 kg. Methods: The study cohort included pediatric patients weighing between 10 and 40 kg, scheduled for surgery for which placement of an AC was planned. Systolic (SBP), diastolic (DBP), and mean arterial (MAP) blood pressure readings were captured from the AC and the NM every second during anesthetic care. Results: The study cohort included 24 pediatric patients undergoing major orthopedic, cardiac, and neurosurgical procedures. A total of 146,562 pairs of SBP, DBP, and MAP values from the AC and NC were analyzed. The absolute difference for the NM and the AC's SBP, DBP, and MAP values were 11 ± 9, 10 ± 7, and 10 ± 7 mm Hg, respectively. The difference between the BP values from the NM and the AC was ≤ 10 mm Hg for 57% of the SBP readings, 60% of the DBP readings, and 56% of the MAP readings. The bias was 4, 4, and 6 mm Hg for the SBP, DBP, and MAP, respectively. Conclusions: Although there were some technical limitations given patient size, potentially resulting in variation in accuracy, the NM provided a continuous noninvasive BP measurement within clinically useful limits during a significant portion of anesthetic care compared to values obtained from an AC. Ongoing modification of the technology to improve its application in pediatric patients will likely increase its accuracy.
No takes yet. Share an insight, caveat, or question.
Bekiroglu et al. (2022) conducted an observational in Pediatric patients undergoing major surgery requiring intra-arterial catheter placement (n=24). NICCI monitor vs. Arterial cannula was evaluated on Agreement between NICCI monitor and arterial cannula for systolic blood pressure (Bias of 4 mm Hg, 95% CI -23 to 31). The NICCI monitor provided continuous noninvasive blood pressure measurements with a bias of 4 mm Hg and 95% limits of agreement of -23 to +31 mm Hg for systolic blood pressure compared to an arterial cannula in pediatric patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: