Noninvasive Assessment of Arterial Pulse-Pressure Variation During General Anesthesia: Clinical Evaluation of a New High-Fidelity Upper Arm Cuff

Abstract

Objectives: To compare noninvasive pulse-pressure variation (PPV) measurements obtained from a new high-fidelity upper arm cuff using a hydraulic coupling technique to corresponding intraarterial PPV measurements.

Design: The authors used prospective multicenter comparison and development studies for the new high-fidelity upper arm cuff.

Setting: The study was performed in the departments of Anesthesiology at the Ludwig-Maximilians-Universität München Hospital, the University Hospital of Bonn, and the RoMed Hospital in Rosenheim (all Germany).

Participants: A total of 153 patients were enrolled, undergoing major abdominal surgery or neurosurgery with mechanical ventilation. For the evaluation of PPV, 1,467 paired measurements in 107 patients were available after exclusion due to predefined quality criteria.

Interventions: Simultaneous measurements of PPV were performed from a reference femoral arterial catheter (PPV_ref) and the high-fidelity upper arm cuff (PPV_cuff). The new device uses a semirigid conical shell. It incorporates a hydraulic sensor pad with a pressure transducer, leading to a tissue pressure-pulse contour with all characteristics of an arterial- pulse contour.

Measurements and main results: The comparative analysis of the included measurements showed that PPV_ref and PPV_cuff were closely correlated (r = 0.92). The mean of the differences between PPV_ref and PPV_cuff was 0.1 ± 2.0%, with 95% limits of agreement between -4.1% and 3.9%. To track absolute changes in PPV >2%, the concordance rate between the 2 methods was 93%.

Conclusions: The new high-fidelity upper arm cuff method provided a clinically reliable estimate of PPV.

Keywords: Fluid management; High-fidelity cuff; New PPV algorithm; Noninvasive assessment; Pulse pressure variation; Upper arm cuff.