Key result
Radial artery tonometry matches invasive blood pressure monitoring for clinical decision-making moments during surgery.
Why the study?
The usefulness of radial artery tonometry for continuous arterial blood pressure monitoring during anesthesia and its agreement with invasive and non-invasive measurements at clinical decision-making moments was unclear.
Does radial artery tonometry (AT) provide comparable clinical decision-making information to invasive blood pressure (IBP) monitoring in patients undergoing elective surgery?
Observational (n=243)
Anesthetist blinded to AT and NIBP values
Randomized to right-arm or left-arm AT application
No
Does radial artery tonometry (AT) provide comparable clinical decision-making information to invasive blood pressure (IBP) monitoring in patients undergoing elective surgery?
Radial artery tonometry provides noninvasive continuous blood pressure monitoring that aligns with invasive monitoring for clinical decision-making during anesthesia.
Answers are grounded in this paper and cite their sources.
AT may align with IBP for anesthesia decision moments; leaves open whether it can replace invasive monitoring in routine practice.
Purpose: Radial artery tonometry (AT) can continuously measure arterial blood pressure (ABP) noninvasively. This study aimed to evaluate AT for continuous ABP monitoring during anesthesia and compared AT to invasive (IBP) and non-invasive (NIBP) ABP measurements at clinical decision-making moments. Methods: 243 patients undergoing elective surgery were prospectively included in the study and AT was applied on the right or left arm while IBP and NIBP were recorded simultaneously. At moments when the IBP signal required a clinical decision by the anesthesiologist for situations of hyper- or hypotension, comparison was made whether AT and NIPB signals would require a clinical decision as well. Agreement/discrepancy of clinical decision-making was analyzed, additionally bias, precision, and percentage error of AT was compared to IBP at these moments. Results: 513 clinical decision moments were recorded. Decision moments based on AT signal did not differ significantly from decision moments based on IBP (1 vs. 1; IQR, 1 – 2 vs. 0 – 3, P = 0.06), while NIBP based decision moments showed significant differences (0 vs. 1; IQR, 0 – 2 vs. 0 – 3, P＜0.001). Subgroup analysis of patients divided by age, BMI and surgery time also showed no significant differences between IBP and AT. Conclusions: ABP measurement using AT is feasible and safe. AT provides relevant and efficient information to anesthesiologists; at moments when IBP called for action, AT called for action as well, but not NIBP. AT also showed clinically satisfactory agreement with IBP at moments of hypo- and hypertension.
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Zhou et al. (2020) conducted an observational in Elective surgery requiring arterial cannulation (n=243). Radial artery applanation tonometry (AT) vs. Invasive arterial blood pressure (IBP) and non-invasive blood pressure (NIBP) was evaluated on Frequency of clinical decision moments for hyper- or hypotension (median) (p=0.06). Radial artery applanation tonometry provided clinical decision-making moments that did not differ significantly from invasive blood pressure monitoring (median 1 vs. 1, p=0.06), whereas non-invasive cuff monitoring missed significantly more events.
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