Validation of non-invasive arterial pressure monitoring during carotid endarterectomy J.F. Heusdens, S. Lof, C.W.A. Pennekamp, J.C. Specken-Welleweerd,

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Presentation transcript:

Validation of non-invasive arterial pressure monitoring during carotid endarterectomy J.F. Heusdens, S. Lof, C.W.A. Pennekamp, J.C. Specken-Welleweerd, G.J. de Borst, W.A. van Klei, L. van Wolfswinkel, R.V. Immink British Journal of Anaesthesia Volume 117, Issue 3, Pages 316-323 (September 2016) DOI: 10.1093/bja/aew268 Copyright © 2016 The Author(s) Terms and Conditions

Fig 1 Typical example of data analysis. 100-Hz sampled radial artery blood pressure (BPrad; panel a) and finger blood pressure (BPfin; panel b) waveform in the 30 min surrounding carotid cross-clamping. At t=1400 s, a non-invasive brachial BP measurement is visible. Black bars underneath indicate the samples that were excluded from analysis. (Panel c) Systolic, mean, and diastolic BP values per beat of the BPrad (blue) and BPfin wave (pink). (Panel d) 10-s averaged systolic, mean, and diastolic values of BPrad (blue) and BPfin (pink) used for data analysis. British Journal of Anaesthesia 2016 117, 316-323DOI: (10.1093/bja/aew268) Copyright © 2016 The Author(s) Terms and Conditions

Fig 2 Individual scatterplots of the mean radial artery BP (BPrad) vs mean finger BP (BPfin) for the 30 min surrounding carotid cross-clamping. Every data point is a 10-s average. British Journal of Anaesthesia 2016 117, 316-323DOI: (10.1093/bja/aew268) Copyright © 2016 The Author(s) Terms and Conditions

Fig 3 (Panel a) Left: Bland–Altman plot with all 10-s mean arterial BP data points (n=3782). Right: Mean radial artery BP (BPrad) vs mean finger BP (BPfin) with all 10-s data points (n=3782) with lines of identity [lines ±5 mm Hg (long brackets) and ±13 mm Hg (short brackets) indicating the AAMI validation borders]. (Panel b) Left: Bland–Altman plot with the averaged mean arterial BP per patient (n=24) with horizontal and vertical error bars (1 sd). Right: Scatterplot of the averaged mean arterial BP per patient with horizontal and vertical error bars (1 sd) with lines of identity [lines ±5 mm Hg (long brackets) and ±13 mm Hg (short brackets) indicating the AAMI validation borders]. British Journal of Anaesthesia 2016 117, 316-323DOI: (10.1093/bja/aew268) Copyright © 2016 The Author(s) Terms and Conditions

Fig 4 Intraoperative BP thresholds. The averaged admission mean BP (BPawake) vs the difference between either (panel a) the mean finger BP (BPfin) and BPawake or (panel b) the mean radial BP (BPrad) and BPawake. The area between the blue lines defines the predetermined thresholds where the BP should be located before carotid cross-clamping. When a data point is located above the blue area, BP before carotid cross-clamping is higher than recommended; when it is located below the blue area, BP before carotid cross-clamping is lower than recommended. The colours of the dots in this figure correspond with their position in the error grid (Fig. 5) British Journal of Anaesthesia 2016 117, 316-323DOI: (10.1093/bja/aew268) Copyright © 2016 The Author(s) Terms and Conditions

Fig 5 Error grid. Mean BP in the radial artery (BPrad) in the minute before carotid cross-clamping related to the mean BP determined during admission the day before surgery on the x-axis and the mean finger BP (BPfin) on the y-axis. The green area between 100 and 120% is the area where both the BPrad and BPfin are within the predefined BP threshold and no wrong decision would be made when BPfin would be used instead of BPrad. The pink area corresponds with the situation where in the minute before carotid cross-clamping both BPrad and BPfin are above or below the predetermined BP threshold, but no wrong decision would be made when BPrad is replaced by BPfin. In the blue area, BPfin is over- or underestimated by BPrad, leading to wrong decisions when BPfin is used instead of BPrad. British Journal of Anaesthesia 2016 117, 316-323DOI: (10.1093/bja/aew268) Copyright © 2016 The Author(s) Terms and Conditions