Application And Evaluation Of Noninvasive Blood Pressure And Hemoglobin Monitoring In Congenital Heart Disease Children Undergoing Cardiac Surgery

Objective To evaluate the agreement of blood pressure measurement between oscillometric method and invasive artery cannulation in anesthetized children with congenital heart disease and assess the accuracy of continuous noninvasive hemoglobin?SpHb?measurememt and blood gas analysis?BGAHb?in pediatric patients with cyanotic congenital heart disease,respectively.Method One-hundred and eighty patients undergoing selective correction operation were included.They were divided into four groups:N1=55?isolated VSD/upper limbs?,N2=60?isolated VSD/lower limbs?,N3=40?isolated CoA/lower limbs?,N4=25?isolated PDA/lower limbs?.A stable hemodynamic condition period was chosen to recording non-invasive and invasive readings.In 60 preoperative children,hemoglobin concentration was measured by a noninvasive method,a laboratory hematology analyzer and a blood gas analyzer.Agreement between the results was assessed by Bland–Altman analysis.Results In group N1,The mean difference and 95%limits of agreement?95%LOA?between NIBP and IABP measurements was-7.00mmHg?-25.26,11.25?for SBP,-2.08mmHg?-15.18,9.57?for DBP,and-1.27 mmHg?-12.73,10.19?for MAP.In group N2,The mean difference and95%LOA between NIBP and IABP measurements was-3.02mmHg?-16.96,10.92?for SBP,-9.75mmHg?-22.59,3.10?for DBP,and-4.07 mmHg?-15.45,7.32?for MAP.In group N3,The mean difference and 95%LOA between NIBP and IABP measurements was 3.83mmHg?-19.30,26.96?for SBP,-8.73mmHg?-26.24,8.79?for DBP,and-3.24 mmHg?-18.84,12.37?for MAP.In group N4,The mean difference and 95%LOA between NIBP and IABP measurements was-2.62mmHg?-19.69,14.45?for SBP,-3.45mmHg?-17.89,10.99?for DBP,and-3.38mmHg?-15.96,9.20?for MAP.The bias/limits of agreement between SpHb and labHb,BGAHb and labHb were-0.71/-5.67 to 4.24 g·dl^-1,0.38/-0.81 to 1.57 g·dl^-1,respectively.Conclusion In children with isolated VSD,the agreement between oscillometric method and invasive method was good for MAP and DBP measurement at upper limbs and SBP and MAP measurement at lower limbs.The agreement between methods was good only for MAP measurement at lower limbs in children with isolated CoA,and in children with isolated PDA,the agreement between two methods was good for SBP,DBP and MAP measurement at lower limbs.In patients with cyanotic congenital heart disease,both methods showed clinically relevant differences from the reference method.However,the measurement of hemoglobin using a blood gas analyzer agreed more with the reference method than noninvasive measurement of hemoglobin.