• Moritz Flick, Alina Bergholz, Karim Kouz, Philipp Breitfeld, Rainer Nitzschke, Doris Flotzinger, and Bernd Saugel.
• From the Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (MF, AB, KK, PB, RN, BS), CNSystems Medizintechnik, Graz, Austria (DF), the Outcomes Research Consortium, Cleveland, Ohio, USA (BS).
• Eur J Anaesthesiol. 2022 Nov 1; 39 (11): 851857851-857.

BackgroundThe NICCI system (Getinge, Gothenburg, Sweden) is a new noninvasive haemodynamic monitoring system using a finger sensor.ObjectivesWe aimed to investigate the performance of the NICCI system to measure blood pressure and pulse pressure variation compared with intra-arterial measurements.DesignA prospective method comparison study.SettingUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany.PatientsForty-seven neurosurgery patients.Main Outcome MeasuresWe performed a method comparison study in 47 neurosurgery patients to compare NICCI blood pressure measurements (BP NICCI ) with intra-arterial blood pressure measurements (BP ART ) (Bland-Altman analysis, four-quadrant plot, error grid analysis) and NICCI pulse pressure variation measurements (PPV NICCI ) with pulse pressure variation calculated manually from the intra-arterial blood pressure waveform (PPV ART ) (Bland-Altman analysis, predictive agreement, Cohen's kappa).ResultsThe mean of the differences ± standard deviation (95% limits of agreement) between BP NICCI and BP ART was 11 ± 10 mmHg (-8 to 30 mmHg) for mean blood pressure (MBP), 3 ± 12 mmHg (-21 to 26 mmHg) for systolic blood pressure (SBP) and 12 ± 10 mmHg (-8 to 31 mmHg) for diastolic blood pressure (DBP). In error grid analysis, 54% of BP NICCI and BP ART MBP measurement pairs were classified as 'no risk', 43% as 'low risk', 3% as 'moderate risk' and 0% as 'significant risk' or 'dangerous risk'. The mean of the differences between PPV NICCI and PPV ART was 1 ± 3% (-4 to 6%). The predictive agreement between PPV NICCI and PPV ART was 80% and Cohen's kappa was 0.55.ConclusionsThe absolute agreement between BP NICCI and BP ART was not clinically acceptable. We recommend not using the current version of the NICCI system for blood pressure monitoring during surgery. The absolute agreement between PPV NICCI and PPV ART was clinically acceptable with moderate predictive agreement regarding pulse pressure variation categories. The NICCI system needs to be further developed and re-evaluated when an improved version is available.Trial RegistrationThe study was registered in the German Clinical Trials Register (DRKS00023188) on 2 October 2020.Copyright © 2022 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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