An Evaluation of the NICCI Monitor in Providing Continuous, Noninvasive Blood Pressure Readings in Children During Intraoperative Anesthetic Care

Background: In specific clinical scenarios or with patient comorbid con-ditions, continuous blood pressure (BP) monitoring may be required as it can be expected to provide superior physiologic monitoring to intermit-tent techniques. However, continuous BP monitoring requires an arte-rial cannula (AC) placement, which may be time-consuming, technically challenging, or associated with adverse events. Various noninvasive BP devices have been developed which provide a continuous BP reading. The current study evaluates the accuracy of a novel continuous BP de-vice, the NICCI monitor (NM), in pediatric patients weighing 10 -40 kg.Methods: The study cohort included pediatric patients weighing be-tween 10 and 40 kg, scheduled for surgery for which placement of an AC was planned. Systolic (SBP), diastolic (DBP), and mean arterial (MAP) blood pressure readings were captured from the AC and the NM every second during anesthetic care.Results: The study cohort included 24 pediatric patients undergoing major orthopedic, cardiac, and neurosurgical procedures. A total of 146,562 pairs of SBP, DBP, and MAP values from the AC and NC were analyzed. The absolute difference for the NM and the AC's SBP, DBP, and MAP values were 11 +/- 9, 10 +/- 7, and 10 +/- 7 mm Hg, re-spectively. The difference between the BP values from the NM and the AC was <= 10 mm Hg for 57% of the SBP readings, 60% of the DBP readings, and 56% of the MAP readings. The bias was 4, 4, and 6 mm Hg for the SBP, DBP, and MAP, respectively.Conclusions: Although there were some technical limitations given pa-tient size, potentially resulting in variation in accuracy, the NM provided a continuous noninvasive BP measurement within clinically useful lim-its during a significant portion of anesthetic care compared to values ob- tained from an AC. Ongoing modification of the technology to improve its application in pediatric patients will likely increase its accuracy.