Noninvasive Blood Pressure Measurement Using the NICCI Monitor in Adolescents During Intraoperative Anesthetic Care

Background: The intermittent measurement of blood pressure (BP) remains the standard of care during anesthesia or procedural sedation. To improve the early identification of hemodynamic compromise, various noninvasive BP devices have been developed which provide a continuous BP reading. The current study evaluates the accuracy of a novel continuous BP device, the NICCI system, in adolescents weighing 40 - 80 kg. Methods: During intraoperative anesthetic care, BP readings (systolic, diastolic, and mean) were captured from the arterial cannula and the NICC1 device every second. Results: The study cohort included 44 pediatric patients undergoing major orthopedic, cardiac, and neurosurgical procedures. A total of 383,126 pairs of systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) values from the arterial cannula and the MCCI device were analyzed. The absolute difference for SBP, DBP, and MAP values from the MCCI monitor and the arterial cannula were 10 +/- 8, 9 +/- 7, and 9 +/- 7 mm Hg, respectively. The difference between the BP values from the MCCI and the arterial cannula was <= 10 mm Hg for 60% of the SBP readings, 67% of the DBP readings, and 56% of the MAP readings. Using Bland-Altman analysis, the bias was 2, 3, and 4 mm Hg for the SBP, DBP, and MAP. Conclusions: Although there were technical limitations related to patient size that affected its ability to meet the strict accuracy criteria set by the American National Standards Institute/Association for the Advancement of Medical Instrumentation standards for noninvasive BP measurement (ANSI/AAMI SP10), the NICCI system provided a continuous noninvasive beat-to-beat BP measurement which was clinically relevant during a significant portion of intraoperative care.