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Lakhal K, Dauvergne JE, Messet-Charriere H, Nay MA, Kamel T, Muller G, Robert-Edan V, Rozec B, Ehrmann S, Jacquier S, Boulain T. Risk factors for poor performance in finger cuff non-invasive monitoring of arterial pressure: A prospective multicenter study. Anaesth Crit Care Pain Med 2024; 43:101333. [PMID: 38048986 DOI: 10.1016/j.accpm.2023.101333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Compared to the invasive technique, non-invasive monitoring of arterial pressure favors easier and faster implementation while potentially sacrificing some reliability. This may be particularly true for the Clearsight™ system (Edwards Lifesciences), which enables continuous monitoring. We evaluated the risk factors for its poor performance. METHODS Patients with an arterial catheter and stable mean arterial pressure (MAP) over a 5-min period were included. Six pairs of invasive and Clearsight measurements of MAP were collected and the bias between the two techniques was calculated. Poor performance of the Clearsight™ system was defined as either a failure to measure and display MAP or displaying an erroneous MAP (individual bias > 5 mmHg). Fingertip perfusion was assessed using the plethysmographic perfusion index (PI) and the capillary refill time (CRT). RESULTS Among 152 ICU patients (MAP of 81 ± 14 mmHg, norepinephrine in 78 [51%]), 78 (51%) experienced a poor performance of the Clearsight™ system: failure to display MAP in 19 (13%) patients, and erroneous value displayed in 59 (44%). In multivariate analysis, PI ≤ 0.85% (adjusted odds ratio [aOR] = 2.94 [95% confidence interval (95%CI):1.34;6.45]), CRT > 4 s (aOR = 5.28 [95%CI 1.39;20.05]), and the presence of hand edema (aOR = 2.06 [95%CI 1.01;4.21]) were associated with a higher likelihood of poor performance. Cardiac arrhythmia (aOR = 1.39 [95%CI 0.64;3.02]) and other tested variables were not associated with poor performance. CONCLUSIONS Half of the included patients exhibited poor Clearsight™ system performance. Our results caution against using finger cuff arterial pressure monitoring in patients with low PI (≤0.85%), protracted CRT (>4 s), or hand edema. REGISTRATION ClinicalTrials.gov, NCT04269382, Dr. G. Muller, February 13, 2020. https://classic. CLINICALTRIALS gov/ct2/show/NCT04269382.
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Affiliation(s)
- Karim Lakhal
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France.
| | - Jérôme E Dauvergne
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France
| | | | - Mai-Anh Nay
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
| | - Toufik Kamel
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
| | - Grégoire Muller
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France; CRICS-TriggerSep F-CRIN research network, Tours, France; Université de Tours, EA4245, Transplantation, Immunologie, Inflammation, Tours, France
| | - Vincent Robert-Edan
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France
| | - Bertrand Rozec
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France; Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes F-44093, France
| | - Stephan Ehrmann
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France; CRICS-TriggerSep F-CRIN research network, Tours, France; INSERM, Centre d'étude des pathologies respiratoires, U1100 Tours, France; Université de Tours, Tours, France
| | - Sophie Jacquier
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France
| | - Thierry Boulain
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
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