title: Accuracy of the CNAP monitor, a noninvasive continuous blood pressure device, in providing beat-to-beat blood pressure readings in the prone position.
abstract: OBJECTIVE
  To assess the accuracy of a noninvasive continuous arterial pressure (CNAP) monitor in patients who are positioned prone in the operating room.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Operating room at a children's hospital.
  
  
  METHODS
  20 pediatric patients, aged 13.8 ± 2 years, and weight 63.7 ± 18.8 kg, scheduled for surgery in the prone position, and for which arterial catheter placement was planned.
  
  
  METHODS
  Measurements were recorded with an arterial line (AL) and a new noninvasive continuous blood pressure (BP) monitor.
  
  
  METHODS
  Systolic (SBP), diastolic (DBP), and mean arterial (MAP) pressure readings were captured from an arterial cannula and the CNAP device every minute during anesthesia.
  
  
  RESULTS
  The study cohort consisted of analysis of 4104 pairs of SBP, DBP, and MAP values, which showed an absolute difference between the AL and CNAP device readings of 7.9 ± 6.3 mmHg for SBP, 5.3 ± 4.3 mmHg for DBP, and 4.6 ± 3.9 mmHg for MAP. Bland-Altman analysis of MAP values showed a bias of 0.26 mmHg, with upper and lower limits of agreement of 12.18 mmHg and -11.67 mmHg, respectively. CNAP readings deviated from arterial values by ≤ 5 mmHg in 67% of MAP values, 59% of DBP values, and 43% of SBP readings. The difference was ≤ 10 mmHg for 94% of MAP readings, 90% of DBP values, and 73% of SBP readings.
  
  
  CONCLUSIONS
  During prone positioning, the CNAP monitor provided clinically acceptable accuracy for MAP values, similar to those reported in adults in the supine position.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH 43205, USA. elisabeth.dewhirst@osumc.edu
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Dewhirst
authors.forename: Marco
authors.initials: M
authors.lastname: Corridore
authors.forename: Jan
authors.initials: J
authors.lastname: Klamar
authors.forename: Allan
authors.initials: A
authors.lastname: Beebe
authors.forename: Julie
authors.initials: J
authors.lastname: Rice
authors.forename: N'diris
authors.initials: N
authors.lastname: Barry
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D000293:Adolescent; D062186:Arterial Pressure / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D015924:Blood Pressure Monitors; D002648:Child; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D016684:Prone Position; D011446:Prospective Studies
keywords: Anesthesia; Blood pressure monitoring devices; Hemodynamics; Hypotension; Pediatric; Pediatrics; intraoperative