Limits...
Evaluation of continuous non-invasive arterial pressure monitoring during induction of general anaesthesia in patients undergoing cardiac surgery.

Kumar GA, Jagadeesh AM, Singh NG, Prasad SR - Indian J Anaesth (2015)

Bottom Line: Continuous non-invasive arterial pressure (CNAP) monitoring is fast gaining importance due to complications associated with the invasive arterial monitoring.Percentage within limits of agreement was 96.0%, 95.2% and 95.7% for systolic, diastolic and MAP.The mountain plot showed similar results as the Bland Altman plots.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India.

ABSTRACT

Background and aims: Continuous arterial pressure monitoring is essential in cardiac surgical patients during induction of general anaesthesia (GA). Continuous non-invasive arterial pressure (CNAP) monitoring is fast gaining importance due to complications associated with the invasive arterial monitoring. Recently, a new continuous non-invasive arterial pressure device (CNAP™) has been validated perioperatively in non-cardiac surgeries. The aim of our study is to compare and assess the performance of CNAP during GA with invasive arterial pressure (IAP) in patients undergoing cardiac surgeries.

Methods: Sixty patients undergoing cardiac surgery were included. Systolic, diastolic, and mean arterial pressure (MAP) data were recorded every minute for 20 min simultaneously for both IAP and CNAP™. Statistical analysis was performed using mountain plot and Bland Altman plots for assessing limits of agreement and bias (accuracy) calculation. Totally 1200 pairs of data were analysed.

Results: The CNAP™ systolic, diastolic and MAP bias was 5.98 mm Hg, -3.72 mm Hg, and - 0.02 mm Hg respectively. Percentage within limits of agreement was 96.0%, 95.2% and 95.7% for systolic, diastolic and MAP. The mountain plot showed similar results as the Bland Altman plots.

Conclusion: We conclude CNAP™ provides real-time estimates of arterial pressure comparable to IAP during induction of GA for cardiac surgery. We recommend CNAP can be used as an alternative to IAP in situations such as cardiac patients coming for non-cardiac surgeries, cardiac catheterization procedures, positive Allen's test, inability to cannulate radial artery and vascular diseases, where continuous blood pressure monitoring is required.

No MeSH data available.


Related in: MedlinePlus

(a) Bland Altman method and (b) Mountain plot method analysis of agreement between the continuous non-invasive arterial pressure device and invasive arterial pressure measurement of systolic blood pressure
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4322097&req=5

Figure 1: (a) Bland Altman method and (b) Mountain plot method analysis of agreement between the continuous non-invasive arterial pressure device and invasive arterial pressure measurement of systolic blood pressure

Mentions: Sixty patients were enrolled in the study. Data from 36 males and 24 females were available for analysis. Twenty-four patients underwent coronary artery bypass grafting, 13 patients had mitral valve repair or replacement, eight patients had atrial septal defect closure, five patients had aortic valve replacement, four patients had double-valve replacement, three patients had Tetralogy of fallot repair, and three patients had ventricular septal defect closure. A total of 1200 paired data were obtained. 2.5% of the patients received a small finger cuff, while 81% received medium and 16.5% received large cuffs, respectively. The system set-up time of CNAP™ is defined as the time between the start of the CNAP™ device and the occurrence of the first valid CNAP™ beat took on an average of 5 min. The systolic ABP by CNAP™ was consistently lower than systolic IAP, and the CNAP™ diastolic ABP was consistently higher than diastolic IAP, yielding a systolic bias of 5.98 mm Hg and a diastolic bias of − 3.72 mm Hg. CNAP™ MAP values were almost close to the IAP mean ABP value, yielding a bias of − 0.02 mm Hg [Table 1]. Frequency of ABP pairs within the limits of agreement was 96.0%, 95.2% and 95.7% for systolic, diastolic, and MAP, respectively. Calculated limits of agreement were − 14.33 to 26.29, −15.68 to 8.23 and − 11.17 to 11.12 for systolic, diastolic and MAP, respectively [Table 1]. Bland Altman plot [Figures 1a, 2a and 3a] showed uniform distribution of the variances over all measured ABP values and a good agreement of ABP between CNAP™ and IAP values. Mountain plot that is generally used as complimentary to Bland Altman plot, also showed similar results [Figures 1b, 2b and 3b]. The median (bias, centre of the plot) between IAP and CNAP™ for systolic ABP was 6.000, for diastolic ABP was − 4.000 and for MAP was − 1.000. No significant differences in performance were present between measurements with different-sized finger cuffs.


Evaluation of continuous non-invasive arterial pressure monitoring during induction of general anaesthesia in patients undergoing cardiac surgery.

Kumar GA, Jagadeesh AM, Singh NG, Prasad SR - Indian J Anaesth (2015)

(a) Bland Altman method and (b) Mountain plot method analysis of agreement between the continuous non-invasive arterial pressure device and invasive arterial pressure measurement of systolic blood pressure
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4322097&req=5

Figure 1: (a) Bland Altman method and (b) Mountain plot method analysis of agreement between the continuous non-invasive arterial pressure device and invasive arterial pressure measurement of systolic blood pressure
Mentions: Sixty patients were enrolled in the study. Data from 36 males and 24 females were available for analysis. Twenty-four patients underwent coronary artery bypass grafting, 13 patients had mitral valve repair or replacement, eight patients had atrial septal defect closure, five patients had aortic valve replacement, four patients had double-valve replacement, three patients had Tetralogy of fallot repair, and three patients had ventricular septal defect closure. A total of 1200 paired data were obtained. 2.5% of the patients received a small finger cuff, while 81% received medium and 16.5% received large cuffs, respectively. The system set-up time of CNAP™ is defined as the time between the start of the CNAP™ device and the occurrence of the first valid CNAP™ beat took on an average of 5 min. The systolic ABP by CNAP™ was consistently lower than systolic IAP, and the CNAP™ diastolic ABP was consistently higher than diastolic IAP, yielding a systolic bias of 5.98 mm Hg and a diastolic bias of − 3.72 mm Hg. CNAP™ MAP values were almost close to the IAP mean ABP value, yielding a bias of − 0.02 mm Hg [Table 1]. Frequency of ABP pairs within the limits of agreement was 96.0%, 95.2% and 95.7% for systolic, diastolic, and MAP, respectively. Calculated limits of agreement were − 14.33 to 26.29, −15.68 to 8.23 and − 11.17 to 11.12 for systolic, diastolic and MAP, respectively [Table 1]. Bland Altman plot [Figures 1a, 2a and 3a] showed uniform distribution of the variances over all measured ABP values and a good agreement of ABP between CNAP™ and IAP values. Mountain plot that is generally used as complimentary to Bland Altman plot, also showed similar results [Figures 1b, 2b and 3b]. The median (bias, centre of the plot) between IAP and CNAP™ for systolic ABP was 6.000, for diastolic ABP was − 4.000 and for MAP was − 1.000. No significant differences in performance were present between measurements with different-sized finger cuffs.

Bottom Line: Continuous non-invasive arterial pressure (CNAP) monitoring is fast gaining importance due to complications associated with the invasive arterial monitoring.Percentage within limits of agreement was 96.0%, 95.2% and 95.7% for systolic, diastolic and MAP.The mountain plot showed similar results as the Bland Altman plots.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India.

ABSTRACT

Background and aims: Continuous arterial pressure monitoring is essential in cardiac surgical patients during induction of general anaesthesia (GA). Continuous non-invasive arterial pressure (CNAP) monitoring is fast gaining importance due to complications associated with the invasive arterial monitoring. Recently, a new continuous non-invasive arterial pressure device (CNAP™) has been validated perioperatively in non-cardiac surgeries. The aim of our study is to compare and assess the performance of CNAP during GA with invasive arterial pressure (IAP) in patients undergoing cardiac surgeries.

Methods: Sixty patients undergoing cardiac surgery were included. Systolic, diastolic, and mean arterial pressure (MAP) data were recorded every minute for 20 min simultaneously for both IAP and CNAP™. Statistical analysis was performed using mountain plot and Bland Altman plots for assessing limits of agreement and bias (accuracy) calculation. Totally 1200 pairs of data were analysed.

Results: The CNAP™ systolic, diastolic and MAP bias was 5.98 mm Hg, -3.72 mm Hg, and - 0.02 mm Hg respectively. Percentage within limits of agreement was 96.0%, 95.2% and 95.7% for systolic, diastolic and MAP. The mountain plot showed similar results as the Bland Altman plots.

Conclusion: We conclude CNAP™ provides real-time estimates of arterial pressure comparable to IAP during induction of GA for cardiac surgery. We recommend CNAP can be used as an alternative to IAP in situations such as cardiac patients coming for non-cardiac surgeries, cardiac catheterization procedures, positive Allen's test, inability to cannulate radial artery and vascular diseases, where continuous blood pressure monitoring is required.

No MeSH data available.


Related in: MedlinePlus