Noninvasive continuous monitoring versus intermittent oscillometric measurements for the detection of hypotension during digestive endoscopy

Abstract

Background: 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.

Purpose: To compare the ability of noninvasive continuous monitoring with that of intermittent oscillometric measurements to detect hypotension during digestive endoscopy.

Methods: 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.

Results: 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.

Conclusion: 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.

Fig 1. Flow of participants through the study.

Fig 2. Comparison between mean arterial pressure measures by standard (oscillometric) and noninvasive continuous (Clearsight^™) monitoring techniques.

Data are presented as box-and-whisker plot with median, quartiles (25%-75%) and percentiles (10^th-90^th); circles are the data below or above those limits. T1: Prior to anesthetic induction; T2: After anesthetic induction; T3: During gastric insufflation; T4: At the end of the gastroscopy; T5: During colonic insufflation.

Fig 3. Comparison of the rate of arterial hypotension measured by noninvasive continuous monitoring between moderate and major insufflation.

Fig 4. Stroke volume (SV) evolution during endoscopy using noninvasive continuous monitoring.

Data are presented as box-and-whisker plot with median, quartiles (25%-75%) and percentiles (10^th-90^th); circles are the data below or above those limits. T1: Prior to anesthetic induction; T2: After anesthetic induction; T3: During gastric insufflation; T4: At the end of the gastroscopy; T5: During colonic insufflation.