Ameloot 2015

REVIEW
URRENT
C
OPINION
The accuracy of noninvasive cardiac output

and pressure measurements with finger cuff:
a concise review
Koen Ameloot a,b, Pieter-Jan Palmers a,b, and Manu L.N.G. Malbrain c,d
Purpose of review
The present review aims to summarize literature on the accuracy of the finger cuff method to measure
cardiac output (CO) and blood pressure, its ability to track hemodynamic changes, and to predict fluid
responsiveness.
Recent findings
Finger cuff is an easy-to-use hemodynamic monitoring technique. Different devices are currently available,
which provide continuous arterial blood pressure (Finapress), whereas only ClearSight (previously known
as Nexfin; BMEYE) provides an estimate of CO. In most studies, the criteria for clinical interchangeability
(for CO) were not met, when compared with the currently used invasive monitoring systems such as
uncalibrated CO via a radial artery line, and calibrated CO either via a pulmonary artery catheter or a
femoral artery catheter connected to the PiCCO (Pulsion Medical Systems) or VolumeView (Edwards
Lifesciences) devices. In particular, ClearSight obtained CO seems to be less accurate in patients with a
low CO. However, in most patients, ClearSight is able to track hemodynamic changes induced by a fluid
challenge or passive leg raising test. We will discuss in this review the relevant literature with regard to
validation of the finger cuff technique for both arterial blood pressure and CO.
Summary
The finger cuff method provides a reasonable estimate of CO and blood pressure, which does not meet the
criteria for clinical interchangeability with the currently used invasive devices.
Keywords
blood pressure, cardiac output, finger cuff, hemodynamic monitoring, noninvasive, thermodilution
INTRODUCTION
Global hemodynamics may change on a minute-tominute basis in critically ill patients. Therefore,
continuous hemodynamic monitoring is of paramount importance [1]. In addition, continuous
hemodynamic monitoring is crucial for real-time
monitoring of the hemodynamic effects of ongoing
therapeutic interventions. Many intensive care
physicians use either a pulmonary artery catheter
(PAC) in combination with an arterial line or a
device based on transpulmonary thermodilution
with either the PiCCO system (PiCCO2; Pulsion
Medical Systems, Munich, Germany) or the VolumeView (Edwards Lifesciences, Irvine, California,
USA) as golden standard to guide fluid resuscitation
and to adjust inotropic and vasopressive agents
[2,3 ]. However, both PiCCO and PAC require invasive catheters and therefore increase the risk of
iatrogenic complications such as pneumothorax,
&&
www.co-criticalcare.com
bleeding, catheter sepsis, and deep venous thrombosis [4]. Moreover, the setup of both systems is time
consuming, they are cost intensive, and cannot be
used prehospital or on a regular ward. Currently,
different devices are available using the finger cuff
method to measure arterial blood pressure continuously (CNAP, FinaPress, ClearSight), whereas some
of these devices also have the possibility to monitor
Department of Cardiology, bDepartment of Intensive Care, University

Hospitals Leuven, Leuven, cDepartment of Intensive Care and
d
Department of High Care Burn Unit, Ziekenhuis Netwerk Antwerpen,
ZNA Stuivenberg, Antwerp, Belgium
Correspondence to Dr Manu L.N.G. Malbrain, MD, PhD, ICU and High
Care Burn Unit Director, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Lange Beeldekensstraat 267, B-2060 Antwerp 6 Belgium. Tel: +32
3 217 7399; fax: + 32 3 217 7574; e-mail: manu.malbrain@skynet.be
Curr Opin Crit Care 2015, 21:232239
DOI:10.1097/MCC.0000000000000198
Volume 21 Number 3 June 2015
Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.
The accuracy of noninvasive cardiac output and pressure measurements with finger cuff Ameloot et al.
KEY POINTS
The finger cuff method provides a reasonable estimate
of cardiac output and blood pressure, which does not
meet the criteria for clinical interchangeability with the
currently used invasive devices.
ClearSight can be applied for an initial quick
hemodynamic assessment as a bridge to installation of
a more advanced invasive monitoring system.
ClearSight showed some accuracy to track the
hemodynamic changes induced by fluid loading or
pharmacological interventions.
ClearSight obtained SVV/PPV shows a correlation with
PiCCO as predictors of volume responsiveness.
cardiac output (CO). The ClearSight (BMEYE,

Amsterdam, the Netherlands) device is the most
widely studied in critically ill patients and is a totally
noninvasive continuous blood pressure and CO
monitor based on finger arterial pressure pulse contour analysis. Potential advantages include its noninvasiveness and ease of use. Questions arose on the
accuracy of ClearSight measurements in critically ill
patients, as there is no initial calibration of the
monitoring system to adjust for the unique mechanical properties of each patients arterial tree.
Moreover, there are concerns about the reliability
of continuous noninvasive finger cuff blood pressure derived pulse contour analysis in critically ill
patients with reduced perfusion of the hand because
of high systemic vascular resistance or hypothermia
or even peripheral edema [5 ,6]. The aims of this
review are to summarize current literature on the
basic principle of finger cuff blood obtained continuous pressure and derived CO via pulse contour
analysis, the feasibility of ClearSight in critically ill
patients, the accuracy of ClearSight to measure CO
and blood pressure, the ability of ClearSight to track
hemodynamic changes, and predict fluid responsiveness and finally to review the potential fields
of application in critically ill patients. We will focus
on the ClearSight device as it has been most
widely studied.
&
BASIC PRINCIPLES OF THE FINGER CUFF

METHOD
The ClearSight (BMEYE) method is based on the
measurement of finger arterial pressure by an inflatable cuff around the middle phalange of the finger
(Fig. 1). The pulsating finger artery is clamped to a
constant volume by applying a varying counter
pressure equivalent to the arterial pressure using a
FIGURE 1. The ClearSight device with wrist unit connected

to the finger cuff with screenshot of arterial blood pressure
curve and trending analysis (circle).
built-in photoelectric plethysmograph and an automatic algorithm (Physiocal). The resulting finger
arterial pressure waveform is reconstructed into a
brachial artery pressure waveform by a generalized
algorithm. CO is calculated by a pulse contour
method (CO-TREK), using the measured systolic
pressure time integral and the hearts afterload
determined from the Windkessel model [7].
FEASIBILITY IN CRITICALLY ILL PATIENTS

ClearSight measurements are feasible in the
majority of ICU and operating room patients
(between 85 and 100%) [5 ,813]. Many authors
reported failure of the device to measure pressure
at any of the fingers in patients with an extreme low
flow in the finger arteries. In addition, we previously
reported a short time to first measurement (<5 min
in 85% of patients), a limited number of repositions
needed to start measuring and high scores on the
nurse questionnaires, illustrating that the device is
very easy to use (plug and play) in the majority of
patients [5 ].
&
&
ACCURACY OF CARDIAC OUTPUT

MONITORING
ClearSight CO has been studied against several
golden standard techniques including PiCCO,
1070-5295 Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.
233
234
Scientific World
Journal 2013
Anesth Analg
2013
Acta Anesth
Scand 2013
Anesthesia 2012
J Clin Anesth 2012
Br J Anesth 2012
Crit Care 2012
Anaesthesia 2010
BMC Anesthesiol
2009
BubenekTurconi
Fischer
Broch
Chen
Fischer
Monnet
Bogert
Stover

PiCCO
[15]
[20]
[11]
[12]
[16]
[14]
[18]
[17]
PAC
PAC
PiCCO
PiCCO
TEE
PiCCO
PiCCO
PAC
PiCCO
&
[8]
[5 ]
PAC
ICU, surgical
ICU, postcardiac
ICU, mixed
ICU, postcardiac
ICU, noncardiac
OR, elective cardiac
ICU, postcardiac
ICU, postcardiac
ICU, mixed
ICU, postcardiac
OR, elective
cardiac
Golden
standard Setting
365
10
25
38
44
25
40
37
28
45
20
53
Bias
NA
NA
NA
NA
7.2 2.3 0.91
5.5 1.4
6.8
5.0 1.2 0.56
4.7 1.8 0.91
4.8 1.2 0.82
4.9 1.1 0.71
6.2 2.1 0.82
NA
0.71
0.10
0.33
0.23
0.44
0.4
0.02
0.88
0.2
0.21
0.05
0.4
0.26
5.2 0.8 0.53 0.35
1094 5.4 1.6 0.79
80
25
76
120
66
80
74
47
135
20
371
Patients Pairs Average

(n)
(n)
CO
29
29
57
50
37
24
56
39
36
39
58
PE
1.22
44
1.15 41.3
1.05
0.81
2.00
1.2
0.86
0.6
1.29
1.05
1.16
1.1
1.5
SD
bias
0.67
0.01
1.18 56
0.14
1.35 55
0.31 1.70 62
3.9 1.4 0.89
After phenylefrine
0.74
5.4 1.7 0.92
5.3
0.9
NA
NA
Baseline
After CPBP
5
4.3
After fluid
Before CPBP
4.1
Baseline
0.7
5.6 1.3
After fluid
1.05
0.75
0.2
0.2
0.01
0.4
0.00
0.1
38
33
26
23
0.83 42
0.9
0.7
0.5
1.45 58
1.12 55
1.1
1.00 39
7.0 2.1 0.76 0.48 1.49 43

4.9 1.1 0.71
8h
Baseline
6.6 2.3 0.84 0.22 1.84 56
0.51 0.01 1.38 51
0.4
0.51
0.46 0.91 1.33 44
0.35 0.78 1.42 47
4h
5.4
1 day postoperative
SD
bias PE
6.1 2.0 0.83 0.05 1.23 40
5.5
Before extubation
Bias
0.49 0.18 1.11 52
0h
6.0
4.9
Arrival ICU
After CPBP
After protamine
4.2
6.0
Before CPBP
4.3
Average
CO
Baseline
Condition
Per condition (if data available)
CO, cardiac output; CPBP, cardiopulmonary bypass; OR, operating room; PAC, pulmonary artery catheter; PE, percentage error; R, Pearson correlation coefficient; SD, standard deviation; TEE, transesophageal
echocardiography.
Weighted
average
Statistics
J Crit Care 2014
Ameloot
&
Ref
J Cardiothorac Vasc [19 ]

Anesth 2014
Hofhuizen
Maass
First author Journal
Average per study
Table 1. Overview of studies on the validation of cardiac output measurements by ClearSight
Cardiopulmonary monitoring
PAC, and transesophageal cardiac ultrasound in 10

studies, including a total of 365 patients [5 ,8,11,12,
1418,19 ,20] (Table 1). For the purpose of this
review, we calculated a weighted average correlation, bias, and percentage error. A new CO
monitoring technique is considered to be clinically
interchangeable if the squared Pearson correlation
coefficient (R2) of the linear regression equation is
larger than 0.6 (R > 0.77), if the bias and its standard
deviation are clinically acceptable and if the percentage error is below 30% [5 ,21,22]. Some authors
reported their research in terms of cardiac index. To
allow an easier comparison for the purpose of this
review, cardiac index was converted to CO. In general, most authors reported a moderate-to-good correlation between ClearSight obtained CO and the
golden standard with a weighted average R of 0.71.
This reflects only the relationship between ClearSight and the golden standard in relative terms. In
absolute values, most authors reported a very low
systematic bias (weighted average 0.10 l/min) with a
considerable standard deviation (weighted average
1.22 l/min). This should be interpreted in the light
of the observed average CO. To take this into
account, the percentage error can be calculated by
taking two times the standard deviation of the bias
normalized by the observed average CO with the
golden standard used [22]. Almost all authors
reported a percentage error that is clinically unacceptable (weighted average 44%). Given a measured
CO with ClearSight of 5 l/min and a weighted average bias of 0.10 1.22 l/min, there is a 95% chance
that the true CO is between 2.7 and 7.5 l/min. In
this way, the added value of the obtained ClearSight
CO for the treating physicians is limited. ClearSight
obtained CO showed to be less accurate in patients
with a lower baseline CO, high peripheral resistance,
hypothermia, or peripheral edema of the fingers
[5 ]. On the contrary, ClearSight seems to perform
better in patients with a higher CO (e.g., medical
ICU, sepsis). The major reason for this is probably
mathematical (a larger denominator will result in a
lower percentage error). Critics will argue that the
added value of CO monitoring is limited in patients
with a high CO. However, because tissue perfusion
and oxygen delivery are determined directly by CO
and only indirectly by mean arterial pressure (MAP),
we strongly believe that with the development and
future fine tuning of noninvasive CO measurement
devices such as ClearSight, determination of target
therapy guidelines for CO should be considered.
several authors with conflicting results [813,15,

2326] (Table 2). In the absence of validation
criteria for continuous blood pressure monitoring
systems, all authors used the Association for the
Advancement of Medical Instrumentation criteria
designed for intermittent noninvasive blood pressure monitoring devices [27]. According to these
criteria, the bias (difference between ClearSight
and golden standard) should be less than 5 mmHg
with a standard deviation less than 8 mmHg to allow
two techniques to be used interchangeably. Most
authors reported a rather small bias (weighted average was 2 mmHg) with an almost acceptable standard deviation (weighted average of 9 mmHg). Our
calculated weighted average percentage error (22%)
is slightly above the previous suggested cutoff for
clinical interchangeability (18%). Therefore, in summary, these results indicate that the accuracy of
ClearSight obtained MAP is slightly insufficient
for full clinical interchangeability. However, at least
three authors reported a good accuracy with ClearSight obtained MAP [6,9,12]. Conflicting results
were previously explained by differences in the
study populations included and the reference techniques used. In particular, it was hypothesized that
ClearSight would not be reliable when applied in
patients with a reduced perfusion of the hand
caused by severe hypotension, a high peripheral
resistance, high dose of vasopressors, hypothermia
or peripheral edema. Disproving these concerns,
extensive subgroup analysis by our group showed
that blood pressure measurements were reliable even in the above-mentioned subgroups [6]. This is in
contrast, however, with a study by Hohn et al. [10]
that showed a poor correlation between invasive
and ClearSight MAP in patients treated with norepinephrine. Future research should focus on patient
characteristics that influence the accuracy of
ClearSight to phenotype a patient group in which
ClearSight may be used with sufficient accuracy.
Several authors also reported results about the
accuracy of ClearSight for SBP and DBP monitoring
[9,13,15,24,26]. In general, ClearSight obtained DBP
may be used interchangeably with invasive DBP
(weighted average bias 0.6 7 mmHg). Although
the bias of SBP is very low (weighted average bias
2 mmHg), the standard deviation is too high to be
clinically acceptable (weighted average standard
deviation 13 mmHg).
ACCURACY OF BLOOD PRESSURE

MONITORING
Global hemodynamics may change on a minute-tominute basis and a continuous hemodynamic

monitor should be able to track hemodynamic
changes over time to assess the effect of ongoing
&
&
&
&
Previously, the accuracy of ClearSight was evaluated

against invasive blood pressure monitoring by
ACCURACY TO TRACK HEMODYNAMIC

CHANGES
235
236
Br J Anaesth 2013
Minerva Anestesiol
2013
Hohn et al.
Broch et al.
Radial artery
Anesthesiology 2012
Am J Emerg Med 2011 [26] Noninvasive
BMC Anesthesiol 2009 [15] Radial artery
Martina et al.
Nowak et al.
Stover et al.
ICU, mixed
[13] Radial artery
[12] Radial artery
ICU, surgical
ER, mixed
OR, cardiac
ICU, postcardiac
504
10
40
50
44
41
38
50
25
29
20
112
45
(n)
77 13
101 27
63 9
74 12
77 17
77 16
71 13
76 12
84 9
NA
82 11
83 17
(mmHg)
Average
MAP
2
4.2
6
4.6
-2.6
0.82
0.79
2.1
4.3
-2
0.81 -2.05
0.96
0.87
NA
NA
0.53 10.9
0.7
18
PE
0.77
22
NA
NA
26
34
39
NA
NA
5.8
NA
NA
NA
0.53 11.4 17.1
NA
NA
NA
22
15
PE
20
30
19
17
0.7
NA
0.83
0.96
9.4
22
0.73
9.3 22.7 0.73
15
6.3
NA
23
14
NA
NA
NA
4.9
NA
29
NA
NA
32
13
25
-8.9
-0.2
NA
13
NA
NA
NA
0.75 -1.24
0.93
0.8
NA
NA
0.48
NA
2.1 13.1
22
0.73 0.6
5.3 12.9 21.5 0.72 6.6
NA
0.8
5.7
NA
38
24
25
NA
NA
47
NA
9.2
NA
NA
23
17
PE
7.6
29
8.1 27.7
NA
15
6.5
NA
13.5
NA
5.2
6.8
NA
SD
Bias bias
0.74 -9.4
0.77
7.8 0.64 -7.0
2.7 11.1 NA
NA
8.2 0.76 -7.6
NA
8.3 13.5
SD
Bias bias
7.5 19.5 NA -13.5 12.5 NA
10
13
15
5.1
4.7
2.3 12.4 14.7 0.62
SD
Bias bias
0.76 -6.9
NA
NA
0.94
0.77
10988 78.6 14.2 0.80
80
344
9000
220
41
76
100
117
NA
20
765
225
(n)
Patients Pairs
AAMI, Association for the Advancement of Medical Instrumentation; LVAD, left ventricular assist device; MAP, mean arterial pressure; OR, operating room; PE, percentage error; SD, standard deviation.
Weighted
average
Statistics
Br J Anaesth 2012
Fischer et al.
[11] PiCCO
Garnier et al.
OR, cardiac
ICU, surgical
ICU, post-LVAD
ICU, postcardiac
ICU medical
surgicalburns
OR elective
Setting
[25] Invasive arterial ICU, pediatric
Crit Care 2012
Br J Anaesth 2012
Monnet et al.
[24] Radial artery
[10] Radial artery
[9]
ASAIO J 2014
Martina et al.
Radial artery
[23] Radial artery

[8]
Hofhuizen et al. J Crit Care 2014
Vos et al.
Ameloot et al.
PiCCO
[6]
Authors
Minerva Anestesiol
2014
Br J Anaesth 2014
Golden
Ref standard
MAP SAP DAP
Table 2. Overview of studies on the validation of blood pressure measurements by ClearSight (according to AAMI criteria)
&
90
1.0
&
0.8
135
0.6
0.4
45
CO (%)
therapeutic interventions. Eight studies addressed

the accuracy of ClearSight to track changes in CO
over time [5 ,11,14,1618,19 ,27]. The level of concordance can be calculated as the percentage of pairs
with the same direction of change. On the basis of
previous reports, the concordance should be greater
than 90% when pairs with less than 15% of change
are excluded for analysis [5 ]. In general, ClearSight
performs well with reported levels of concordance
between 84 and 100% [5 ,11,16,17]. One smaller
study showed a more limited concordance when
compared with transesophageal echocardiography
as a golden standard [28]. This means that, in a
majority of cases, ClearSight changed in the same
direction as the golden standard, which would
suggest a good trending ability. Nonetheless, this
four-quadrant analysis only takes into account the
direction of CO changes and not their magnitude.
For clinical practice, not only the direction but also
the amplitude of CO changes might be important.
Therefore, Critchley et al. [29] suggested converting
the xy values to polar coordinates, in which agreement is shown by the angle the vector makes with
the line of identity (y x) and magnitude of change
by the length of the vector (example in Fig. 2). In
this way, ClearSight also showed an acceptable
trending capability with 8489% of the data points
lying within the 1.0 l/min (or 10%) limits of
agreement lines [5 ,19 ]. Five studies used a prespecified hemodynamic intervention, such as a fluid
challenge [11,17,18], administration of phenylefrine [16], or a passive leg raising test [14] to assess the
dynamical tracking ability. Results are conflicting
with reported levels of concordance between 94 and
100%, but varying correlation coefficients between
0.39 and 0.94. Three studies addressed the accuracy
of ClearSight to track changes in MAP over time and
generally a high level of concordance (between 85
and 100%) is reported [6,8,24].
&
0.2
&
&
&
ACCURACY TO PREDICT FLUID

RESPONSIVENESS
In fully sedated and mechanically ventilated
patients (in sinus rhythm), pulse pressure (PPV)
and stroke volume variation (SVV) can be considered as a golden standard for the prediction of
fluid responsiveness [30,31]. The ability of SVV and
PPV obtained with ClearSight to predict fluid
responsiveness was assessed in two studies showing
conflicting results. Fischer et al. [18] reported that
PPV and SVV given by ClearSight were not able to
predict fluid responsiveness [areas under receiver
operating characteristics curves 0.57 (95% confidence interval 0.400.73) and 0.50 (0.330.67)].
On the contrary, Lansdorp et al. [32] compared
180
1.0
0.8
0.6
0.4
0.0
0.2 0.0
0.2
0.2
0.4
0.6
0.8
0
1.0
0.4
0.6
225
315
0.8
1.0
270
FIGURE 2. Example of a polar plot. The distance from the

center of the plot represents the mean change in cardiac
output (DCO, expressed as %, with 1.0 referring to 100%
change from baseline) and the angle u with the horizontal
(08 radial) axis represents agreement. The less the
disagreement between CO measurements, the closer data
pairs will lie along the horizontal radial axis. Data with
good trending will lie within 10% limits of agreement.
However, data with poor trending will be scattered
throughout the plot and lie outside the limits of good and
acceptable agreement (i.e., 10 and 20%, respectively). The
polar plot shows 90 paired measurements of mean DCO
(%), calculated as absolute value of (DNeX CO
Dthermodilution CO)/2. From the 90 initial data, 98.9% of
the data points lie within the 20% lines and 89% within the
10% lines, suggesting acceptable trending capabilities.
Reproduced with permission from [5 ].
&
ClearSight obtained SVV/PPV with invasive SVV/

PPV in post-CABG ICU patients. They found a good
correlation (R 0.95) with a low mean bias (0.95%
for PPV and 0.22% for SVV) and a good correlation
between changes in PPV and SVV as a result of
volume expansion (R 0.88). On the basis of these
results, these authors concluded that ClearSight
SVV/PPV is accurate.
POTENTIAL FIELDS OF APPLICATION

Based on extensive review of the literature, we conclude that ClearSight is an easy-to-use hemodynamic monitor that provides a reasonable
estimate of CO and blood pressure; however, both
do not meet the criteria for clinical interchangeability with the currently used invasive techniques. We
believe the ClearSight device can be applied in ICU,
237
operating room, or emergency room patients,

potentially also on the regular wards and even out
of hospital (if the manufacturer could provide a
battery), for an initial quick hemodynamic assessment as a bridge to installation of a more advanced
invasive monitoring system. Differentiation of the
different types of shock on a clinical basis showed to
be a major challenge and often inaccurate, even in
hands of experienced ICU physicians [33]. Also,
ClearSight showed some accuracy to track the
hemodynamic changes induced by fluid loading
or pharmacological interventions and ClearSight
obtained SVV/PPV shows a correlation with PiCCO
as predictors of volume responsiveness. Finally, the
finger cuff method can be applied when catheter
placement is problematic, for instance in patients
with active catheter infections after removal of the
previously infected arterial line.
On the contrary, in our opinion there are five
main reasons why ClearSight cannot always be used
as a first choice in the general ICU population with
good intravenous and intraarterial access requiring
prolonged advanced hemodynamic monitoring.
Obviously, in general, the accuracy of ClearSight
to measure CO and MAP is slightly above the
suggested cutoffs for clinical interchangeability.
Of note however, in a recent meta-analysis, none
of the four tested methods achieved satisfactory
agreement with bolus thermodilution within the
expected 30% percentage error limits [34]. Therefore, questions are raised on the feasibility of the
current validation criteria for uncalibrated CO and a
fortiori other noninvasive devices. Second, many
studies showed that ClearSight obtained CO is less
accurate in patients with a reduced baseline CO.
Third, ClearSight cannot entirely replace (less) invasive monitoring with an arterial line because arterial
blood gas analysis and follow-up of arterial lactate
will always be one of the cornerstones of critical care
management. Fourth, in some unstable patients and
especially those with changing conditions of preload, afterload or contractility it may be advisable to
calibrate the CO device in relation to the new hemodynamic situation. Finally, ClearSight is not always
feasible in patients with an extreme low flow in the
finger arteries, hypothermia, or peripheral edema.
CONCLUSION
The finger cuff method provides a reasonable estimate of CO and blood pressure, which does not meet
the criteria for clinical interchangeability with the
currently used invasive devices. More studies are
needed to identify specific patient populations that
could benefit from the use of this promising and
totally noninvasive technique.
238
Acknowledgements
None.
Financial support and sponsorship
The present study was not financially supported.
Conflicts of interest
MLNGM is a member of the medical advisory board of
Pulsion Medical Systems. The remaining authors have no
conflicts of interest.
REFERENCES AND RECOMMENDED

READING
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&
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&&
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REVIEW

The accuracy of noninvasive cardiac output

Department of Cardiology, bDepartment of Intensive Care, University

Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.

cardiac output (CO). The ClearSight (BMEYE,

BASIC PRINCIPLES OF THE FINGER CUFF

FIGURE 1. The ClearSight device with wrist unit connected

FEASIBILITY IN CRITICALLY ILL PATIENTS

ACCURACY OF CARDIAC OUTPUT

Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.

J Clin Anesth 2012

Crit Care 2012

Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.

OR, elective cardiac

5.0 1.2 0.56

4.7 1.8 0.91

4.8 1.2 0.82

4.9 1.1 0.71

6.2 2.1 0.82

5.2 0.8 0.53 0.35

1094 5.4 1.6 0.79

Patients Pairs Average

3.9 1.4 0.89

7.0 2.1 0.76 0.48 1.49 43

6.6 2.3 0.84 0.22 1.84 56

0.51 0.01 1.38 51

0.46 0.91 1.33 44

0.35 0.78 1.42 47

6.1 2.0 0.83 0.05 1.23 40

0.49 0.18 1.11 52

Per condition (if data available)

J Crit Care 2014

J Cardiothorac Vasc [19 ]

First author Journal

Average per study

Table 1. Overview of studies on the validation of cardiac output measurements by ClearSight

Volume 21 Number 3 June 2015

PAC, and transesophageal cardiac ultrasound in 10

several authors with conflicting results [813,15,

ACCURACY OF BLOOD PRESSURE

Global hemodynamics may change on a minute-tominute basis and a continuous hemodynamic

Previously, the accuracy of ClearSight was evaluated

ACCURACY TO TRACK HEMODYNAMIC

Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.

Am J Emerg Med 2011 [26] Noninvasive

BMC Anesthesiol 2009 [15] Radial artery

[13] Radial artery

[12] Radial artery

0.53 11.4 17.1

9.3 22.7 0.73

5.3 12.9 21.5 0.72 6.6

7.8 0.64 -7.0

8.2 0.76 -7.6

7.5 19.5 NA -13.5 12.5 NA

2.3 12.4 14.7 0.62

10988 78.6 14.2 0.80

[25] Invasive arterial ICU, pediatric

Crit Care 2012

[24] Radial artery

[10] Radial artery

[23] Radial artery

Hofhuizen et al. J Crit Care 2014

MAP SAP DAP

Volume 21 Number 3 June 2015