British Journal of Anaesthesia, Vol 76, Issue 3 405-411, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
B. M. Weiss, D. R. Spahn, H. Rahmig, R. Rohling and T. Pasch
Radial artery tonometry provides continuous measurement of non-invasive
arterial pressure (CNAP) by a sensor positioned above the radial artery. An
inflatable upper arm cuff enables intermittent oscillometric calibration.
CNAP was compared with invasive radial artery pressure recordings from the
opposite wrist in 22 high-risk surgical patients with an inter-arm
oscillometric mean arterial pressure difference < or = 10 mm Hg.
Oscillometric, tonometric and invasive digital pressure values, and
invasive and CNAP waveforms were obtained by the same instrument (Colin
BP-508). Correlation coefficients (r) of invasive vs oscillometric values
(n = 481 pairs) were 0.83, 0.90 and 0.92, and mean absolute errors of
oscillometry were 7.6, 4.7, and 2.6 mm Hg for systolic, diastolic and mean
arterial pressures, respectively. Correlation was poor for systolic (r =
0.80), diastolic (r = 0.77) and mean (r = 0.84) invasive vs CNAP values (n
= 1375). Compared with oscillometry, mean absolute errors of 15.2, 10.9 and
9.4 mm Hg for systolic, diastolic and mean CNAP, respectively, were
significantly (P < 0.001) higher. Mean prediction errors of CNAP,
compared with invasive values, were -5.8 (SD 14.2) mm Hg for systolic, +7.2
(8.3) mm Hg for diastolic and +3.9 (8.8) mm Hg for mean arterial pressure.
Individual patient accuracy of CNAP was assessed as good (individual
prediction error < or = 5 (8) mm Hg and individual absolute error <
or = 10 mm Hg) in seven patients, as acceptable (< or = 10 (12) and <
or = 15 mm Hg) in 11 patients, and as inadequate in four of 22 patients.
Individual accuracy of oscillometry was good or acceptable in all 22
patients. The trend in CNAP changes (difference between consecutive
measurements) was sufficiently accurate during induction of anaesthesia, as
only 47 (7.6%), 14 (2.3%) and 27 (4.4%) of 616 systolic, diastolic and mean
CNAP values differed by more than 10 mm Hg of invasive pressure trends. We
conclude that: intermittent oscillometry provides accurate arterial
pressure monitoring; CNAP measurements offer a reliable trend indicator of
pressure changes during induction of anaesthesia and may be considered an
alternative to invasive pressure measurements, should arterial cannulation
be difficult in an awake patient; and accuracy of absolute CNAP values is
only moderate and unpredictable, thus radial artery tonometry should not
replace invasive monitoring in high-risk patients during major surgical
procedures.
CLINICAL INVESTIGATIONS
Radial artery tonometry: moderately accurate but unpredictable technique of continuous non-invasive arterial pressure measurement
Department of Anaesthesiology, University Hospital Zurich, CH-8091 Zurich, Switzerland
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