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1.
Biomed Res Int ; 2021: 6685584, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33855080

RESUMO

Background: Although fixed-volume conventional fluid preloading protocol fails to attenuate postspinal hypotension during cesarean delivery, the effect of goal-directed fluid therapy (GDFT) remains less explored. Continuous noninvasive finger cuff arterial pressure monitoring using devices such as the ClearSight System can provide the noninvasive stroke volume value, enabling clinicians to perform GDFT before spinal anesthesia; however, the efficacy of GDFT requires further elucidation. Method: In total, 71 consecutive full-term pregnant women were randomly divided into a control group (n = 34) and a GDFT group (n = 37). Before spinal anesthesia, the control group received a fixed dose (1000 mL) of crystalloid fluid, but the GDFT group received repeated 3 mL/kg body weight of crystalloid fluid challenges within 3 minutes with a 1-minute interval between each fluid challenge based on the stroke volume incremental changes obtained using the ClearSight System (targeting a stroke volume increase of ≥5% after a fluid challenge). The primary outcome was the incidence of postspinal hypotension. The secondary outcomes were total fluid volume, vasopressor dosage, hemodynamic parameter changes, maternal adverse effects, and neonatal profiles. Result: Women in the GDFT group received more fluid than did those in the control group (1132 ± 108 vs. 1247 ± 202 mL; p = 0.0044), but the incidence of postspinal hypotension (79.4% vs. 73.0%,; p = 0.5864) and norepinephrine dose (12.5 ± 10.6 vs. 15.1 ± 12.8 mcg, respectively; p = 0.3512) was comparable between the two groups. Fewer women in the GDFT group experienced nausea (61.76% vs. 35.14%; p = 0.0332). Neonatal outcomes (Apgar score and umbilical blood analysis) were comparable and typical in both groups. Conclusion: ClearSight-guided GDFT did not ameliorate postspinal hypotension but may reduce nausea. This trial is registered with NCT03013140.


Assuntos
Pressão Arterial/fisiologia , Determinação da Pressão Arterial/instrumentação , Cesárea , Dedos/fisiologia , Hidratação , Objetivos , Adulto , Hemodinâmica , Humanos , Recém-Nascido , Cuidados Intraoperatórios
2.
Medicine (Baltimore) ; 100(11): e25152, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33726000

RESUMO

ABSTRACT: Noninvasive continuous arterial pressure monitoring may be clinically useful in patients who require continuous blood pressure monitoring in situations where arterial catheter placement is limited. Many previous studies on the accuracy of the noninvasive continuous blood pressure monitoring method reported various results. However, there is no research on the effectiveness of noninvasive arterial pressure monitoring during one-lung ventilation. The purpose of this study was to compare arterial blood pressure obtained through invasive method and noninvasive method by using ClearSight during one-lung ventilation.In this retrospective observational study, a total of 26 patients undergoing one-lung ventilation for thoracic surgery at a single institution between March and July 2019 were recruited. All patients in this study were cannulated on their radial artery to measure continuously invasive blood pressures and applied ClearSight on the ipsilateral side of the cannulated arm. We compared and analyzed the agreement and trendability of blood pressure recorded with invasive and noninvasive methods during one-lung ventilation.Blood pressure and pulse rate showed a narrower limit of agreement with a percentage error value of around 30%. In addition, the tracking ability of each measurement could be determined by the concordance rate, all of which were below acceptable limits (92%).In noninvasive arterial blood pressure monitoring using ClearSight, mean blood pressure and pulse rate show acceptable agreement with the invasive method.


Assuntos
Determinação da Pressão Arterial/instrumentação , Monitores de Pressão Arterial/estatística & dados numéricos , Monitorização Intraoperatória/instrumentação , Ventilação Monopulmonar , Procedimentos Cirúrgicos Torácicos , Idoso , Pressão Arterial , Determinação da Pressão Arterial/métodos , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Artéria Radial/fisiopatologia , Reprodutibilidade dos Testes , Estudos Retrospectivos
3.
Res Vet Sci ; 135: 162-166, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33524826

RESUMO

We evaluated the agreement between oscillometric and direct blood pressure monitors in anesthetized dogs and evaluated the ability of the oscillometric method to detect MAP <60 mmHg. Forty client-owned dogs, three months to 14 years old, 4.6-50.2 kg, under general anesthesia were studied. Systolic (SAP), mean (MAP) and diastolic (DAP) arterial pressures were measured directly via an arterial catheter and with an oscillometric cuff (Cardell Touch monitor). Paired values were compared with mixed effect models. Bias and limits of agreement (LOA) were calculated. The sensitivity and false negative rate to detect hypotension (invasive MAP <60 mmHg) using an oscillometric MAP <60 and < 70 mmHg were calculated. A receiver operating characteristics (ROC) curve was constructed and the area under the curve calculated. SAP and DAP differed between methods (both P < 0.001), but MAP did not (P = 0.5). Bland-Altman plots showed small biases but wide LOA for all variables. The sensitivity to detect hypotension was 40% with a false negative rate of 60% when using an oscillometric MAP <60 mmHg, and 68% and 32%, respectively, with a MAP <70 mmHg. The area under the ROC curve for MAP was 0.82. While the oscillometric MAP did not differ from invasive values, the device failed to recognize hypotensive events when 60 mmHg was used as the threshold to detect hypotension. Higher MAP values increased the ability to correctly recognize hypotension, but at the expense of a higher incidence of false positives.


Assuntos
Determinação da Pressão Arterial/veterinária , Monitores de Pressão Arterial/veterinária , Doenças do Cão/diagnóstico , Hipotensão/veterinária , Oscilometria/veterinária , Animais , Determinação da Pressão Arterial/instrumentação , Monitores de Pressão Arterial/estatística & dados numéricos , Cães , Feminino , Hipotensão/diagnóstico , Masculino , Oscilometria/instrumentação
4.
High Blood Press Cardiovasc Prev ; 28(2): 185-249, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33620672

RESUMO

INTRODUCTION: Systolic blood pressure (SBPA) and pulse pressure amplification (PPA) were quantified using different methodological and calibration approaches to analyze (1) the association and agreement between different SBPA and PPA parameters and (2) the association between these SBPA and PPA parameters and left ventricle (LV) and atrium (LA) structural and functional characteristics. METHODS: In 269 healthy subjects, LV and LA parameters were echocardiography-derived. SBPA and PPA parameters were quantified using: (1) different equations (n = 9), (2) methodological approaches (n = 3): brachial sub-diastolic (Mobil-O-Graph®) and supra-systolic oscillometry (Arteriograph®) and aortic diameter waveform re-calibration (RCD; ultrasonography), and (3) using three different calibration schemes: systo-diastolic (SD), calculated mean (CM) and oscillometric mean (OscM). RESULTS: SBPA and PPA parameters obtained with different equations, techniques, and calibration schemes show a highly variable association level (negative, non-significant, and/or positive) among them. The association between SBPA and PPA with cardiac parameters were highly variable (negative, non-significant, or positive associations). Differences in BPA parameter data between approaches were more sensitive to the calibration method than to the device used. Both, SBPA and PPA obtained with brachial sub-diastolic technique and calibrated to CM or OscM showed higher levels of association with LV and LA structural characteristics. CONCLUSIONS: Our data show that many of the parameters that assume to quantify the same phenomenon of BPA are not related to each other in the different age groups. Both, SBPA and PPA obtained with brachial sub-diastolic technique and calibrated to CM or OscM showed higher levels of association with LV and LA structural characteristics.


Assuntos
Função do Átrio Esquerdo , Determinação da Pressão Arterial/normas , Pressão Sanguínea , Coração/fisiologia , Função Ventricular Esquerda , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial/instrumentação , Calibragem , Criança , Estudos Transversais , Ecocardiografia Doppler , Feminino , Voluntários Saudáveis , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Oscilometria , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Adulto Jovem
5.
Am J Physiol Heart Circ Physiol ; 320(4): H1554-H1564, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33606586

RESUMO

Accurate assessment of the left ventricular (LV) systolic function is indispensable in the clinic. However, estimation of a precise index of cardiac contractility, i.e., the end-systolic elastance (Ees), is invasive and cannot be established as clinical routine. The aim of this work was to present and validate a methodology that allows for the estimation of Ees from simple and readily available noninvasive measurements. The method is based on a validated model of the cardiovascular system and noninvasive data from arm-cuff pressure and routine echocardiography to render the model patient-specific. Briefly, the algorithm first uses the measured aortic flow as model input and optimizes the properties of the arterial system model to achieve correct prediction of the patient's peripheral pressure. In a second step, the personalized arterial system is coupled with the cardiac model (time-varying elastance model) and the LV systolic properties, including Ees, are tuned to predict accurately the aortic flow waveform. The algorithm was validated against invasive measurements of Ees (multiple pressure-volume loop analysis) taken from n = 10 patients with heart failure with preserved ejection fraction and n = 9 patients without heart failure. Invasive measurements of Ees (median = 2.4 mmHg/mL, range = [1.0, 5.0] mmHg/mL) agreed well with method predictions (normalized root mean square error = 9%, ρ = 0.89, bias = -0.1 mmHg/mL, and limits of agreement = [-0.9, 0.6] mmHg/mL). This is a promising first step toward the development of a valuable tool that can be used by clinicians to assess systolic performance of the LV in the critically ill.NEW & NOTEWORTHY In this study, we present a novel model-based method to estimate the left ventricular (LV) end-systolic elastance (Ees) according to measurement of the patient's arm-cuff pressure and a routine echocardiography examination. The proposed method was validated in vivo against invasive multiple-loop measurements of Ees, achieving high correlation and low bias. This tool could be most valuable for clinicians to assess the cardiovascular health of critically ill patients.


Assuntos
Algoritmos , Determinação da Pressão Arterial , Ecocardiografia , Insuficiência Cardíaca/diagnóstico , Hemodinâmica , Modelos Cardiovasculares , Função Ventricular Esquerda , Idoso , Determinação da Pressão Arterial/instrumentação , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Esfigmomanômetros , Sístole
6.
Am Heart J ; 233: 102-108, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33321118

RESUMO

BACKGROUND: The possibility to use built-in smartphone-cameras for photoplethysmographic (PPG) recording of pulse waves lead to the release of numerous health apps, claiming to measure blood pressure (BP) based on PPG signals. Even though these apps are highly popular, not a single one is clinically validated. Aim of the current study was to test systolic BP (sBP) estimation by a promising new algorithm in a large clinical setting. METHODS: The study was designed based on the European Society of Hypertension International Protocol Revision 2010. Each individual received 7 sequential BP measurements, starting with the reference device - an automated oscillometric cuff device - followed by the PPG recording at the patients' index finger. RESULTS: A total 1,036 subjects were recruited of which 965 could be included for final analysis leading to 2,895 pairs of comparison. Mean (±SD) error between test and reference device was -0.41 (±16.52) mmHg. Only 38.1% of all 2,895 BP comparisons reached a delta within ±5 mmHg, while 29.3% reached a delta larger than 15 mmHg. Bland-Altman plot showed an overestimation of smartphone sBP in comparison to reference sBP in low range and an underestimation in high sBP range. CONCLUSIONS: According to the European Society of Hypertension International Protocol Revision 2010 specifications the algorithm failed validation criteria for sBP measurement and was not commercialized. These findings emphasize that health apps should be rigorously validated according to common guidelines before market release as under- and/or overestimation of BP is potentially exposing persons at health risks in short and long term. TRIAL REGISTRATION: ClinicalTrials.gov, number NCT02552030.


Assuntos
Algoritmos , Determinação da Pressão Arterial/métodos , Aplicativos Móveis , Smartphone , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fotopletismografia , Reprodutibilidade dos Testes , Sístole
7.
JAMA ; 324(18): 1884-1895, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-33170247

RESUMO

Importance: Childhood hypertension can result in adverse outcomes during adulthood; identifying and treating primary and secondary childhood hypertension may reduce such risks. Objective: To update the evidence on screening and treatment of hypertension in childhood and adolescence for the US Preventive Services Task Force. Data Sources: PubMed, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, and trial registries through September 3, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through October 6, 2020. Study Selection: Fair- or good-quality English-language studies evaluating diagnostic accuracy of blood pressure screening; cohort studies assessing the association of hypertension in childhood and adolescence with blood pressure or other intermediate outcomes in adulthood; randomized clinical trials (RCTs) or meta-analyses of pharmacological and lifestyle interventions. Data Extraction and Synthesis: Two reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; the evidence was synthesized qualitatively. Main Outcomes and Measures: Sensitivity, specificity, and measures of association between childhood and adulthood blood pressure; reduction of childhood blood pressure; adverse effects of treatments. Results: Forty-two studies from 43 publications were included (N>12 400). No studies evaluated the benefits or harms of screening and the effect of treating childhood hypertension on outcomes in adulthood. One study reported a sensitivity of 0.82 and a specificity of 0.70 for 2 office-based blood pressure measurements. Twenty observational studies suggested a significant association between childhood hypertension and abnormal blood pressure in adulthood (odds ratios, 1.1-4.5; risk ratios, 1.45-3.60; hazard ratios, 2.8-3.2). Thirteen placebo-controlled RCTs and 1 meta-analysis assessed reductions in systolic (SBP) and diastolic blood pressure from pharmacological treatments. Pooled reductions of SBP were -4.38 mm Hg (95% CI, -7.27 to -2.16) for angiotensin-converting enzyme inhibitors and -3.07 mm Hg (95% CI, -4.99 to -1.44) for angiotensin receptor blockers. Candesartan reduced SBP by -6.56 mm Hg (P < .001; n = 240). ß-Blockers, calcium channel blockers, and mineralocorticoid receptor antagonists did not achieve significant reductions over 2 to 4 weeks. SBP was significantly reduced by exercise over 8 months (-4.9 mm Hg, P ≤ .05; n = 69), by dietary approaches to stop hypertension over 3 months (-2.2 mm Hg, P < .01; n = 57), and by a combination of drug treatment and lifestyle interventions over 6 months (-7.6 mm Hg; P < .001; n = 95). Low-salt diet did not achieve reductions of blood pressure. Conclusions and Relevance: Observational studies indicate an association between hypertension in childhood and hypertension in adulthood. However, the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care.


Assuntos
Hipertensão/diagnóstico , Programas de Rastreamento , Adolescente , Adulto , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial/instrumentação , Doenças Cardiovasculares/prevenção & controle , Criança , Pré-Escolar , Terapia Combinada , Dieta Saudável , Exercício Físico , Feminino , Humanos , Hipertensão/terapia , Masculino , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/psicologia , Estudos Observacionais como Assunto , Guias de Prática Clínica como Assunto , Serviços Preventivos de Saúde , Sensibilidade e Especificidade
8.
JAMA ; 324(18): 1878-1883, 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33170248

RESUMO

Importance: Prevalence of hypertension (both primary and secondary) in children and adolescents in the US ranges from 3% to 4%. Primary hypertension in children and adolescents occurs primarily in children older than 13 years and has no known cause but is associated with several risk factors, including family history and higher body mass index. Secondary hypertension occurs primarily in younger children and is most commonly caused by genetic disorders, renal disease, endocrine disorders, or cardiovascular abnormalities. Objective: To update its 2013 recommendation, the USPSTF commissioned a review of the evidence on the benefits and harms of screening, test accuracy, the effectiveness and harms of treatment, and the association between hypertension and markers of cardiovascular disease in childhood and adulthood. Population: This recommendation statement applies to children and adolescents aged 3 to 18 years not known to have hypertension or who are asymptomatic. Evidence Assessment: The USPSTF concludes that the evidence to support screening for high blood pressure in children and adolescents is insufficient and that the balance of benefits and harms cannot be determined. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for high blood pressure in children and adolescents. (I statement).


Assuntos
Hipertensão/diagnóstico , Programas de Rastreamento , Adolescente , Determinação da Pressão Arterial/instrumentação , Doenças Cardiovasculares/prevenção & controle , Criança , Pré-Escolar , Reações Falso-Positivas , Feminino , Humanos , Hipertensão/terapia , Masculino , Programas de Rastreamento/efeitos adversos , Serviços Preventivos de Saúde , Valores de Referência
9.
Anesthesiology ; 133(5): 997-1006, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-33048167

RESUMO

BACKGROUND: In most patients having noncardiac surgery, blood pressure is measured with the oscillometric upper arm cuff method. Although the method is noninvasive and practical, it is known to overestimate intraarterial pressure in hypotension and to underestimate it in hypertension. A high-fidelity upper arm cuff incorporating a hydraulic sensor pad was recently developed. The aim of the present study was to investigate whether noninvasive blood pressure measurements with the new high-fidelity cuff correspond to invasive measurements with a femoral artery catheter, especially at low blood pressure. METHODS: Simultaneous measurements of blood pressure recorded from a femoral arterial catheter and from the high-fidelity upper arm cuff were compared in 110 patients having major abdominal surgery or neurosurgery. RESULTS: 550 pairs of blood pressure measurements (5 pairs per patient) were considered for analysis. For mean arterial pressure measurements, the average bias was 0 mmHg, and the precision was 3 mmHg. The Pearson correlation coefficient was 0.96 (P < 0.0001; 95% CI, 0.96 to 0.97), and the percentage error was 9%. Error grid analysis showed that the proportions of mean arterial pressure measurements done with the high-fidelity cuff method were 98.4% in zone A (no risk), 1.6% in zone B (low risk) and 0% in zones C, D, and E (moderate, significant, and dangerous risk, respectively). The high-fidelity cuff method detected mean arterial pressure values less than 65 mmHg with a sensitivity of 84% (95% CI, 74 to 92%) and a specificity of 97% (95% CI, 95% to 98%). To detect changes in mean arterial pressure of more than 5 mmHg, the concordance rate between the two methods was 99.7%. Comparable accuracy and precision were observed for systolic and diastolic blood pressure measurements. CONCLUSIONS: The new high-fidelity upper arm cuff method met the current international standards in terms of accuracy and precision. It was also very accurate to track changes in blood pressure and reliably detect severe hypotension during noncardiac surgery.


Assuntos
Pressão Arterial/fisiologia , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Monitorização Intraoperatória/métodos , Monitorização Intraoperatória/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/instrumentação , Oscilometria/instrumentação , Oscilometria/métodos , Oscilometria/normas , Estudos Prospectivos , Adulto Jovem
10.
Br J Anaesth ; 125(1): 25-37, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32475686

RESUMO

BACKGROUND: Finger cuff technologies allow continuous noninvasive arterial blood pressure (AP) and cardiac output/index (CO/CI) monitoring. METHODS: We performed a meta-analysis of studies comparing finger cuff-derived AP and CO/CI measurements with invasive measurements in surgical or critically ill patients. We calculated overall random effects model-derived pooled estimates of the mean of the differences and of the percentage error (PE; CO/CI studies) with 95%-confidence intervals (95%-CI), pooled 95%-limits of agreement (95%-LOA), Cochran's Q and I2 (for heterogeneity). RESULTS: The pooled mean of the differences (95%-CI) was 4.2 (2.8 to 5.62) mm Hg with pooled 95%-LOA of -14.0 to 22.5 mm Hg for mean AP (Q=230.4 [P<0.001], I2=91%). For mean AP, the mean of the differences between finger cuff technologies and the reference method was ≤5±8 mm Hg in 9/27 data sets (33%). The pooled mean of the differences (95%-CI) was -0.13 (-0.43 to 0.18) L min-1 with pooled 95%-LOA of -2.56 to 2.23 L min-1 for CO (Q=66.7 [P<0.001], I2=90%) and 0.07 (0.01 to 0.13) L min-1 m-2 with pooled 95%-LOA of -1.20 to 1.15 L min-1 m-2 for CI (Q=5.8 [P=0.326], I2=0%). The overall random effects model-derived pooled estimate of the PE (95%-CI) was 43 (37 to 49)% (Q=48.6 [P<0.001], I2=63%). In 4/19 data sets (21%) the PE was ≤30%, and in 10/19 data sets (53%) it was ≤45%. CONCLUSIONS: Study heterogeneity was high. Several studies showed interchangeability between AP and CO/CI measurements using finger cuff technologies and reference methods. However, the pooled results of this meta-analysis indicate that AP and CO/CI measurements using finger cuff technologies and reference methods are not interchangeable in surgical or critically ill patients. CLINICAL TRIAL NUMBER: PROSPERO registration number: CRD42019119266.


Assuntos
Pressão Arterial/fisiologia , Determinação da Pressão Arterial/métodos , Débito Cardíaco/fisiologia , Cuidados Críticos/métodos , Assistência Perioperatória/métodos , Análise de Onda de Pulso/métodos , Determinação da Pressão Arterial/instrumentação , Dedos , Humanos
12.
Vasc Health Risk Manag ; 16: 133-142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32308406

RESUMO

Objective: A new automated and adjustable blood pressure (BP) system has been developed to improve the accuracy of BP measurements on public-use health stations. This self-fitting BP system includes a mechanical cuff that wraps down to the user's arm prior to bladder inflation. The purpose of this study was to validate the adaptable BP system (ABPS) using the current standards from the Association for the Advancement of Medical Instrumentation (AAMI). Methods: The AAMI/ISO 81060:2013 standards for clinical validation of non-invasive automated arterial BP measurement devices were followed precisely using the same arm sequential method. For each participant, BP was measured over multiple trials by trained observers alternating a reference sphygmomanometer with the ABPS. All study requirements were met with 85 qualifying participants, each with 3 valid paired determinations. Results: The mean difference between ABPS BP and reference BP using all 255 paired determinations was -2.4 ± 7.7 mmHg for systolic and 1.7 ± 5.7 mmHg for diastolic. The standard deviation of the averaged paired determinations per participant was 6.3 mmHg for systolic and 5.2 mmHg for diastolic. Arm circumference measurements had a mean error of -2.1 ± 2.4 cm (R2 = 0.87). A new prediction model for arm circumference was validated using a holdout dataset (R2 = 0.94). Conclusion: The results of the study confirm that the ABPS met all benchmarks established by the AAMI. The device accurately measures BP across a wide range of arm circumferences (24-44 cm) and is suitable for use by individuals to self-monitor BP.


Assuntos
Braço/irrigação sanguínea , Determinação da Pressão Arterial/instrumentação , Pressão Sanguínea , Hipertensão/diagnóstico , Saúde Pública/instrumentação , Adolescente , Adulto , Idoso , Automação , California , Desenho de Equipamento , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Adulto Jovem
13.
Phys Ther ; 100(6): 1008-1019, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32232372

RESUMO

Hypertension (HTN) is among the leading global preventable risk factors for cardiovascular disease and premature mortality. Early detection and effective management of HTN have demonstrated significant reductions in mortality, morbidity rate, and health care costs. Furthermore, screening for HTN by nonphysician health care providers improves detection rates and medical management. As physical therapist practice advances to a more independent care model, physical therapists may serve as the first point of contact into the health care system, thereby necessitating a need for routine blood pressure (BP) monitoring. This is especially relevant in the outpatient physical therapist practice setting, where there is evidence for elevated BP measures among patients, yet omission of routine screening in this setting is well documented. Leading physical therapy professional organizations include statements in their guidelines that suggest that physical therapists have a duty to provide a standard of care that protects the safety and optimizes the overall health of patients under their care. Therefore, it is imperative not only that physical therapists include BP examination into routine practice protocols but that the knowledge and skills to accurately measure and interpret BP at rest and during exercise be integrated into the standard of care. The authors suggest that the profession of physical therapy proactively embrace their potential to address the national and worldwide HTN epidemic through routine assessment of BP, appropriate referral for elevated BP measures, and exploration of HTN management by physical therapists.


Assuntos
Assistência Ambulatorial , Determinação da Pressão Arterial , Hipertensão/diagnóstico , Fisioterapeutas , Assistência Ambulatorial/ética , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/ética , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/normas , Calibragem , Tomada de Decisão Clínica , Diagnóstico Precoce , Desenho de Equipamento , Exercício Físico/fisiologia , Terapia por Exercício , Humanos , Hipertensão/terapia , Fisioterapeutas/ética , Postura/fisiologia , Encaminhamento e Consulta , Padrão de Cuidado
14.
Crit Care ; 24(1): 172, 2020 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-32331527

RESUMO

Arterial blood pressure (BP) is a fundamental cardiovascular variable, is routinely measured in perioperative and intensive care medicine, and has a significant impact on patient management. The clinical reference method for BP monitoring in high-risk surgical patients and critically ill patients is continuous invasive BP measurement using an arterial catheter. A key prerequisite for correct invasive BP monitoring using an arterial catheter is an in-depth understanding of the measurement principle, of BP waveform quality criteria, and of common pitfalls that can falsify BP readings. Here, we describe how to place an arterial catheter, correctly measure BP, and identify and solve common pitfalls. We focus on 5 important steps, namely (1) how to choose the catheter insertion site, (2) how to choose the type of arterial catheter, (3) how to place the arterial catheter, (4) how to level and zero the transducer, and (5) how to check the quality of the BP waveform.


Assuntos
Pressão Arterial , Determinação da Pressão Arterial/métodos , Dispositivos de Acesso Vascular , Determinação da Pressão Arterial/instrumentação , Estado Terminal/terapia , Guias como Assunto , Humanos , Unidades de Terapia Intensiva/organização & administração , Monitorização Fisiológica/métodos , Posicionamento do Paciente/instrumentação , Posicionamento do Paciente/métodos , Ultrassonografia de Intervenção/métodos
15.
Eur J Vasc Endovasc Surg ; 59(6): 965-971, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32217116

RESUMO

OBJECTIVE: In patients with peripheral arterial disease (PAD), measurements of distal blood pressure form the basis of assessing the severity of the disease along with symptoms and objective findings. The reliability and accuracy of a fully automated bedside device (SysToe) vs. strain gauge plethysmography (SGP) in patients with low toe pressures in a bedside setting in an outpatient clinic of vascular surgery were investigated. METHODS: This was a prospective, single blinded study carried out in compliance with the Standards of Reporting of Diagnostic Accuracy Studies. A total of 94 outpatients with symptomatic PAD in an outpatient vascular surgery clinic were included and had index measurements performed with the automated bedside device in a bedside setting by observers with no training in routine distal pressure measurements. SGP reference measurements were performed in a vascular laboratory. RESULTS: There was agreement between modalities regarding the diagnostic classification of chronic limb threatening ischaemia (CLTI) in 79/94 (84%) patients. For detection of CLTI, Cohen's kappa was 0.57 with a sensitivity of 94%, specificity of 82%, positive predictive value (PPV) 52%, and negative predictive value (NPV) 98%. On average, the automated bedside device underestimated the pressures, compared with the SGP. The mean difference between SGP and SysToe was 9 ± 16 mmHg for right limbs and 10 ± 16 mmHg for left limbs (p < .001). CONCLUSION: The automated bedside device showed a high sensitivity and a high NPV for excluding CLTI. However, the low PPV may result in overdiagnosis. The automated bedside device may function as a screening tool identifying patients in need of further diagnostics with more accurate equipment, for example SGP.


Assuntos
Determinação da Pressão Arterial/métodos , Isquemia/diagnóstico , Doença Arterial Periférica/complicações , Testes Imediatos , Dedos do Pé/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial/instrumentação , Dinamarca , Feminino , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar , Pletismografia , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
16.
J Spec Oper Med ; 20(1): 47-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32203606

RESUMO

BACKGROUND: Pressure is an important variable in emergency use limb tourniquet science. This study characterizes one system for measuring tourniquet-applied pressure. METHODS: A neonatal blood pressure cuff bladder was inflated to target pressures over atmospheric. Unconstrained or constrained within 1-inch tubular polyester webbing, the neonatal cuff was placed in a 500mL Erlenmeyer flask. A 3-hole stopper provided connections to flask interior (chamber) and bladder pressure sensors and a 60mL syringe for altering chamber pressure: atmospheric to >1500mmHg absolute to atmospheric. RESULTS: Within a finite range of chamber pressures, the neonatal cuffbased system accurately indicates applied pressure (minimum and maximum 95% confidence interval linear regression slopes of 0.9871 to 0.9953 and y-intercepts of -0.1144 to 2.157). The visually defined linear response ranges for bladder inflation pressures were as follows for unconstrained/ constrained: 100 to 400mmHg unconstrained/450mmHg constrained for 10mmHg, 150 unconstrained/100 constrained to 450mmHg for 12mmHg, 150 to 500mmHg for 15mmHg, 150 to 500mmHg unconstrained/550mmHg constrained for 18mmHg, 150 to 550mmHg for 21mmHg. Below the linear response range, the inflated bladder system indicated higher pressures than chamber pressures. Above the linear response range, the system indicated progressively lower pressures than chamber pressures. CONCLUSIONS: Within the linear response range, the bladder pressure accurately indicates surface-applied pressure.


Assuntos
Determinação da Pressão Arterial/instrumentação , Extremidades , Pressão , Torniquetes , Humanos , Reprodutibilidade dos Testes
17.
Obesity (Silver Spring) ; 28(4): 718-723, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32096341

RESUMO

OBJECTIVE: In patients with obesity, it was determined what proportion had an arm slant angle (SA) < 83° and which measure best predicted arm conicity. Patient experience with noninvasive blood pressure measurement was evaluated. METHODS: Arm SA was calculated from arm measurements. Linear regression determined whether BMI, weight, or right midarm circumference (MAC) best predicted conicity. Patient experiences were evaluated by survey and conventional content analysis of free-text comments. RESULTS: One hundred participants had a median (interquartile range; range) BMI of 44.1 (39.1-53.1; 31.1-80.8). Thirty-three (33%) had a right arm SA < 83°. Seven (7%) had a right MAC outside the recommended range. BMI, weight, and the right MAC showed low correlation with and explained little of the variation (with age and sex adjustment) in right arm SA (r = -0.29, -0.27, -0.31; P = 0.003, 0.007, 0.002; R2 = 0.09, 0.08, 0.10). Forty-two (42%) reported noninvasive blood pressure measurement caused severe pain, and 30 (30%) reported skin damage. Themes identified in free-text responses were "problems with equipment," "feelings and experiences," and "concerns about accuracy." CONCLUSIONS: Current equipment is inadequate for patients with obesity based on MAC and conicity. Pain and skin damage contributed to negative experiences of these patients.


Assuntos
Braço/anatomia & histologia , Determinação da Pressão Arterial/instrumentação , Pressão Sanguínea/fisiologia , Obesidade/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Sensors (Basel) ; 20(1)2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31906383

RESUMO

This paper presents a newly-designed and realized Invasive Blood Pressure (IBP) device for the simulation on patient's monitors. This device shows improvements and presents extended features with respect to a first prototype presented by the authors and similar systems available in the state-of-the-art. A peculiarity of the presented device is that all implemented features can be customized from the developer and from the point of view of the end user. The realized device has been tested, and its performances in terms of accuracy and of the back-loop measurement of the output for the blood pressure regulation utilization have been described. In particular, an accuracy of ±1 mmHg at 25 °C, on a range from -30 to 300 mmHg, was evaluated under different test conditions. The designed device is an ideal tool for testing IBP modules, for zero setting, and for calibrations. The implemented extended features, like the generation of custom waveforms and the Universal Serial Bus (USB) connectivity, allow use of this device in a wide range of applications, from research to equipment maintenance in clinical environments to educational purposes. Moreover, the presented device represents an innovation, both in terms of technology and methodologies: It allows quick and efficient tests to verify the proper functioning of IBP module of patients' monitors. With this innovative device, tests can be performed directly in the field and faster procedures can be implemented by the clinical maintenance personnel. This device is an open source project and all materials, hardware, and software are fully available for interested developers or researchers.


Assuntos
Determinação da Pressão Arterial/instrumentação , Monitores de Pressão Arterial , Pressão Sanguínea/fisiologia , Monitorização Fisiológica/instrumentação , Determinação da Pressão Arterial/métodos , Calibragem , Desenho de Equipamento , Humanos , Monitorização Fisiológica/métodos , Software
20.
Blood Press Monit ; 25(2): 115-117, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31913149

RESUMO

OBJECTIVE: The aim of this study was to evaluate the accuracy of the InBody BPBIO250 oscillometric upper-arm professional office blood pressure (BP) monitor in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018). METHODS: Subjects were recruited to fulfil the age, gender, BP, and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method. Two cuffs of the test device were used for arm circumference 22-32 (medium) and 32-42 cm (large). RESULTS: Ninety-seven subjects were recruited and 88 were analyzed. For validation criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 1.9 ± 5.9/0.9 ± 4.9 mmHg (systolic/diastolic). For criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 4.78/4.31 mmHg (systolic/diastolic). CONCLUSION: The InBody BPBIO250 professional oscillometric device for office BP measurement fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in general population and can be recommended for clinical use.


Assuntos
Hipertensão , Determinação da Pressão Arterial/instrumentação , Monitores de Pressão Arterial/normas , Diástole , Humanos , Hipertensão/fisiopatologia , Oscilometria , Sociedades Médicas , Sístole
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