University of Twente Student Theses


Accuracy of arterial blood pressure waveform measurement via catheter manometer systems in neonatal intensive care

Timmermans, N.A. (2023) Accuracy of arterial blood pressure waveform measurement via catheter manometer systems in neonatal intensive care.

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Embargo date:23 March 2025
Abstract:Background: Advanced analysis of the arterial blood pressure waveform (ABPW), as part of comprehensive hemodynamic monitoring in critically ill neonates, requires an accurate measurement method. Measuring blood pressure with a liquid-filled catheter manometer system (CMS) is currently considered the gold standard in neonates. However, the measured ABPW may be distorted by an inadequate dynamic response (DR) of the CMS. Although it is generally understood how an inadequate DR can affect the measured ABPW in adults, the DR characteristics of the CMS currently used in neonatal intensive care and their effect on the neonatal ABPW remain unknown. Aim: The primary aim of this study is to evaluate the accuracy of the ABPW measured in neonatal intensive care based on DR characteristics of liquid-filled CMS. To improve the accuracy of the measured ABPW, the secondary aim is to provide the initial validation of a reconstruction method for ABPW in case of inadequate DR. Methods: First, the flush pulse method for assessing the DR characteristics of neonatal CMS was validated in-vitro. Subsequently, this method was applied to assess the in-vivo DR characteristics of CMS at the neonatal intensive care unit. Computer simulations were performed to quantify the effect of the total monitoring chain, composed of a CMS and monitor low pass filter, on several neonatal ABPW parameters. Lastly, a measurement-specific reconstruction method for distorted ABPW was proposed and initially validated. Results: DR characteristics were assessed in 18 patients with 20 arterial lines in total. Based on these measurements, computer simulations of the CMS and monitor low pass filter showed that the errors in pulse and dicrotic notch pressures, maximal slope of the systolic upstroke and systolic area under the curve of a neonatal ABPW could exceed 10%. Furthermore, considerable variation in DR characteristics across and within individual arterial lines was found. Initial validation of the proposed reconstruction method for distorted ABPW showed that this method is not yet adequate for clinical practice. Conclusion: Accuracy of the ABPW measured in critically ill neonates can be considerably affected by the DR of CMS in combination with the monitor low pass filter. Until the accuracy of ABPW measurement is improved or a valid reconstruction method exists, it is not recommended to investigate or implement advanced ABPW analysis techniques in neonatal intensive care.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine, 50 technical science in general
Programme:Technical Medicine MSc (60033)
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