Skip to main content
Top
Published in: Journal of Clinical Monitoring and Computing 2/2021

01-04-2021 | Original Research

Real-time estimation of mean arterial blood pressure based on photoplethysmography dicrotic notch and perfusion index. A pilot study

Authors: Jona Joachim, Maxime Coutrot, Sandrine Millasseau, Joaquim Matéo, Alexandre Mebazaa, Etienne Gayat, Fabrice Vallée

Published in: Journal of Clinical Monitoring and Computing | Issue 2/2021

Login to get access

Abstract

Hypotension during general anesthesia is associated with poor outcome. Continuous monitoring of mean blood pressure (MAP) during anesthesia is useful and needs to be reliable and minimally invasive. Conventional cuff measurements can lead to delays due to its discontinuous nature. It has been shown that there is a relationship between MAP and photoplethysmography (PPG) parameters like the dicrotic notch and perfusion index (PI). The objective of the study was to continuously estimate MAP from PPG. Pulse wave analysis based on PPG was implemented using either notch relative amplitude (MAPNRA), notch absolute amplitude (MAPNAA) or PI (MAPPI) to estimate MAP from PPG waveform features during general anesthesia. Estimated MAP values were compared to brachial cuff MAP (MAPcuff) and to radial invasive MAP (MAPinv). Forty-six patients were analyzed for a total of 235 h. Compared to MAPcuff, mean bias and limits of agreement were 1 mmHg (− 26 to +29), − 1 mmHg (− 10 to +8) and − 3 mmHg (− 21 to +13) for MAPNRA, MAPNAA and MAPPI respectively. Compared to MAPinv, mean absolute error (MAE) was 20 mmHg [10 to 39], 11 mmHg [5 to 18] and 16 mmHg [9 to 24] for MAP derived from MAPNRA, MAPNAA and MAPPI respectively. When calibrated every 5 min, MAPNAA showed a MAE of 6 mmHg [5 to 9]. MAPNAA provides the best estimates with respect to brachial cuff MAP and invasive MAP. Regular calibration allows to reduce drift over time. Beat to beat estimation of MAP during general anesthesia from the PPG appears possible with an acceptable average error.
Literature
2.
go back to reference Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte Op Reimer WJM, Vrints C, Wood D, Zamorano JL, Zannad F, Other experts who contributed to parts of the guidelines: Cooney MT, ESC Committee for Practice Guidelines (CPG), Bax J, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Document Reviewers: Funck-Brentano C, Sirnes PA, Aboyans V, Ezquerra EA, Baigent C, Brotons C, Burell G, Ceriello A, De Sutter J, Deckers J, Del Prato S, Diener H-C, Fitzsimons D, Fras Z, Hambrecht R, Jankowski P, Keil U, Kirby M, Larsen ML, Mancia G, Manolis AJ, McMurray J, Pajak A, Parkhomenko A, Rallidis L, Rigo F, Rocha E, Ruilope LM, van der Velde E, Vanuzzo D, Viigimaa M, Volpe M, Wiklund O, Wolpert C. European Guidelines on cardiovascular disease prevention in clinical practice (version. the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). Eur Heart J. 2012;2012(33):1635–701. https://doi.org/10.1093/eurheartj/ehs092. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte Op Reimer WJM, Vrints C, Wood D, Zamorano JL, Zannad F, Other experts who contributed to parts of the guidelines: Cooney MT, ESC Committee for Practice Guidelines (CPG), Bax J, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Document Reviewers: Funck-Brentano C, Sirnes PA, Aboyans V, Ezquerra EA, Baigent C, Brotons C, Burell G, Ceriello A, De Sutter J, Deckers J, Del Prato S, Diener H-C, Fitzsimons D, Fras Z, Hambrecht R, Jankowski P, Keil U, Kirby M, Larsen ML, Mancia G, Manolis AJ, McMurray J, Pajak A, Parkhomenko A, Rallidis L, Rigo F, Rocha E, Ruilope LM, van der Velde E, Vanuzzo D, Viigimaa M, Volpe M, Wiklund O, Wolpert C. European Guidelines on cardiovascular disease prevention in clinical practice (version. the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). Eur Heart J. 2012;2012(33):1635–701. https://​doi.​org/​10.​1093/​eurheartj/​ehs092.
5.
6.
go back to reference Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med. 2002;30:1210–3.CrossRefPubMed Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med. 2002;30:1210–3.CrossRefPubMed
10.
go back to reference Abramowitz M. Handbook of mathematical functions, with formulas, graphs, and mathematical tables. Mineola: Dover Publications, Incorporated; 1974. Abramowitz M. Handbook of mathematical functions, with formulas, graphs, and mathematical tables. Mineola: Dover Publications, Incorporated; 1974.
13.
go back to reference Montenij LJ, Buhre WF, Jansen JR, Kruitwagen CL, de Waal EE. Methodology of method comparison studies evaluating the validity of cardiac output monitors: a stepwise approach and checklist ††This Article is accompanied by Editorial Aew110. Br J Anaesth. 2016;116:750–8. https://doi.org/10.1093/bja/aew094.CrossRefPubMed Montenij LJ, Buhre WF, Jansen JR, Kruitwagen CL, de Waal EE. Methodology of method comparison studies evaluating the validity of cardiac output monitors: a stepwise approach and checklist ††This Article is accompanied by Editorial Aew110. Br J Anaesth. 2016;116:750–8. https://​doi.​org/​10.​1093/​bja/​aew094.CrossRefPubMed
15.
go back to reference Nichols WW. McDonald’s blood flow in arteries: theoretical, experimental and clinical principles. London: Hodder Arnold; 2010. Nichols WW. McDonald’s blood flow in arteries: theoretical, experimental and clinical principles. London: Hodder Arnold; 2010.
16.
go back to reference Peňáz J. Photoelectric measurement of blood pressure, volume and flow in the finger. In: Digest of the 10th international conference on medical and biological engineering, 1973, p. 104. Peňáz J. Photoelectric measurement of blood pressure, volume and flow in the finger. In: Digest of the 10th international conference on medical and biological engineering, 1973, p. 104.
19.
go back to reference Stergiou GS, Palatini P, Asmar R, Ioannidis JP, Kollias A, Lacy P, McManus RJ, Myers MG, Parati G, Shennan A, Wang J, O’Brien E, European Society of Hypertension Working Group on Blood Pressure Monitoring. Recommendations and Practical Guidance for performing and reporting validation studies according to the Universal Standard for the validation of blood pressure measuring devices by the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO). J Hypertens. 2019;37:459–66. https://doi.org/10.1097/HJH.0000000000002039.CrossRefPubMed Stergiou GS, Palatini P, Asmar R, Ioannidis JP, Kollias A, Lacy P, McManus RJ, Myers MG, Parati G, Shennan A, Wang J, O’Brien E, European Society of Hypertension Working Group on Blood Pressure Monitoring. Recommendations and Practical Guidance for performing and reporting validation studies according to the Universal Standard for the validation of blood pressure measuring devices by the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO). J Hypertens. 2019;37:459–66. https://​doi.​org/​10.​1097/​HJH.​0000000000002039​.CrossRefPubMed
Metadata
Title
Real-time estimation of mean arterial blood pressure based on photoplethysmography dicrotic notch and perfusion index. A pilot study
Authors
Jona Joachim
Maxime Coutrot
Sandrine Millasseau
Joaquim Matéo
Alexandre Mebazaa
Etienne Gayat
Fabrice Vallée
Publication date
01-04-2021
Publisher
Springer Netherlands
Published in
Journal of Clinical Monitoring and Computing / Issue 2/2021
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-020-00486-y

Other articles of this Issue 2/2021

Journal of Clinical Monitoring and Computing 2/2021 Go to the issue