J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 14, Number 4, April 2022, pages 158-164

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

Figure 1. The NICCI device attached to a patient in the prone position with the calibrating noninvasive blood pressure cuff and finger cuffs in place (left). The inflation of the two finger cuffs is alternated to avoid pressure injury. The external pressure required to maintain blood flow within the fingers is measured using infrared technology. The pressure is then converted into a continuous readout which is displayed on the bedside monitor (right).

Figure 2. Bland-Altman analysis of the agreement for systolic blood pressure (SBP) readings from the arterial cannula (AC) and the NICCI monitor (NM). The difference between the NM and AC values are plotted on the vertical axis while the average of the two values is plotted on the horizontal access. All values are in mm Hg. The red horizontal lines demonstrate the 95% limits of agreement, and the blue horizontal line corresponds to the bias.

Figure 3. Bland-Altman analysis of the agreement for diastolic blood pressure (DBP) readings from the arterial cannula (AC) and the NICCI monitor (NM). The difference between the NM and AC values are plotted on the vertical axis while the average of the two values is plotted on the horizontal access. All values are in mm Hg. The red horizontal lines demonstrate the 95% limits of agreement, and the blue horizontal line corresponds to the bias.

Figure 4. Bland-Altman analysis of the agreement for mean arterial pressure (MAP) readings from the arterial cannula (AC) and the NICCI monitor (NM). The difference between the NM and AC values are plotted on the vertical axis while the average of the two values is plotted on the horizontal access. All values are in mm Hg. The red horizontal lines demonstrate the 95% limits of agreement, and the blue horizontal line corresponds to the bias.

**Table 1.** Demographic and Clinical Characteristics of Study Cohort
	10 - 40 kg	10 - 25 kg	25 - 40 kg
Data are presented as n (%), mean ± SD. BMI: body mass index; ASA: American Society of Anesthesiology; SD: standard deviation.
Gender, n (%)
Female	12 (50)	3 (43)	9 (53)
Male	12(50)	4 (57)	8 (47)
Age (years)	11 ± 4	6 ± 2	13 ± 3
Weight (kg)	30 ± 8	20 ± 4	34 ± 4
Height (cm)	134 ± 19	112 ± 13	142 ± 14
BMI (kg/m²)	17 ± 2	16 ± 2	17 ± 2
Type of procedure (n)
Orthopedic	17	3	14
Cardiothoracic	4	2	2
Neurosurgical	3	2	1
Patient position (n)
Prone	18	4	14
Supine	6	3	3
ASA physical class (n)
I	1	0	1
II	10	3	7
III	10	3	7
IV	3	1	2

Table 1. Demographic and Clinical Characteristics of Study Cohort

10 - 40 kg

10 - 25 kg

25 - 40 kg

Data are presented as n (%), mean ± SD. BMI: body mass index; ASA: American Society of Anesthesiology; SD: standard deviation.

Gender, n (%)

Female

12 (50)

3 (43)

9 (53)

Male

12(50)

4 (57)

8 (47)

Age (years)

11 ± 4

6 ± 2

13 ± 3

Weight (kg)

30 ± 8

20 ± 4

34 ± 4

Height (cm)

134 ± 19

112 ± 13

142 ± 14

BMI (kg/m²)

17 ± 2

16 ± 2

17 ± 2

Type of procedure (n)

Orthopedic

Cardiothoracic

Neurosurgical

Patient position (n)

Prone

Supine

ASA physical class (n)

III

**Table 2.** Comparison of Blood Pressure Readings From the Arterial Cannula and the NM Monitor
Parameter	Arterial cannula vs. NM	Percentage of NM readings ≤ 5 mm Hg from AC	Percentage of NM readings ≤ 10 mm Hg from AC	Percentage of NM readings > 10 mm Hg from AC	Correlation coefficient
Data are displayed in mm Hg as the mean ± SD of absolute values or as percentages. Values are compared to those obtained from the arterial cannula. BP: blood pressure; MAP: mean arterial pressure; NM: NICCI monitor; AC: arterial cannula; SD: standard deviation. *Correlation is significant with a P value ≤ 0.01 (two-tailed).
Systolic BP	11 ± 9	32%	57%	43%	0.65*
Diastolic BP	10 ± 7	35%	60%	40%	0.43*
MAP	10 ± 7	31%	56%	44%	0.59*

Table 2. Comparison of Blood Pressure Readings From the Arterial Cannula and the NM Monitor

Parameter

Arterial cannula vs. NM

Percentage of NM readings ≤ 5 mm Hg from AC

Percentage of NM readings ≤ 10 mm Hg from AC

Percentage of NM readings > 10 mm Hg from AC

Correlation coefficient

Data are displayed in mm Hg as the mean ± SD of absolute values or as percentages. Values are compared to those obtained from the arterial cannula. BP: blood pressure; MAP: mean arterial pressure; NM: NICCI monitor; AC: arterial cannula; SD: standard deviation. *Correlation is significant with a P value ≤ 0.01 (two-tailed).

Systolic BP

11 ± 9

32%

57%

43%

0.65*

Diastolic BP

10 ± 7

35%

60%

40%

0.43*

MAP

10 ± 7

31%

56%

44%

0.59*

**Table 3.** Bland-Altman Analysis Comparing Blood Pressure Readings From the Arterial Cannula and NM Monitor
Parameter	Bias	Precision	95% level of agreement
Data are presented in mm Hg rounded to the nearest whole integer. Values are compared to those obtained from an arterial cannula. BP: blood pressure; MAP: mean arterial pressure; NM: NICCI monitor.
Systolic BP	4	14	-23 to +31
Diastolic BP	4	12	-19 to +26
MAP	6	12	-17 to +28

Table 3. Bland-Altman Analysis Comparing Blood Pressure Readings From the Arterial Cannula and NM Monitor

Parameter

Bias

Precision

95% level of agreement

Data are presented in mm Hg rounded to the nearest whole integer. Values are compared to those obtained from an arterial cannula. BP: blood pressure; MAP: mean arterial pressure; NM: NICCI monitor.

Systolic BP

-23 to +31

Diastolic BP

-19 to +26

MAP

-17 to +28

**Table 4.** Comparison of Blood Pressure Readings From the Arterial Cannula and NM Monitor Based on Weight
Parameter	Arterial cannula vs. NM	Percentage of NM readings ≤ 5 mm Hg from AC	Percentage of NM readings ≤ 10 mm Hg from AC	Percentage of NM readings > 10 mm Hg from AC	Correlation coefficient
Data are displayed in mm Hg as the mean ± SD of absolute values or as percentages. Values are compared to those obtained from the arterial cannula. BP: blood pressure; MAP: mean arterial pressure; NM: NICCI monitor; AC: arterial cannula; SD: standard deviation. *Correlation is significant with a P value ≤ 0.01 (two-tailed).
10 - 25 kg
Systolic BP	10 ± 8	36	59	40	0.70*
Diastolic BP	9 ± 7	40	66	34	0.83*
MAP	10 ± 7	27	56	44	0.77*
25 - 40 kg
Systolic BP	11 ± 9	31	56	44	0.73*
Diastolic BP	10 ± 7	34	59	41	0.69*
MAP	11 ± 8	31	56	44	0.66*

Table 4. Comparison of Blood Pressure Readings From the Arterial Cannula and NM Monitor Based on Weight

Parameter

Arterial cannula vs. NM

Percentage of NM readings ≤ 5 mm Hg from AC

Percentage of NM readings ≤ 10 mm Hg from AC

Percentage of NM readings > 10 mm Hg from AC

Correlation coefficient

10 - 25 kg

Systolic BP

10 ± 8

0.70*

Diastolic BP

9 ± 7

0.83*

MAP

10 ± 7

0.77*

25 - 40 kg

Systolic BP

11 ± 9

0.73*

Diastolic BP

10 ± 7

0.69*

MAP

11 ± 8

0.66*

**Table 5.** Bland-Altman Analysis Based on Weight
Parameter	Bias	Precision	95% level of agreement
Data are presented in mm Hg rounded to the nearest whole integer. Values are compared to those obtained from an arterial cannula. BP: blood pressure; MAP: mean arterial pressure.
10 - 25 kg
Systolic BP	7	11	-15 to +29
Diastolic BP	6	10	-13 to +25
MAP	9	8	-8 to +26
25 - 40 kg
Systolic BP	3	14	-24 to + 31
Diastolic BP	4	12	-20 to + 27
MAP	5	12	-19 to + 28

Table 5. Bland-Altman Analysis Based on Weight

Parameter

Bias

Precision

95% level of agreement

Data are presented in mm Hg rounded to the nearest whole integer. Values are compared to those obtained from an arterial cannula. BP: blood pressure; MAP: mean arterial pressure.

10 - 25 kg

Systolic BP

-15 to +29

Diastolic BP

-13 to +25

MAP

-8 to +26

25 - 40 kg

Systolic BP

-24 to + 31

Diastolic BP

-20 to + 27

MAP

-19 to + 28