Skip to main content

Advertisement

Log in

Continuous noninvasive arterial pressure measurement using the volume clamp method: an evaluation of the CNAP device in intensive care unit patients

  • Original Research
  • Published:
Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

The CNAP system allows continuous noninvasive arterial pressure measurement based on the volume clamp method using a finger cuff. We aimed to evaluate the agreement between arterial pressure measurements noninvasively obtained using the CNAP device and arterial catheter-derived arterial pressure measurements in intensive care unit patients. In 55 intensive care unit patients, we simultaneously recorded arterial pressure values obtained by an arterial catheter placed in the abdominal aorta through the femoral artery (criterion standard) and arterial pressure values determined noninvasively using CNAP. We performed Bland–Altman analysis and calculated the percentage error. The mean difference (±standard deviation, 95 % limits of agreement, percentage error) between noninvasive (CNAP) and invasively assessed arterial pressure was for mean arterial pressure +1 mmHg (±9 mmHg, −16 to +19 mmHg, 22 %), for systolic arterial pressure −10 mmHg (±16 mmHg, −42 to +21 mmHg, 27 %), and for diastolic arterial pressure +7 mmHg (±9 mmHg, −10 to +24 mmHg, 28 %). Our results indicate a reasonable accuracy and precision for the determination of mean and diastolic arterial pressure by noninvasive continuous arterial pressure measurements using the volume clamp method compared with the criterion standard (invasive arterial catheter). Systolic arterial pressure is determined less accurately and precisely.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Frezza EE, Mezghebe H. Indications and complications of arterial catheter use in surgical or medical intensive care units: analysis of 4932 patients. Am Surg. 1998;64:127–31.

    CAS  PubMed  Google Scholar 

  2. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S, Healthcare Infection Control Practices Advisory C. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011;39:S1–34.

    Article  PubMed  Google Scholar 

  3. Penaz J, Voigt A, Teichmann W. Contribution to the continuous indirect blood pressure measurement. Z Gesamte Inn Med. 1976;31:1030–3.

    CAS  PubMed  Google Scholar 

  4. Fortin J, Marte W, Grullenberger R, Hacker A, Habenbacher W, Heller A, Wagner C, Wach P, Skrabal F. Continuous non-invasive blood pressure monitoring using concentrically interlocking control loops. Comput Biol Med. 2006;36:941–57.

    Article  CAS  PubMed  Google Scholar 

  5. Biais M, Vidil L, Roullet S, Masson F, Quinart A, Revel P, Sztark F. Continuous non-invasive arterial pressure measurement: evaluation of CNAP device during vascular surgery. Ann Fr Anesth Reanim. 2010;29:530–5.

    Article  CAS  PubMed  Google Scholar 

  6. Jeleazcov C, Krajinovic L, Munster T, Birkholz T, Fried R, Schuttler J, Fechner J. Precision and accuracy of a new device (CNAPTM) for continuous non-invasive arterial pressure monitoring: assessment during general anaesthesia. Br J Anaesth. 2010;105:264–72.

    Article  CAS  PubMed  Google Scholar 

  7. Jagadeesh AM, Singh NG, Mahankali S. A comparison of a continuous noninvasive arterial pressure (CNAP) monitor with an invasive arterial blood pressure monitor in the cardiac surgical ICU. Ann Card Anaesth. 2012;15:180–4.

    Article  CAS  PubMed  Google Scholar 

  8. Bland JM, Altman DG. Agreement between methods of measurement with multiple observations per individual. J Biopharm Stat. 2007;17:571–82.

    Article  PubMed  Google Scholar 

  9. Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput. 1999;15:85–91.

    Article  CAS  PubMed  Google Scholar 

  10. Martina JR, Westerhof BE, van Goudoever J, de Beaumont EM, Truijen J, Kim YS, Immink RV, Jobsis DA, Hollmann MW, Lahpor JR, de Mol BA, van Lieshout JJ. Noninvasive continuous arterial blood pressure monitoring with Nexfin(R). Anesthesiology. 2012;116:1092–103.

    Article  CAS  PubMed  Google Scholar 

  11. Meidert AS, Huber W, Muller JN, Schofthaler M, Hapfelmeier A, Langwieser N, Wagner JY, Eyer F, Schmid RM, Saugel B. Radial artery applanation tonometry for continuous non-invasive arterial pressure monitoring in intensive care unit patients: comparison with invasively assessed radial arterial pressure. Br J Anaesth. 2014;112:521–8.

    Article  CAS  PubMed  Google Scholar 

  12. Hahn R, Rinosl H, Neuner M, Kettner SC. Clinical validation of a continuous non-invasive haemodynamic monitor (CNAP™ 500) during general anaesthesia. Br J Anaesth. 2012;108:581–5.

    Article  CAS  PubMed  Google Scholar 

  13. Ilies C, Bauer M, Berg P, Rosenberg J, Hedderich J, Bein B, Hinz J, Hanss R. Investigation of the agreement of a continuous non-invasive arterial pressure device in comparison with invasive radial artery measurement. Br J Anaesth. 2012;108:202–10.

    Article  CAS  PubMed  Google Scholar 

  14. Gayat E, Mongardon N, Tuil O, Sievert K, Chazot T, Liu N, Fischler M. CNAP(®) does not reliably detect minimal or maximal arterial blood pressures during induction of anaesthesia and tracheal intubation. Acta Anaesthesiol Scand. 2013;57:468–73.

    Article  CAS  PubMed  Google Scholar 

  15. Saugel B, Fassio F, Hapfelmeier A, Meidert AS, Schmid RM, Huber W. The T-Line TL-200 system for continuous non-invasive blood pressure measurement in medical intensive care unit patients. Intensive Care Med. 2012;38:1471–7.

    Article  PubMed  Google Scholar 

  16. ANSI/AAMI SP10:2002. American national standard for manual electronic, or automated sphygmomanometers. Association for the Advancement of Medical Instrumentation, 2002.

  17. Saugel B, Reuter DA. Are we ready for the age of non-invasive haemodynamic monitoring? Br J Anaesth. 2014;113:340–3.

    Article  CAS  PubMed  Google Scholar 

  18. O’Brien E, Pickering T, Asmar R, Myers M, Parati G, Staessen J, Mengden T, Imai Y, Waeber B, Palatini P, Gerin W, Working Group on Blood Pressure Monitoring of the European Society of H. Working Group on Blood Pressure Monitoring of the European Society of Hypertension International Protocol for validation of blood pressure measuring devices in adults. Blood Press Monit. 2002;7:3–17.

    Article  PubMed  Google Scholar 

  19. Saugel B, Dueck R, Wagner JY. Measurement of blood pressure. Best Pract Res Clin Anaesthesiol. 2014;28:309–22.

    Article  PubMed  Google Scholar 

  20. Wagner JY, Saugel B. When should we adopt continuous noninvasive hemodynamic monitoring technologies into clinical routine? J Clin Monit Comput. 2014;29:1–3.

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank CNSystems Medizintechnik AG (Graz, Austria) for providing the technical equipment needed for the study and Johannes N. Müller for his assistance with the study.

Conflict of interest

W.H. and B.S. collaborate with Pulsion Medical Systems SE (Feldkirchen, Germany) as members of the Medical Advisory Board. J.Y.W., A.S.M., and B.S. received refunds of travel expenses from CNSystems Medizintechnik AG (Graz, Austria). CNSystems Medizintechnik AG (Graz, Austria) provided the technical equipment for recording and extraction of arterial pressure measurements. For all other authors there is no conflict of interest to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bernd Saugel.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wagner, J.Y., Negulescu, I., Schöfthaler, M. et al. Continuous noninvasive arterial pressure measurement using the volume clamp method: an evaluation of the CNAP device in intensive care unit patients. J Clin Monit Comput 29, 807–813 (2015). https://doi.org/10.1007/s10877-015-9670-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-015-9670-2

Keywords

Navigation