Multimodal Noninvasive Monitoring of Arterial Pressure: Do Limitations of Finger Cuff Monitoring Compromise Upper Arm Measurements? A Post Hoc Analysis of Two Prospective Cohorts.

Abstract

To assess the reliability of conventional automated oscillometric upper arm cuff (cuff ARM ): 1) when finger cuff monitoring (cuff FINGER ) of arterial pressure (AP) is suspected to be unreliable due to poor fingertip perfusion and/or hand edema or 2) fails to provide a reading. Prospective observational study based on cohorts evaluating the CNAP (Dräger Medical) and ClearSight (Edwards Lifesciences) systems. Three ICUs. Adults with an arterial catheter and stable AP. Three sets of triplicate AP measurements-simultaneous readings from the cuff FINGER , cuff ARM and, as a reference, arterial catheter-were collected for each patient. We analyzed 352 patients: 214 with the CNAP and 138 with the ClearSight cuff FINGER . In the 102 patients (29%) with poor fingertip perfusion-defined as a capillary refill time greater than 4 seconds-and/or hand edema, cuff ARM mean AP measurements ( n = 304) never failed, met the International Organization for Standardization (ISO) 81060-2:2018 standard (bias ± sd : 2.2 ± 7.2 mm Hg), posed no or low risk of harm in 99.7% of cases, and demonstrated good ability to detect hypotension and hypertension (area under the receiver operating characteristic curve, 0.91 [95% CI, 0.87-0.94] and 0.92 [95% CI, 0.75-1], respectively). In these 102 patients, cuff FINGER failed to display a reading in 17 patients (17%), and if not, did not meet the ISO 81060-2:2018 standard. In 38 of 352 patients (11%) in whom the cuff FINGER failed to display an AP measurement, cuff ARM met the ISO 81060-2:2018 standard for mean AP (bias ± sd : 1.7 ± 7.1 mm Hg). In the absence of failure and risk factors for erroneous measurements, ClearSight met the ISO 81060-2:2018 standard for mean AP, unlike the CNAP system. In a multimodal, noninvasive strategy for AP monitoring, ClearSight cuff FINGER may be suitable as a first-line tool due to its continuous nature. When unreliable or unavailable, cuff ARM provides reliable measurements, effectively detects hypotension and hypertension, and poses no significant risk to the patient.