Nexfin

Manufactured by Edwards Lifesciences

Sourced in Canada, United States

The Nexfin is a non-invasive medical device that continuously measures arterial blood pressure. It uses a finger cuff to detect changes in the volume of blood vessels and provides real-time monitoring of blood pressure.

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Lab products found in correlation

Cardiocap 5, by GE Healthcare (4 mentions) Nexfin co trek, by Edwards Lifesciences (2 mentions) Tonocap, by GE Healthcare (1 mentions) Matlab r2007b, by MathWorks (1 mentions) Hem 907xl, by Omron (1 mentions) Sphygmocor system, by AtCor Medical (1 mentions) Datex ohmeda, by GE Healthcare (1 mentions) Bio amp, by ADInstruments (1 mentions)

24 protocols using nexfin

Noninvasive Cardiovascular Monitoring Protocol

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Heart rate was measured using a three‐lead electrocardiograph (ECG). Beat‐to‐beat blood pressure (BP) was measured by the volume clamp method using a finger cuff (Nexfin, Edwards Lifesciences, Ontario, Canada). The cuff was placed on the right middle finger and referenced to the level of the heart using a height correct unit for BP correction. MAP was obtained by integration of the pressure curve divided by the duration of the cardiac cycle. This method has been shown to reliably measure the dynamic changes in beat‐to‐beat BP which correlate well with the intraarterial BP recordings and can be used to describe the dynamic relationship between BP and cerebral blood velocity (Omboni et al. 1993; Sammons et al. 2007).

Labrecque L., Rahimaly K., Imhoff S., Paquette M., Le Blanc O., Malenfant S., Lucas S.J., Bailey D.M., Smirl J.D, & Brassard P. (2017). Diminished dynamic cerebral autoregulatory capacity with forced oscillations in mean arterial pressure with elevated cardiorespiratory fitness. Physiological Reports, 5(21), e13486.

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Cardiovascular Autonomic Function in RA

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In the study cohort, during one single visit demographics, anthropometric data, smoking and alcohol status, medical history, RA medication history and current medication were obtained between 8:30 and 10 am, after patients had fasted for 8 to 10 h. Continuous heart rate (HR) and blood pressure (BP) measurements were obtained non-invasively using finger arterial pressure waveform recording of the left hand by Nexfin (Edwards Lifesciences, BMEYE B.V. Amsterdam, the Netherlands), a validated method to assess HRV parameters (Rang et al., 2004 (link), Prevoo et al., 1995 (link)). The recording session contained two parts: ten-minute period in supine (resting) position, and a ten-minute period of orthostatic stress in upright (active) position. Individuals were allowed to equilibrate to the positional change before data were collected, followed by assessment of RA disease activity (Disease Activity Score of 28 joints (DAS28) with erythrocyte sedimentation rate (ESR) (Prevoo et al., 1995 (link))) and a blood draw.
In the validation cohort we determined vital signs at yearly visits, including resting heart rate (RHR) in sitting position, using an automated monitor system. This measurement took place in non-fasting state either in the morning or the afternoon.

Koopman F.A., Tang M.W., Vermeij J., de Hair M.J., Choi I.Y., Vervoordeldonk M.J., Gerlag D.M., Karemaker J.M, & Tak P.P. (2016). Autonomic Dysfunction Precedes Development of Rheumatoid Arthritis: A Prospective Cohort Study. EBioMedicine, 6, 231-237.

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Noninvasive Cardiovascular Monitoring Protocol

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Heart rate (HR) was measured using a 5‐lead ECG. Beat‐to‐beat BP and cardiac output (CO) were measured by the volume‐clamp method using a finger cuff (Nexfin, Edwards Lifesciences, Ontario, Canada). The cuff was placed on the right middle finger and referenced to the level of the heart using a height correct unit for BP correction. MAP was obtained by integration of the pressure curve divided by the duration of the cardiac cycle. The volume‐clamp method has been shown to reliably index the dynamic changes in beat‐to‐beat BP which correlate well with the intra‐arterial BP recordings and can be used to describe the dynamic relationship between BP and cerebral blood velocity (Sammons et al. 2007; Omboni et al. 1993).

Labrecque L., Rahimaly K., Imhoff S., Paquette M., Le Blanc O., Malenfant S., Drapeau A., Smirl J.D., Bailey D.M, & Brassard P. (2019). Dynamic cerebral autoregulation is attenuated in young fit women. Physiological Reports, 7(2), e13984.

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Hemodynamic Monitoring in Critical Care

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Blood pressure (BP) was continuously measured using a non-invasive volume clamp method (Nexfin, Edwards Lifesciences BMEYE, Amsterdam, the Netherlands). Left ventricular SV was estimated by a pulse contour method (Nexfin CO-trek, Edwards Lifesciences BMEYE, Amsterdam, the Netherlands) [24 (link), 25 (link)] and CO was SV times heart rate (HR). SV index (SVI) was the ratio of SV and body surface area [26 ]. SPV and PPV were calculated from the BP signal:

100 \times \frac{A_{max} - A_{min}}{(A_{max} + A_{min}) / 2}

with A_max/min equal to, respectively, systolic arterial pressure (SAP) and pulse pressure (PP; SAP minus diastolic arterial pressure (DAP)). PPV and SPV were calculated for each breath and averaged over 5 consecutive breaths.
Airway flow and pressure were measured using an Alveotest flowmeter (Jaeger, Würzburg, Germany), tidal volume (TV) was the integral of airway flow (expressed in mL per kg predicted body weight) and end-tidal CO₂ (PetCO₂) was measured by capnography (Tonocap, Datex-Ohmeda, Madison, USA). Signals were visually inspected for artefacts and 60-second intervals were used for offline analysis (Matlab R2007b, Mathworks Inc. MA, USA).

Bronzwaer A.S., Ouweneel D.M., Stok W.J., Westerhof B.E, & van Lieshout J.J. (2015). Arterial Pressure Variation as a Biomarker of Preload Dependency in Spontaneously Breathing Subjects – A Proof of Principle. PLoS ONE, 10(9), e0137364.

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Hemodynamic Responses During Squat-Stand Maneuvers

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Height and body mass of all participants were measured (Table 1). Then, resting hemodynamics of all participants was recorded for 10 min in the supine position. Heart rate was measured by 5‐lead ECG and blood pressure was measured using arterial volume clamping (Nexfin, Edwards Lifesciences, Ontario, Canada) on the middle finger of the right hand. MCAv was monitored with a 2 MHz pulsed transcranial Doppler ultrasound (Doppler Box, Compumedics DWL USA, Inc.). End‐tidal partial pressure of carbon dioxide (P_ETCO₂) was recorded by a gas analyzer (Breezesuite, MedGraphics Corp.) during baseline rest and repeated squat‐stand maneuvers. The gas analyzer was calibrated according to the manufacturer's instructions before each measurement.

Abbariki F., Roy M., Labrecque L., Drapeau A., Imhoff S., Smirl J.D, & Brassard P. (2022). Influence of high‐intensity interval training to exhaustion on the directional sensitivity of the cerebral pressure‐flow relationship in young endurance‐trained men. Physiological Reports, 10(13), e15384.

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Cardiovascular Measurements During Rest

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Heart rate (HR) was recorded via continuous three-lead electrocardiogram, and systemic blood pressure was assessed (beat-to-beat) via finger plethysmography (Nexfin; Edwards Lifesciences, Irvine, CA) on the nonexercising hand. Brachial artery pressure was measured in duplicate using an automated cuff (Cardiocap/5, Datex-Ohmeda, Louisville, CO) prior to beginning exercise trials while the subjects were in a supine position following 15 min of rest.

Hughes W.E., Ueda K., Treichler D.P, & Casey D.P. (2015). Rapid onset vasodilation with single muscle contractions in the leg: influence of age. Physiological Reports, 3(8), e12516.

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Non-invasive Cardiovascular Monitoring

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A non-invasive SV monitor, the Nexfin (Edwards Lifesciences), was used throughout the study and synchronized with the carotid Doppler monitor for each cardiac cycle. Alignment of the Doppler spectrograms to the non-invasive SV monitor was performed by cross-correlating heart rate (HR) to find the optimal lag in the Doppler signal. Systolic, diastolic and mean arterial pressure were also obtained from the Nexfin.

Kerrebijn I., Atwi S., Elfarnawany M., Eibl A.M., Eibl J.K., Taylor J.L., Kim C.H., Johnson B.D, & Kenny J.É. (2024). The correlation between carotid artery Doppler and stroke volume during central blood volume loss and resuscitation. Acute and Critical Care, 39(1), 162-168.

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Noninvasive Hemodynamic Monitoring During Physiological Challenges

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Continuous blood pressure (BP) was measured noninvasively by finger plethysmography with the cuff placed around the middle phalanx of the nondominant hand placed at heart level (Nexfin, Edwards Lifesciences BMEYE, the Netherlands). Left ventricular stroke volume (SV) was estimated beat by beat by pulse contour (Nexfin CO‐trek, Edwards Lifesciences BMEYE, Amsterdam, the Netherlands) and by inert gas rebreathing (Innocor, Innovision A/S, Odense, Denmark) (Gabrielsen et al. 2002; Bartels et al. 2011). CO was stroke volume (SV) times heart rate (HR). Total peripheral resistance (TPR) was the ratio of mean arterial pressure (BP_mean) and CO. End‐tidal CO₂ partial pressure (PetCO₂) was monitored through a nasal cannula connected to a sampling capnograph (Datex Normocap 200, Helsinki, Finland).
Changes in MCAV were followed in the proximal segment of the middle cerebral artery (MCA) by transcranial Doppler ultrasonography (TCD; DWL Multidop X4, Sipplingen, Germany). The left MCA was insonated through the temporal window just above the zygomatic arch at a depth of 40–60 mm with a pulsed 2 MHz probe. Once the optimal signal‐to‐noise ratio was obtained, the probe was immobilized by a head band.

Bronzwaer A.G., Verbree J., Stok W.J., Daemen M.J., van Buchem M.A., van Osch M.J, & van Lieshout J.J. (2017). Aging modifies the effect of cardiac output on middle cerebral artery blood flow velocity. Physiological Reports, 5(17), e13361.

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Continuous Noninvasive Blood Pressure Monitoring

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Seated BP was measured in triplicate using standard technique. Beat-to-beat arterial BP was measured continuously and noninvasively using digital pulse photoplethysmography12 (link), 13 (link) (NexFin, Edwards LifeSciences, Irvine, CA).

Park S.H., Fonkoue I.T., Li Y., DaCosta D.R., Middlekauff H.R, & Park J. (2018). Augmented Cardiopulmonary Baroreflex Sensitivity in Intradialytic Hypertension. Kidney International Reports, 3(6), 1394-1402.

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Endothelium-Dependent Vascular Reactivity Assessment

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Venous occlusion plethysmography (EC-6, D.E. Hokanson Inc. Indianapolis, IN) was used to determine endothelium-dependent reactivity in the left forearm and left calf (14 ). Baseline blood flow was measured by inflating the distal cuff (wrist or ankle) to a supra-systolic pressure (220 mmHg) then cyclically inflating the respective proximal cuff (upper arm or thigh) to 60 mmHg every 15 seconds for two minutes. Baseline blood flow was the average of all eight cycles. Following baseline, circulation to the experimental limb was arrested for five minutes by rapidly inflating the proximal cuffs to 240 mmHg inducing ischemia. Peak blood flow (BF_Peak) was the highest measurement observed following deflation (reactive hyperemia). Total blood flow (BF_Total) for three minutes after cuff release was recorded and was defined as the area under the curve using the trapezium rule (28 (link)). Vascular conductance served as a surrogate of vasodilatory capacity and calculated as blood flow/mean arterial pressure (Nexfin, Edwards Lifesciences Irvine, CA). Peak and total vascular conductance (VC_Peak and VC_Total, respectively) were determined in the same fashion as BF_Peak and BF_Total, respectively. Blood pressure and plethysmography data were collected at 250 Hz and analyzed offline (WinDaq, DATAQ Instruments Akron, OH).

Bock J.M., Treichler D.P., Norton S.L., Ueda K., Hughes W.E, & Casey D.P. (2018). Inorganic nitrate supplementation enhances functional capacity and lower-limb microvascular reactivity in patients with peripheral artery disease. Nitric oxide : biology and chemistry, 80, 45-51.

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