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.
Similar content being viewed by others
References
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.
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.
Penaz J, Voigt A, Teichmann W. Contribution to the continuous indirect blood pressure measurement. Z Gesamte Inn Med. 1976;31:1030–3.
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.
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.
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.
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.
Bland JM, Altman DG. Agreement between methods of measurement with multiple observations per individual. J Biopharm Stat. 2007;17:571–82.
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.
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.
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.
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.
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.
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.
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.
ANSI/AAMI SP10:2002. American national standard for manual electronic, or automated sphygmomanometers. Association for the Advancement of Medical Instrumentation, 2002.
Saugel B, Reuter DA. Are we ready for the age of non-invasive haemodynamic monitoring? Br J Anaesth. 2014;113:340–3.
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.
Saugel B, Dueck R, Wagner JY. Measurement of blood pressure. Best Pract Res Clin Anaesthesiol. 2014;28:309–22.
Wagner JY, Saugel B. When should we adopt continuous noninvasive hemodynamic monitoring technologies into clinical routine? J Clin Monit Comput. 2014;29:1–3.
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
Corresponding author
Rights and permissions
About this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10877-015-9670-2