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Journal of Clinical Monitoring and Computing

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25-02-2021 | Original Research

Non-invasive measurement of pulse pressure variation using a finger-cuff method (CNAP system): a validation study in patients having neurosurgery

Authors: Moritz Flick, Phillip Hoppe, Jasmin Matin Mehr, Luisa Briesenick, Karim Kouz, Gillis Greiwe, Jürgen Fortin, Bernd Saugel

Published in: Journal of Clinical Monitoring and Computing | Issue 2/2022

Abstract

The finger-cuff system CNAP (CNSystems Medizintechnik, Graz, Austria) allows non-invasive automated measurement of pulse pressure variation (PPV_CNAP). We sought to validate the PPV_CNAP-algorithm and investigate the agreement between PPV_CNAP and arterial catheter-derived manually calculated pulse pressure variation (PPV_INV). This was a prospective method comparison study in patients having neurosurgery. PPV_INV was the reference method. We applied the PPV_CNAP-algorithm to arterial catheter-derived blood pressure waveforms (PPV_INV−CNAP) and to CNAP finger-cuff-derived blood pressure waveforms (PPV_CNAP). To validate the PPV_CNAP-algorithm, we compared PPV_INV−CNAP to PPV_INV. To investigate the clinical performance of PPV_CNAP, we compared PPV_CNAP to PPV_INV. We used Bland–Altman analysis (absolute agreement), Deming regression, concordance, and Cohen's kappa (predictive agreement for three pulse pressure variation categories). We analyzed 360 measurements from 36 patients. The mean of the differences between PPV_INV−CNAP and PPV_INV was −0.1% (95% limits of agreement (95%-LoA) −2.5 to 2.3%). Deming regression showed a slope of 0.99 (95% confidence interval (95%-CI) 0.91 to 1.06) and intercept of −0.02 (95%-CI −0.52 to 0.47). The predictive agreement between PPV_INV−CNAP and PPV_INV was 92% and Cohen’s kappa was 0.79. The mean of the differences between PPV_CNAP and PPV_INV was −1.0% (95%-LoA−6.3 to 4.3%). Deming regression showed a slope of 0.85 (95%-CI 0.78 to 0.91) and intercept of 0.10 (95%-CI −0.34 to 0.55). The predictive agreement between PPV_CNAP and PPV_INV was 82% and Cohen’s kappa was 0.48. The PPV_CNAP-algorithm reliably calculates pulse pressure variation compared to manual offline pulse pressure variation calculation when applied on the same arterial blood pressure waveform. The absolute and predictive agreement between PPV_CNAP and PPV_INV are moderate.

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Title: Non-invasive measurement of pulse pressure variation using a finger-cuff method (CNAP system): a validation study in patients having neurosurgery
Authors: Moritz Flick
Phillip Hoppe
Jasmin Matin Mehr
Luisa Briesenick
Karim Kouz
Gillis Greiwe
Jürgen Fortin
Bernd Saugel
Publication date: 25-02-2021
Publisher: Springer Netherlands
Published in: Journal of Clinical Monitoring and Computing / Issue 2/2022
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-021-00669-1

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Non-invasive measurement of pulse pressure variation using a finger-cuff method (CNAP system): a validation study in patients having neurosurgery

Abstract

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Abstract

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