Radial artery applanation tonometry for continuous non-invasive arterial pressure monitoring in intensive care unit patients: comparison with invasively.

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Radial artery applanation tonometry for continuous non-invasive arterial pressure monitoring in intensive care unit patients: comparison with invasively assessed radial arterial pressure A.S. Meidert, W. Huber, J.N. Müller, M. Schöfthaler, A. Hapfelmeier, N. Langwieser, J.Y. Wagner, F. Eyer, R.M. Schmid, B. Saugel British Journal of Anaesthesia Volume 112, Issue 3, Pages 521-528 (March 2014) DOI: 10.1093/bja/aet400 Copyright © 2014 The Author(s) Terms and Conditions

Fig 1 Scatter plots with non-invasive AP measurements plotted against invasive AP measurements. For each individual patient we computed an individual scatter plot with radial artery applanation tonometry-derived AP measurements (non-invasive, y-axis) plotted against invasively assessed AP measurements (invasive, x-axis). One plot provides information on MAP, SAP, and DAP. In each figure, the diagonal represents perfect concordance. British Journal of Anaesthesia 2014 112, 521-528DOI: (10.1093/bja/aet400) Copyright © 2014 The Author(s) Terms and Conditions

Fig 2 Bland–Altman plots illustrating accuracy and precision of radial artery applanation tonometry. For the 24 patients enrolled in the study, we computed the Bland–Altman plots for repeated measurements in one individual to investigate the accuracy (mean difference; continuous line) and precision [95% limits of agreement, i.e. mean difference ±(1.96× sd); dashed lines] of radial artery applanation tonometry compared with reference AP measurements from a radial arterial catheter for MAP (a), SAP (b), and DAP (c). Potential non-uniform relations between the bias and mean AP measurements were assessed by mixed models analysis and are illustrated by the diagonal black lines, with the diagonal dashed lines representing the respective 95% confidence interval. MAP-ni, non-invasively assessed mean arterial pressure; MAP-i, invasively assessed mean arterial pressure; SAP-ni, non-invasively assessed systolic arterial pressure; SAP-i, invasively assessed systolic arterial pressure; DAP-ni, non-invasively assessed diastolic arterial pressure; DAP-i, invasively assessed diastolic arterial pressure. British Journal of Anaesthesia 2014 112, 521-528DOI: (10.1093/bja/aet400) Copyright © 2014 The Author(s) Terms and Conditions

Fig 3 Modified Bland–Altman plots showing individual mean AP measurements, the intra-individual AP variability, the individual mean difference, and the intra-individual mean difference variability. Bland–Altman plots showing the accuracy (mean difference; continuous line) and precision [95% limits of agreement, i.e. mean difference ±(1.96×sd); dashed lines] of radial artery applanation tonometry compared with reference AP measurements from a radial arterial catheter for MAP (a), SAP (b), and DAP (c). One data point in these Bland–Altman plots represents a patient's individual mean AP value. In addition, the intra-individual AP variability (sd in parallel to the x-axis), the individual mean difference, and the intra-individual mean difference variability (sd in parallel to the y-axis) are shown. MAP-ni, non-invasively assessed mean arterial pressure; MAP-i, invasively assessed mean arterial pressure; SAP-ni, non-invasively assessed systolic arterial pressure; SAP-i, invasively assessed systolic arterial pressure; DAP-ni, non-invasively assessed diastolic arterial pressure; DAP-i, invasively assessed diastolic arterial pressure. British Journal of Anaesthesia 2014 112, 521-528DOI: (10.1093/bja/aet400) Copyright © 2014 The Author(s) Terms and Conditions

Fig 4 Four-quadrant plots illustrating the ability of radial artery applanation tonometry to follow AP changes. We computed four-quadrant plots to evaluate the ability of radial artery applanation tonometry to follow changes in MAP (a), SAP (b), and DAP (c). An exclusion zone of 3 mm Hg was used. MAP-ni, non-invasively assessed mean arterial pressure; MAP-i, invasively assessed mean arterial pressure; SAP-ni, non-invasively assessed systolic arterial pressure; SAP-i, invasively assessed systolic arterial pressure; DAP-ni, non-invasively assessed diastolic arterial pressure; DAP-i, invasively assessed diastolic arterial pressure. British Journal of Anaesthesia 2014 112, 521-528DOI: (10.1093/bja/aet400) Copyright © 2014 The Author(s) Terms and Conditions