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The T-Line TL-200 system for continuous non-invasive blood pressure measurement in medical intensive care unit patients

Bernd Saugel| Florian Fassio| Alexander Hapfelmeier| Agnes S. Meidert| Roland M. Schmid| Wolfgang Huber
Original
Volume 38, Issue 9 / September , 2012

Pages 1471 - 1477

Abstract

Purpose

The T-Line TL-200 (Tensys Medical, San Diego, CA, USA) is a non-invasive arterial blood pressure (BP) monitoring system allowing continuous “beat-to-beat” monitoring of systolic arterial pressure (SAP), mean arterial pressure (MAP), and diastolic arterial pressure (DAP). It provides a real-time BP waveform like that obtained using an arterial catheter. The aim of this study was to compare BP measurements obtained using the T-Line TL-200 with simultaneous invasive BP measurements using a femoral arterial catheter in unselected critically ill medical patients.

Methods

In 28 patients treated in a medical intensive care unit (ICU), BP values were simultaneously obtained using a femoral arterial catheter and the T-Line TL-200. All recorded data were included in the final analysis. For comparison of BP measurements, Bland–Altman analysis accounting for repeated measurements was performed (primary endpoint).

Results

A total of 76,826 pairs of BP measurements (each consisting of SAP, MAP, and DAP) were analyzed. For MAP, Bland–Altman analysis revealed a mean difference of +0.47 mmHg (95 % limits of agreement −16.53 to +17.46 mmHg). For SAP and DAP, the bias and 95 % limits of agreement were −9.01 mmHg (−37.47 to +19.45 mmHg) and +5.22 mmHg (−13.50 to +23.94 mmHg), respectively.

Conclusions

Non-invasive, continuous, radial BP measurement with the T-Line TL-200 is basically feasible in medical ICU patients (with a low bias for MAP compared to MAP assessed using a femoral arterial catheter). High limits of agreement (particularly of SAP and DAP) preclude the use of the device as a single source of BP information in unstable critically ill patients.

Keywords

References

  1. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377
    • View reference on PubMed
    • View reference on publisher's website
  2. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Cheang M (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34:1589–1596
    • View reference on PubMed
    • View reference on publisher's website
  3. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S (2011) Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52:e162–e193
    • View reference on PubMed
    • View reference on publisher's website
  4. Janelle GM, Gravenstein N (2006) An accuracy evaluation of the T-Line Tensymeter (continuous noninvasive blood pressure management device) versus conventional invasive radial artery monitoring in surgical patients. Anesth Analg 102:484–490
    • View reference on PubMed
    • View reference on publisher's website
  5. Szmuk P, Pivalizza E, Warters RD, Ezri T, Gebhard R (2008) An evaluation of the T-Line Tensymeter continuous noninvasive blood pressure device during induced hypotension. Anaesthesia 63:307–312
    • View reference on PubMed
    • View reference on publisher's website
  6. Dueck R, Goedje O, Clopton P (2012) Noninvasive continuous beat-to-beat radial artery pressure via TL-200 applanation tonometry. J Clin Monit Comput 26:75–83
    • View reference on PubMed
    • View reference on publisher's website
  7. Bland JM, Altman DG (2007) Agreement between methods of measurement with multiple observations per individual. J Biopharm Stat 17:571–582
    • View reference on PubMed
    • View reference on publisher's website
  8. Frezza EE, Mezghebe H (1998) Indications and complications of arterial catheter use in surgical or medical intensive care units: analysis of 4932 patients. Am Surg 64:127–131
    • View reference on PubMed
  9. Jeleazcov C, Krajinovic L, Munster T, Birkholz T, Fried R, Schuttler J, Fechner J (2010) Precision and accuracy of a new device (CNAPTM) for continuous non-invasive arterial pressure monitoring: assessment during general anaesthesia. Br J Anaesth 105:264–272
    • View reference on PubMed
    • View reference on publisher's website
  10. Hahn R, Rinosl H, Neuner M, Kettner SC (2012) Clinical validation of a continuous non-invasive haemodynamic monitor (CNAP™ 500) during general anaesthesia. Br J Anaesth 108:581–585
  11. Ilies C, Bauer M, Berg P, Rosenberg J, Hedderich J, Bein B, Hinz J, Hanss R (2012) Investigation of the agreement of a continuous non-invasive arterial pressure device in comparison with invasive radial artery measurement. Br J Anaesth 108:202–210
    • View reference on PubMed
    • View reference on publisher's website
  12. Eeftinck Schattenkerk DW, van Lieshout JJ, van den Meiracker AH, Wesseling KR, Blanc S, Wieling W, van Montfrans GA, Settels JJ, Wesseling KH, Westerhof BE (2009) Nexfin noninvasive continuous blood pressure validated against Riva-Rocci/Korotkoff. Am J Hypertens 22:378–383
    • View reference on PubMed
    • View reference on publisher's website
  13. Nowak RM, Sen A, Garcia AJ, Wilkie H, Yang JJ, Nowak MR, Moyer ML (2011) Noninvasive continuous or intermittent blood pressure and heart rate patient monitoring in the ED. Am J Emerg Med 29:782–789
    • View reference on PubMed
    • View reference on publisher's website
  14. Galluccio ST, Chapman MJ, Finnis ME (2009) Femoral-radial arterial pressure gradients in critically ill patients. Crit Care Resusc 11:34–38
    • View reference on PubMed
  15. Dorman T, Breslow MJ, Lipsett PA, Rosenberg JM, Balser JR, Almog Y, Rosenfeld BA (1998) Radial artery pressure monitoring underestimates central arterial pressure during vasopressor therapy in critically ill surgical patients. Crit Care Med 26:1646–1649
    • View reference on PubMed
    • View reference on publisher's website
  16. Mignini MA, Piacentini E, Dubin A (2006) Peripheral arterial blood pressure monitoring adequately tracks central arterial blood pressure in critically ill patients: an observational study. Crit Care 10:R43
    • View reference on PubMed
    • View reference on publisher's website
  17. Segers P, Mahieu D, Kips J, Rietzschel E, De Buyzere M, De Bacquer D, Bekaert S, De Backer G, Gillebert T, Verdonck P, Van Bortel L (2009) Amplification of the pressure pulse in the upper limb in healthy, middle-aged men and women. Hypertension 54:414–420
    • View reference on PubMed
    • View reference on publisher's website

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