A new noninvasive finger sensor (NICCI system) for continuous blood pressure and pulse pressure variation monitoring: A method comparison study in patients undergoing neurosurgery

TY - JOUR

T1 - A new noninvasive finger sensor (NICCI system) for continuous blood pressure and pulse pressure variation monitoring: A method comparison study in patients undergoing neurosurgery

AU - Flick, Moritz

AU - Bergholz, Alina

AU - Kouz, Karim

AU - Breitfeld, Philipp

AU - Nitzschke, Rainer

AU - Flotzinger, Doris

AU - Saugel, Bernd

N1 - Copyright © 2022 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

PY - 2022/11/1

Y1 - 2022/11/1

N2 - BACKGROUND: The NICCI system (Getinge, Gothenburg, Sweden) is a new noninvasive haemodynamic monitoring system using a finger sensor.OBJECTIVES: We aimed to investigate the performance of the NICCI system to measure blood pressure and pulse pressure variation compared with intra-arterial measurements.DESIGN: A prospective method comparison study.SETTING: University Medical Center Hamburg-Eppendorf, Hamburg, Germany.PATIENTS: Forty-seven neurosurgery patients.MAIN OUTCOME MEASURES: We performed a method comparison study in 47 neurosurgery patients to compare NICCI blood pressure measurements (BP NICCI ) with intra-arterial blood pressure measurements (BP ART ) (Bland-Altman analysis, four-quadrant plot, error grid analysis) and NICCI pulse pressure variation measurements (PPV NICCI ) with pulse pressure variation calculated manually from the intra-arterial blood pressure waveform (PPV ART ) (Bland-Altman analysis, predictive agreement, Cohen's kappa).RESULTS: The mean of the differences ± standard deviation (95% limits of agreement) between BP NICCI and BP ART was 11 ± 10 mmHg (-8 to 30 mmHg) for mean blood pressure (MBP), 3 ± 12 mmHg (-21 to 26 mmHg) for systolic blood pressure (SBP) and 12 ± 10 mmHg (-8 to 31 mmHg) for diastolic blood pressure (DBP). In error grid analysis, 54% of BP NICCI and BP ART MBP measurement pairs were classified as 'no risk', 43% as 'low risk', 3% as 'moderate risk' and 0% as 'significant risk' or 'dangerous risk'. The mean of the differences between PPV NICCI and PPV ART was 1 ± 3% (-4 to 6%). The predictive agreement between PPV NICCI and PPV ART was 80% and Cohen's kappa was 0.55.CONCLUSIONS: The absolute agreement between BP NICCI and BP ART was not clinically acceptable. We recommend not using the current version of the NICCI system for blood pressure monitoring during surgery. The absolute agreement between PPV NICCI and PPV ART was clinically acceptable with moderate predictive agreement regarding pulse pressure variation categories. The NICCI system needs to be further developed and re-evaluated when an improved version is available.TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register (DRKS00023188) on 2 October 2020.

AB - BACKGROUND: The NICCI system (Getinge, Gothenburg, Sweden) is a new noninvasive haemodynamic monitoring system using a finger sensor.OBJECTIVES: We aimed to investigate the performance of the NICCI system to measure blood pressure and pulse pressure variation compared with intra-arterial measurements.DESIGN: A prospective method comparison study.SETTING: University Medical Center Hamburg-Eppendorf, Hamburg, Germany.PATIENTS: Forty-seven neurosurgery patients.MAIN OUTCOME MEASURES: We performed a method comparison study in 47 neurosurgery patients to compare NICCI blood pressure measurements (BP NICCI ) with intra-arterial blood pressure measurements (BP ART ) (Bland-Altman analysis, four-quadrant plot, error grid analysis) and NICCI pulse pressure variation measurements (PPV NICCI ) with pulse pressure variation calculated manually from the intra-arterial blood pressure waveform (PPV ART ) (Bland-Altman analysis, predictive agreement, Cohen's kappa).RESULTS: The mean of the differences ± standard deviation (95% limits of agreement) between BP NICCI and BP ART was 11 ± 10 mmHg (-8 to 30 mmHg) for mean blood pressure (MBP), 3 ± 12 mmHg (-21 to 26 mmHg) for systolic blood pressure (SBP) and 12 ± 10 mmHg (-8 to 31 mmHg) for diastolic blood pressure (DBP). In error grid analysis, 54% of BP NICCI and BP ART MBP measurement pairs were classified as 'no risk', 43% as 'low risk', 3% as 'moderate risk' and 0% as 'significant risk' or 'dangerous risk'. The mean of the differences between PPV NICCI and PPV ART was 1 ± 3% (-4 to 6%). The predictive agreement between PPV NICCI and PPV ART was 80% and Cohen's kappa was 0.55.CONCLUSIONS: The absolute agreement between BP NICCI and BP ART was not clinically acceptable. We recommend not using the current version of the NICCI system for blood pressure monitoring during surgery. The absolute agreement between PPV NICCI and PPV ART was clinically acceptable with moderate predictive agreement regarding pulse pressure variation categories. The NICCI system needs to be further developed and re-evaluated when an improved version is available.TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register (DRKS00023188) on 2 October 2020.

UR - http://europepmc.org/abstract/med/36155392

U2 - 10.1097/EJA.0000000000001754

DO - 10.1097/EJA.0000000000001754

M3 - SCORING: Journal article

C2 - 36155392

VL - 39

SP - 851

EP - 857

JO - EUR J ANAESTH

JF - EUR J ANAESTH

SN - 0265-0215

IS - 11

ER -