Key result
Radial artery applanation tonometry matches invasive arterial monitoring for intraoperative blood pressure decision moments.
Why the study?
The usefulness of radial artery tonometry for continuous arterial blood pressure monitoring during anesthesia and its comparison to invasive and non-invasive methods at clinical decision-making moments was not established.
Does radial artery tonometry provide comparable clinical decision-making information to invasive blood pressure monitoring in patients undergoing elective surgery?
Observational (n=243)
Single-blind (anesthetist blinded to AT and NIBP values)
Randomly assigned to right-arm or left-arm AT group
No
Does radial artery tonometry provide comparable clinical decision-making information to invasive blood pressure monitoring in patients undergoing elective surgery?
Radial artery tonometry provides continuous noninvasive blood pressure monitoring that aligns with invasive monitoring for clinical decision-making during anesthesia, outperforming standard non-invasive methods.
Answers are grounded in this paper and cite their sources.
AT may align with IBP for intraoperative decisions unlike NIBP; leaves open routine adoption pending randomized trials.
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.
No takes yet. Share an insight, caveat, or question.
Zhou et al. (2019) conducted an observational in Elective major surgery requiring arterial cannulation (n=243). Radial artery applanation tonometry (AT) vs. Invasive arterial blood pressure (IBP) was evaluated on Frequency of blood pressure-related clinical decision moments (p=0.06). Radial artery applanation tonometry yielded a similar frequency of blood pressure-related clinical decision moments compared to invasive arterial monitoring (median 1 vs 1, P=0.06) during anesthesia.
Synapse has enriched 8 closely related papers on similar clinical questions. Consider them for comparative context: