Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website https://www.jocmr.org

Original Article

Volume 14, Number 4, April 2022, pages 158-164


An Evaluation of the NICCI Monitor in Providing Continuous, Noninvasive Blood Pressure Readings in Children During Intraoperative Anesthetic Care

Figures

Figure 1.
Figure 1. The NICCI device attached to a patient in the prone position with the calibrating noninvasive blood pressure cuff and finger cuffs in place (left). The inflation of the two finger cuffs is alternated to avoid pressure injury. The external pressure required to maintain blood flow within the fingers is measured using infrared technology. The pressure is then converted into a continuous readout which is displayed on the bedside monitor (right).
Figure 2.
Figure 2. Bland-Altman analysis of the agreement for systolic blood pressure (SBP) readings from the arterial cannula (AC) and the NICCI monitor (NM). The difference between the NM and AC values are plotted on the vertical axis while the average of the two values is plotted on the horizontal access. All values are in mm Hg. The red horizontal lines demonstrate the 95% limits of agreement, and the blue horizontal line corresponds to the bias.
Figure 3.
Figure 3. Bland-Altman analysis of the agreement for diastolic blood pressure (DBP) readings from the arterial cannula (AC) and the NICCI monitor (NM). The difference between the NM and AC values are plotted on the vertical axis while the average of the two values is plotted on the horizontal access. All values are in mm Hg. The red horizontal lines demonstrate the 95% limits of agreement, and the blue horizontal line corresponds to the bias.
Figure 4.
Figure 4. Bland-Altman analysis of the agreement for mean arterial pressure (MAP) readings from the arterial cannula (AC) and the NICCI monitor (NM). The difference between the NM and AC values are plotted on the vertical axis while the average of the two values is plotted on the horizontal access. All values are in mm Hg. The red horizontal lines demonstrate the 95% limits of agreement, and the blue horizontal line corresponds to the bias.

Tables

Table 1. Demographic and Clinical Characteristics of Study Cohort
 
10 - 40 kg10 - 25 kg25 - 40 kg
Data are presented as n (%), mean ± SD. BMI: body mass index; ASA: American Society of Anesthesiology; SD: standard deviation.
Gender, n (%)
  Female12 (50)3 (43)9 (53)
  Male12(50)4 (57)8 (47)
Age (years)11 ± 46 ± 213 ± 3
Weight (kg)30 ± 820 ± 434 ± 4
Height (cm)134 ± 19112 ± 13142 ± 14
BMI (kg/m2)17 ± 216 ± 217 ± 2
Type of procedure (n)
  Orthopedic17314
  Cardiothoracic422
  Neurosurgical321
Patient position (n)
  Prone18414
  Supine633
ASA physical class (n)
  I101
  II1037
  III1037
  IV312

 

Table 2. Comparison of Blood Pressure Readings From the Arterial Cannula and the NM Monitor
 
ParameterArterial cannula vs. NMPercentage of NM readings ≤ 5 mm Hg from ACPercentage of NM readings ≤ 10 mm Hg from ACPercentage of NM readings > 10 mm Hg from ACCorrelation coefficient
Data are displayed in mm Hg as the mean ± SD of absolute values or as percentages. Values are compared to those obtained from the arterial cannula. BP: blood pressure; MAP: mean arterial pressure; NM: NICCI monitor; AC: arterial cannula; SD: standard deviation. *Correlation is significant with a P value ≤ 0.01 (two-tailed).
Systolic BP11 ± 932%57%43%0.65*
Diastolic BP10 ± 735%60%40%0.43*
MAP10 ± 731%56%44%0.59*

 

Table 3. Bland-Altman Analysis Comparing Blood Pressure Readings From the Arterial Cannula and NM Monitor
 
ParameterBiasPrecision95% level of agreement
Data are presented in mm Hg rounded to the nearest whole integer. Values are compared to those obtained from an arterial cannula. BP: blood pressure; MAP: mean arterial pressure; NM: NICCI monitor.
Systolic BP414-23 to +31
Diastolic BP412-19 to +26
MAP612-17 to +28

 

Table 4. Comparison of Blood Pressure Readings From the Arterial Cannula and NM Monitor Based on Weight
 
ParameterArterial cannula vs. NMPercentage of NM readings ≤ 5 mm Hg from ACPercentage of NM readings ≤ 10 mm Hg from ACPercentage of NM readings > 10 mm Hg from ACCorrelation coefficient
Data are displayed in mm Hg as the mean ± SD of absolute values or as percentages. Values are compared to those obtained from the arterial cannula. BP: blood pressure; MAP: mean arterial pressure; NM: NICCI monitor; AC: arterial cannula; SD: standard deviation. *Correlation is significant with a P value ≤ 0.01 (two-tailed).
10 - 25 kg
  Systolic BP10 ± 83659400.70*
  Diastolic BP9 ± 74066340.83*
  MAP10 ± 72756440.77*
25 - 40 kg
  Systolic BP11 ± 93156440.73*
  Diastolic BP10 ± 73459410.69*
  MAP11 ± 83156440.66*

 

Table 5. Bland-Altman Analysis Based on Weight
 
ParameterBiasPrecision95% level of agreement
Data are presented in mm Hg rounded to the nearest whole integer. Values are compared to those obtained from an arterial cannula. BP: blood pressure; MAP: mean arterial pressure.
10 - 25 kg
  Systolic BP711-15 to +29
  Diastolic BP610-13 to +25
  MAP98-8 to +26
25 - 40 kg
  Systolic BP314-24 to + 31
  Diastolic BP412-20 to + 27
  MAP512-19 to + 28