Finger cuff versus invasive and noninvasive arterial pressure measurement in pregnant patients with obesity

Victoria Eley; Stacey Llewellyn; Anita Pelecanos; Leonie Callaway; Matthew Smith; Andre van Zundert; Michael Stowasser

doi:10.1111/aas.14399

Finger cuff versus invasive and noninvasive arterial pressure measurement in pregnant patients with obesity

Acta Anaesthesiol Scand. 2024 May;68(5):645-654. doi: 10.1111/aas.14399. Epub 2024 Mar 5.

Authors

Victoria Eley^{1

2}, Stacey Llewellyn³, Anita Pelecanos³, Leonie Callaway^{2

4}, Matthew Smith⁵, Andre van Zundert^{1

2}, Michael Stowasser^{2

6}

Affiliations

¹ Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
² Medical School, Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia.
³ Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia.
⁴ Obstetric Medicine, Women's and Newborns Services, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
⁵ Obstetrics and Gynaecology, Women's and Newborns Services, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
⁶ Endocrine Hypertension Research Centre, University of Queensland Frazer Institute, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia.

PMID: 38442731
DOI: 10.1111/aas.14399

Abstract

Background: Pregnant patients with obesity may have compromised noninvasive blood pressure (NIBP) measurement. We assessed the accuracy and trending ability of the ClearSight™ finger cuff (FC) with invasive arterial monitoring (INV) and arm NIBP, in obese patients having cesarean delivery.

Methods: Participants were aged ≥18 years, ≥34 weeks gestation, and body mass index (BMI) ≥ 40 kg m^-2. FC, INV, and NIBP measurements were obtained across 5-min intervals. The primary outcome was agreement of FC measurements with those of the reference standard INV, using modified Bland-Altman plots. Secondary outcomes included comparisons between FC and NIBP and NIBP versus INV, with four-quadrant plots performed to report discordance rates and evaluate trending ability.

Results: Twenty-three participants had a median (IQR) BMI of 45 kg m^-2 (44-48). When comparing FC and INV the mean bias (SD, 95% limits of agreement) for systolic blood pressure (SBP) was 16 mmHg (17, -17.3 to 49.3 mmHg), for diastolic blood pressure (DBP) -0.2 mmHg (10.5, -20.7 to 20.3), and for mean arterial pressure (MAP) 5.2 mmHg (11.1, -16.6 to 27.0 mmHg). Discordance occurred in 54 (26%) pairs for SBP, 41 (23%) for DBP, and 41 (21.7%) for MAP. Error grid analysis showed 92.1% of SBP readings in Zone A (no-risk zone). When comparing NIBP and INV, the mean bias (95% limits of agreement) for SBP was 13.0 mmHg (16.7, -19.7 to 29.3), for DBP 5.9 mmHg (11.9, -17.4 to 42.0), and for MAP 8.2 mmHg (11.9, -15.2 to 31.6). Discordance occurred in SBP (84 of 209, 40.2%), DBP (74 of 187, 39.6%), and MAP (63 of 191, 33.0%).

Conclusions: The FC and NIBP techniques were not adequately in agreement with INV. Trending capability was better for FC than NIBP. Clinically important differences may occur in the setting of the perfusion-dependent fetus.

Keywords: ClearSight™; cesarean delivery; class 3 obesity; invasive blood pressure; noninvasive blood pressure; vascular unloading.

MeSH terms

Adolescent
Adult
Arterial Pressure* / physiology
Blood Pressure / physiology
Blood Pressure Determination* / methods
Body Mass Index
Female
Humans
Obesity / complications

Abstract

MeSH terms

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