Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Continuous Noninvasive Arterial Pressure Monitoring in Obese Patients During Bariatric Surgery: An Evaluation of the Vascular Unloading Technique (Clearsight system)

Rogge, Dorothea E. MD*; Nicklas, Julia Y. MD*; Schön, Gerhard MSc; Grothe, Oliver PhD; Haas, Sebastian A. MD*; Reuter, Daniel A. MD*; Saugel, Bernd MD*

doi: 10.1213/ANE.0000000000003943
Technology, Computing, and Simulation: Original Clinical Research Report
Continuing Medical Education

BACKGROUND: Continuous monitoring of arterial pressure is important in severely obese patients who are at particular risk for cardiovascular complications. Innovative technologies for continuous noninvasive arterial pressure monitoring are now available. In this study, we compared noninvasive arterial pressure measurements using the vascular unloading technique (Clearsight system; Edwards Lifesciences Corp, Irvine, CA) with invasive arterial pressure measurements (radial arterial catheter) in severely obese patients during laparoscopic bariatric surgery.

METHODS: In 35 severely obese patients (median body mass index, 47 kg/m2), we simultaneously recorded noninvasive and invasive arterial pressure measurements over a period of 45 minutes. We compared noninvasive (test method) and invasive (reference method) arterial pressure measurements (sampling rate 1 Hz = 1/s) using Bland-Altman analysis (accounting for multiple measurements per subject), 4-quadrant plot/concordance analysis (2-minute interval, 5 mm Hg exclusion zone), and error grid analysis (calculating the proportions of measurements in risk zones A–E with A indicating no risk, B low risk, C moderate risk, D significant risk, and E dangerous risk for the patient due to the risk of wrong clinical interventions because of measurement errors).

RESULTS: We observed a mean of the differences (±SD, 95% limits of agreement) between the noninvasively and invasively assessed arterial pressure values of 1.1 mm Hg (±7.4 mm Hg, −13.5 to 15.6 mm Hg) for mean arterial pressure (MAP), 6.8 mm Hg (±10.3 mm Hg, −14.4 to 27.9 mm Hg) for systolic arterial pressure, and 0.8 mm Hg (±6.9 mm Hg, −12.9 to 14.4 mm Hg) for diastolic arterial pressure. The 4-quadrant plot concordance rate (ie, the proportion of arterial pressure measurement pairs showing concordant changes to all changes) was 93% (CI, 89%–96%) for MAP, 93% (CI, 89%–97%) for systolic arterial pressure, and 88% (CI, 84%–92%) for diastolic arterial pressure. Error grid analysis showed that the proportions of measurements in risk zones A–E were 89.5%, 10.0%, 0.5%, 0%, and 0% for MAP and 93.7%, 6.0%, 0.3%, 0%, and 0% for systolic arterial pressure, respectively.

CONCLUSIONS: During laparoscopic bariatric surgery, the accuracy and precision of the vascular unloading technique (Clearsight system) was good for MAP and diastolic arterial pressure, but only moderate for systolic arterial pressure according to Bland-Altman analysis. The system showed good trending capabilities. In the error grid analysis, >99% of vascular unloading technique–derived arterial pressure measurements were categorized in no- or low-risk zones.

From the *Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine

Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Institute of Operations Research, Karlsruhe Institute of Technology, Karlsruhe, Germany.

Published ahead of print 18 October 2018.

Accepted for publication October 18, 2018.

Sebastian A. Haas, MD, and Daniel A. Reuter, MD, are currently affiliated with the Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany.

Funding: Edwards Lifesciences Corp (Irvine, CA) provided the technical equipment for the study. Edwards Lifesciences was not involved in the collection of the data, drafting of the manuscript, or the decision to submit the manuscript for publication.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Dorothea E. Rogge, MD, Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Address e-mail to

Copyright © 2019 International Anesthesia Research Society
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website