Noninvasive continuous monitoring versus intermittent oscillometric measurements for the detection of hypotension during digestive endoscopy
Hemodynamic monitoring during digestive endoscopy is usually minimal and involves intermittent brachial pressure measurements. New continuous noninvasive devices to acquire instantaneous arterial blood pressure may be more sensitive to detect procedural hypotension. To compare the ability of noninva...
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| description | Hemodynamic monitoring during digestive endoscopy is usually minimal and involves intermittent brachial pressure measurements. New continuous noninvasive devices to acquire instantaneous arterial blood pressure may be more sensitive to detect procedural hypotension.
To compare the ability of noninvasive continuous monitoring with that of intermittent oscillometric measurements to detect hypotension during digestive endoscopy.
In this observational prospective study, patients scheduled for gastrointestinal endoscopy and colonoscopy under sedation were monitored using intermittent pressure measurements and a noninvasive continuous technique (ClearSight™, Edwards). Stroke volume was estimated from the arterial pressure waveform. Mean arterial pressure and stroke volume values were recorded at T1 (prior to anesthetic induction), T2 (after anesthetic induction), T3 (gastric insufflation), T4 (end of gastroscopy), T5 (colonic insufflation). Hypotension was defined as mean arterial pressure < 65 mmHg.
Twenty patients (53±17 years) were included. Six patients (30%) had a hypotension detected using intermittent pressure measurements versus twelve patients (60%) using noninvasive continuous monitoring (p = 0.06). Mean arterial pressure decreased during the procedure with respect to T1 (p < 0.05), but the continuous method provided an earlier warning than the intermittent method (T3 vs T4). Nine patients (45%) had at least a 25% reduction in stroke volume, with respect to baseline.
Noninvasive continuous monitoring was more sensitive than intermittent measurements to detect hypotension. Estimation of stroke volume revealed profound reductions in systemic flow. Noninvasive continuous monitoring in high-risk patients undergoing digestive endoscopy under sedation could help in detecting hypoperfusion earlier than the usual intermittent blood pressure measurements. |
| doi_str_mv | 10.1371/journal.pone.0240241 |
| format | Article |
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To compare the ability of noninvasive continuous monitoring with that of intermittent oscillometric measurements to detect hypotension during digestive endoscopy.
In this observational prospective study, patients scheduled for gastrointestinal endoscopy and colonoscopy under sedation were monitored using intermittent pressure measurements and a noninvasive continuous technique (ClearSight™, Edwards). Stroke volume was estimated from the arterial pressure waveform. Mean arterial pressure and stroke volume values were recorded at T1 (prior to anesthetic induction), T2 (after anesthetic induction), T3 (gastric insufflation), T4 (end of gastroscopy), T5 (colonic insufflation). Hypotension was defined as mean arterial pressure < 65 mmHg.
Twenty patients (53±17 years) were included. Six patients (30%) had a hypotension detected using intermittent pressure measurements versus twelve patients (60%) using noninvasive continuous monitoring (p = 0.06). Mean arterial pressure decreased during the procedure with respect to T1 (p < 0.05), but the continuous method provided an earlier warning than the intermittent method (T3 vs T4). Nine patients (45%) had at least a 25% reduction in stroke volume, with respect to baseline.
Noninvasive continuous monitoring was more sensitive than intermittent measurements to detect hypotension. Estimation of stroke volume revealed profound reductions in systemic flow. Noninvasive continuous monitoring in high-risk patients undergoing digestive endoscopy under sedation could help in detecting hypoperfusion earlier than the usual intermittent blood pressure measurements.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0240241</identifier><identifier>PMID: 33007051</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Anesthesia ; Anesthesiology ; Biology and Life Sciences ; Blood pressure ; Blood Pressure - physiology ; Blood Pressure Determination - methods ; Blood pressure measurement ; Colon ; Colonoscopy ; Critical care ; Diagnosis ; Endoscopy ; Endoscopy, Gastrointestinal - methods ; Gastroenterology ; Gastrointestinal endoscopy ; Gastroscopy ; Hemodynamics ; Humans ; Hypotension ; Hypotension - physiopathology ; Intraoperative monitoring ; Medicine ; Medicine and Health Sciences ; Methods ; Middle Aged ; Monitoring ; Oscillometry - methods ; Patients ; Pressure measurement ; Prospective Studies ; Pulse oximetry ; Risk groups ; Stroke ; Stroke volume ; Telemedicine ; Variance analysis ; Ventilators ; Waveforms</subject><ispartof>PloS one, 2020-10, Vol.15 (10), p.e0240241</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Phan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Phan et al 2020 Phan et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-aa212d7313937a27f5fc15acf845edd58fa2f83a19864131777b90a404facf083</citedby><cites>FETCH-LOGICAL-c692t-aa212d7313937a27f5fc15acf845edd58fa2f83a19864131777b90a404facf083</cites><orcidid>0000-0002-1365-181X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531858/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531858/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33007051$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Farag, Ehab</contributor><creatorcontrib>Phan, Anh-Dao</creatorcontrib><creatorcontrib>Neuschwander, Arthur</creatorcontrib><creatorcontrib>Perrod, Guillaume</creatorcontrib><creatorcontrib>Rahmi, Gabriel</creatorcontrib><creatorcontrib>Cellier, Christophe</creatorcontrib><creatorcontrib>Cholley, Bernard</creatorcontrib><title>Noninvasive continuous monitoring versus intermittent oscillometric measurements for the detection of hypotension during digestive endoscopy</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Hemodynamic monitoring during digestive endoscopy is usually minimal and involves intermittent brachial pressure measurements. New continuous noninvasive devices to acquire instantaneous arterial blood pressure may be more sensitive to detect procedural hypotension.
To compare the ability of noninvasive continuous monitoring with that of intermittent oscillometric measurements to detect hypotension during digestive endoscopy.
In this observational prospective study, patients scheduled for gastrointestinal endoscopy and colonoscopy under sedation were monitored using intermittent pressure measurements and a noninvasive continuous technique (ClearSight™, Edwards). Stroke volume was estimated from the arterial pressure waveform. Mean arterial pressure and stroke volume values were recorded at T1 (prior to anesthetic induction), T2 (after anesthetic induction), T3 (gastric insufflation), T4 (end of gastroscopy), T5 (colonic insufflation). Hypotension was defined as mean arterial pressure < 65 mmHg.
Twenty patients (53±17 years) were included. Six patients (30%) had a hypotension detected using intermittent pressure measurements versus twelve patients (60%) using noninvasive continuous monitoring (p = 0.06). Mean arterial pressure decreased during the procedure with respect to T1 (p < 0.05), but the continuous method provided an earlier warning than the intermittent method (T3 vs T4). Nine patients (45%) had at least a 25% reduction in stroke volume, with respect to baseline.
Noninvasive continuous monitoring was more sensitive than intermittent measurements to detect hypotension. Estimation of stroke volume revealed profound reductions in systemic flow. Noninvasive continuous monitoring in high-risk patients undergoing digestive endoscopy under sedation could help in detecting hypoperfusion earlier than the usual intermittent blood pressure measurements.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia</subject><subject>Anesthesiology</subject><subject>Biology and Life Sciences</subject><subject>Blood pressure</subject><subject>Blood Pressure - physiology</subject><subject>Blood Pressure Determination - methods</subject><subject>Blood pressure measurement</subject><subject>Colon</subject><subject>Colonoscopy</subject><subject>Critical care</subject><subject>Diagnosis</subject><subject>Endoscopy</subject><subject>Endoscopy, Gastrointestinal - methods</subject><subject>Gastroenterology</subject><subject>Gastrointestinal endoscopy</subject><subject>Gastroscopy</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Hypotension - physiopathology</subject><subject>Intraoperative monitoring</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Monitoring</subject><subject>Oscillometry - methods</subject><subject>Patients</subject><subject>Pressure measurement</subject><subject>Prospective Studies</subject><subject>Pulse oximetry</subject><subject>Risk groups</subject><subject>Stroke</subject><subject>Stroke volume</subject><subject>Telemedicine</subject><subject>Variance analysis</subject><subject>Ventilators</subject><subject>Waveforms</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk92K1DAUx4so7rr6BqIFQfRixqRJms6NsCyrDiwu-HUbsulJJ0ObjEk6OO-wD206012mshfSQtOT3_mf5Hxk2UuM5phw_GHtem9lO984C3NU0PTiR9kpXpBiVhaIPD5an2TPQlgjxEhVlk-zE0IQ4ojh0-z2q7PGbmUwW8iVs9HY3vUh75I5Om9sk2_Bh2QxNoLvTIxgY-6CMm3rOojeqLwDGXoPXdoJuXY-jyvIa4igonE2dzpf7TYuOYbht-73srVpIMQhLNg66bnN7nn2RMs2wIvxe5b9_HT54-LL7Or68_Li_GqmykURZ1IWuKg5wWRBuCy4ZlphJpWuKIO6ZpWWha6IxIuqpJhgzvnNAkmKqE4QqshZ9vqgu2ldEGMigygorTAuSk4TsTwQtZNrsfGmk34nnDRib3C-EdJHo1oQJaNUl1LXCmHKKllRqVQqB0aUEcZJ0vo4RutvOqhVypKX7UR0umPNSjRuKzgjuGLDcd-NAt797lPSRGeCgraVFlKt9uemKIFlQt_8gz58u5FqZLqAsdqluGoQFecl4QXGFR6o-QNUemroTGoV0CbZJw7vJw5DO8Gf2Mg-BLH8_u3_2etfU_btEbsC2cZVcG0_NFeYgvQAKu9C8KDvk4yRGIbmLhtiGBoxDk1ye3VcoHunuykhfwFHmhVl</recordid><startdate>20201002</startdate><enddate>20201002</enddate><creator>Phan, Anh-Dao</creator><creator>Neuschwander, Arthur</creator><creator>Perrod, Guillaume</creator><creator>Rahmi, Gabriel</creator><creator>Cellier, Christophe</creator><creator>Cholley, Bernard</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-1365-181X</orcidid></search><sort><creationdate>20201002</creationdate><title>Noninvasive continuous monitoring versus intermittent oscillometric measurements for the detection of hypotension during digestive endoscopy</title><author>Phan, Anh-Dao ; Neuschwander, Arthur ; Perrod, Guillaume ; Rahmi, Gabriel ; Cellier, Christophe ; Cholley, Bernard</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-aa212d7313937a27f5fc15acf845edd58fa2f83a19864131777b90a404facf083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia</topic><topic>Anesthesiology</topic><topic>Biology and Life Sciences</topic><topic>Blood pressure</topic><topic>Blood Pressure - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Phan, Anh-Dao</au><au>Neuschwander, Arthur</au><au>Perrod, Guillaume</au><au>Rahmi, Gabriel</au><au>Cellier, Christophe</au><au>Cholley, Bernard</au><au>Farag, Ehab</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Noninvasive continuous monitoring versus intermittent oscillometric measurements for the detection of hypotension during digestive endoscopy</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-10-02</date><risdate>2020</risdate><volume>15</volume><issue>10</issue><spage>e0240241</spage><pages>e0240241-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Hemodynamic monitoring during digestive endoscopy is usually minimal and involves intermittent brachial pressure measurements. New continuous noninvasive devices to acquire instantaneous arterial blood pressure may be more sensitive to detect procedural hypotension.
To compare the ability of noninvasive continuous monitoring with that of intermittent oscillometric measurements to detect hypotension during digestive endoscopy.
In this observational prospective study, patients scheduled for gastrointestinal endoscopy and colonoscopy under sedation were monitored using intermittent pressure measurements and a noninvasive continuous technique (ClearSight™, Edwards). Stroke volume was estimated from the arterial pressure waveform. Mean arterial pressure and stroke volume values were recorded at T1 (prior to anesthetic induction), T2 (after anesthetic induction), T3 (gastric insufflation), T4 (end of gastroscopy), T5 (colonic insufflation). Hypotension was defined as mean arterial pressure < 65 mmHg.
Twenty patients (53±17 years) were included. Six patients (30%) had a hypotension detected using intermittent pressure measurements versus twelve patients (60%) using noninvasive continuous monitoring (p = 0.06). Mean arterial pressure decreased during the procedure with respect to T1 (p < 0.05), but the continuous method provided an earlier warning than the intermittent method (T3 vs T4). Nine patients (45%) had at least a 25% reduction in stroke volume, with respect to baseline.
Noninvasive continuous monitoring was more sensitive than intermittent measurements to detect hypotension. Estimation of stroke volume revealed profound reductions in systemic flow. Noninvasive continuous monitoring in high-risk patients undergoing digestive endoscopy under sedation could help in detecting hypoperfusion earlier than the usual intermittent blood pressure measurements.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33007051</pmid><doi>10.1371/journal.pone.0240241</doi><tpages>e0240241</tpages><orcidid>https://orcid.org/0000-0002-1365-181X</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Anesthesia Anesthesiology Biology and Life Sciences Blood pressure Blood Pressure - physiology Blood Pressure Determination - methods Blood pressure measurement Colon Colonoscopy Critical care Diagnosis Endoscopy Endoscopy, Gastrointestinal - methods Gastroenterology Gastrointestinal endoscopy Gastroscopy Hemodynamics Humans Hypotension Hypotension - physiopathology Intraoperative monitoring Medicine Medicine and Health Sciences Methods Middle Aged Monitoring Oscillometry - methods Patients Pressure measurement Prospective Studies Pulse oximetry Risk groups Stroke Stroke volume Telemedicine Variance analysis Ventilators Waveforms |
| title | Noninvasive continuous monitoring versus intermittent oscillometric measurements for the detection of hypotension during digestive endoscopy |
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