Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 13, Number 3, June 2022, pages 154-161

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

Figure 1. The NICCI device with the calibrating noninvasive blood pressure cuff and finger cuffs in place. The inflation of the two finger cuffs is alternated to avoid pressure injury. The external pressure required to maintain blood flow within the fingers is measured using infrared technology which is converted into a continuous waveform on the monitor.

Figure 2. Bland-Altman analysis of the systolic blood pressure (SBP) from the arterial cannula (AC) and the NICCI device, both in mm Hg. The difference between the values (NICCI and AC) are plotted on the vertical axis and the average of the two values on the horizontal access. The red lines demonstrate the 95% limits of agreement (-23 to +31 mm Hg), and the blue line corresponds to the bias (2 mm Hg). BP: blood pressure.

Figure 3. Bland-Altman analysis of the diastolic blood pressure (DBP) from the arterial cannula (AC) and the NICCI device, both in mm Hg. The difference between the values (NICCI and AC) are plotted on the vertical axis and the average of the two values on the horizontal access. The red lines demonstrate the 95% limits of agreement (-19 to +26 mm Hg), and the blue line corresponds to the bias (3 mm Hg). BP: blood pressure.

Figure 4. Bland-Altman analysis of the mean arterial pressure (MAP) from the arterial cannula (AC) and the NICCI device, both in mm Hg. The difference between the values (NICCI and AC) are plotted on the vertical axis and the average of the two values on the horizontal access. The red lines demonstrate the 95% limits of agreement (-16 to +25 mm Hg), and the blue line corresponds to the bias (4 mm Hg).

**Table 1.** Demographic and Clinical Characteristics of the Study Cohort
Patient and surgical characteristics	Data
Data are presented as n (%), mean ± SD. SD: standard deviation; ASA: American Society of Anesthesiology; BMI: body mass index.
Gender (female/male)	23/21
Age (years)	15 ± 2
Weight (kg)	56 ± 10
Height (cm)	162 ± 9
BMI (kg/m²)	22 ± 4
Type of procedure
Orthopedic	40
Cardiothoracic	2
Neurosurgical	2
Patient position
Prone	40
Supine	3
Lateral	1
ASA Physical Classification
I	8
II	22
III	13
IV	1

Table 1. Demographic and Clinical Characteristics of the Study Cohort

Patient and surgical characteristics

Data

Data are presented as n (%), mean ± SD. SD: standard deviation; ASA: American Society of Anesthesiology; BMI: body mass index.

Gender (female/male)

23/21

Age (years)

15 ± 2

Weight (kg)

56 ± 10

Height (cm)

162 ± 9

BMI (kg/m²)

22 ± 4

Type of procedure

Orthopedic

Cardiothoracic

Neurosurgical

Patient position

Prone

Supine

Lateral

ASA Physical Classification

III

**Table 2.** Comparison of Blood Pressure Readings From the AC and the NICCI Monitor
Parameter	Difference between AC and NICCI	Percentage of NICCI readings ≤ 5 mm Hg from AC value	Percentage of NICCI readings ≤ 10 mm Hg from AC value	Percentage of NICCI readings > 10 mm Hg from AC value	Correlation coefficient
Data are displayed in mm Hg as the mean ± SD of absolute values or as percentages. Values are compared to those obtained from the AC. *Correlation is significant with a P value ≤ 0.01 (two-tailed). SD: standard deviation; SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure; AC: arterial cannula.
SBP	10 ± 8	35%	60%	40%	0.60*
DBP	9 ± 7	39%	67%	33%	0.55*
MAP	9 ± 7	31%	56%	44%	0.59*

Table 2. Comparison of Blood Pressure Readings From the AC and the NICCI Monitor

Parameter

Difference between AC and NICCI

Percentage of NICCI readings ≤ 5 mm Hg from AC value

Percentage of NICCI readings ≤ 10 mm Hg from AC value

Percentage of NICCI readings > 10 mm Hg from AC value

Correlation coefficient

Data are displayed in mm Hg as the mean ± SD of absolute values or as percentages. Values are compared to those obtained from the AC. *Correlation is significant with a P value ≤ 0.01 (two-tailed). SD: standard deviation; SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure; AC: arterial cannula.

SBP

10 ± 8

35%

60%

40%

0.60*

DBP

9 ± 7

39%

67%

33%

0.55*

MAP

9 ± 7

31%

56%

44%

0.59*

**Table 3.** Comparison of Blood Pressure Readings From the AC and the NICCI Monitor Based on Weight
Parameter	Difference between AC and NICCI	Percentage of NICCI readings ≤ 5 mm Hg from AC value	Percentage of NICCI readings ≤ 10 mm Hg from AC value	Percentage of NICCI readings > 10 mm Hg from AC value	Correlation coefficient
Data are displayed in mm Hg as the mean ± SD of absolute values or as percentages. Values are compared to those obtained from the AC. *Correlation is significant with a P value ≤ 0.01 (two-tailed). SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure; AC: arterial cannula.
Patients weighing 40 - 60 kg
SBP	10 ± 9	34%	60%	40%	0.70^*
DBP	9 ± 8	39%	66%	34%	0.68^*
MAP	9 ± 8	35%	63%	37%	0.81^*
Patients weighing 60 - 80 kg
SBP	10 ± 9	37%	62%	38%	0.64^*
DBP	9 ± 8	41%	69%	31%	0.67^*
MAP	8 ± 7	41%	70%	30%	0.56^*

Table 3. Comparison of Blood Pressure Readings From the AC and the NICCI Monitor Based on Weight

Parameter

Difference between AC and NICCI

Percentage of NICCI readings ≤ 5 mm Hg from AC value

Percentage of NICCI readings ≤ 10 mm Hg from AC value

Percentage of NICCI readings > 10 mm Hg from AC value

Correlation coefficient

Data are displayed in mm Hg as the mean ± SD of absolute values or as percentages. Values are compared to those obtained from the AC. *Correlation is significant with a P value ≤ 0.01 (two-tailed). SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure; AC: arterial cannula.

Patients weighing 40 - 60 kg

SBP

10 ± 9

34%

60%

40%

0.70^*

DBP

9 ± 8

39%

66%

34%

0.68^*

MAP

9 ± 8

35%

63%

37%

0.81^*

Patients weighing 60 - 80 kg

SBP

10 ± 9

37%

62%

38%

0.64^*

DBP

9 ± 8

41%

69%

31%

0.67^*

MAP

8 ± 7

41%

70%

30%

0.56^*

**Table 4.** Comparison of SBP and MAP Readings From the AC and NICCI Monitor
Parameter	SBP ≤ 70 mm Hg	SBP > 70 mm Hg	MAP ≤ 50 mm Hg	MAP > 50 mm Hg
Data are displayed in mm Hg as the mean ± SD of absolute values or as percentages. Values are compared to those obtained from the AC. SD: standard deviation; SBP: systolic blood pressure; MAP: mean arterial pressure; AC: arterial cannula.
AC	3%	62 ± 6	97%	93 ± 12	2.3%	48 ± 3	97.7%	66 ± 8
NICCI	7%	62 ± 7	93%	97 ± 13	5.5%	45 ± 5	94.5%	72 ± 11

Table 4. Comparison of SBP and MAP Readings From the AC and NICCI Monitor

Parameter

SBP ≤ 70 mm Hg

SBP > 70 mm Hg

MAP ≤ 50 mm Hg

MAP > 50 mm Hg

Percent of values

Mean ± SD

Percent of values

Mean ± SD

Percent of values

Mean ± SD

Percent of values

Mean ± SD

Data are displayed in mm Hg as the mean ± SD of absolute values or as percentages. Values are compared to those obtained from the AC. SD: standard deviation; SBP: systolic blood pressure; MAP: mean arterial pressure; AC: arterial cannula.

62 ± 6

97%

93 ± 12

2.3%

48 ± 3

97.7%

66 ± 8

NICCI

62 ± 7

93%

97 ± 13

5.5%

45 ± 5

94.5%

72 ± 11

**Table 5.** Bland-Altman Analysis Comparing Blood Pressure Readings From the AC and NICCI Monitor
Parameter	Bias	Precision	95% level of agreement
Data are presented in mm Hg rounded to the nearest whole integer. Values are compared to those obtained from an AC. SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure; AC: arterial cannula.
SBP	2	13	-23 to +31
DBP	3	11	-19 to +26
MAP	4	12	-16 to +25

Table 5. Bland-Altman Analysis Comparing Blood Pressure Readings From the AC and NICCI Monitor

Parameter

Bias

Precision

95% level of agreement

Data are presented in mm Hg rounded to the nearest whole integer. Values are compared to those obtained from an AC. SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure; AC: arterial cannula.

SBP

-23 to +31

DBP

-19 to +26

MAP

-16 to +25