Utility of the Photoplethysmogram in Circulatory Monitoring

Reisner, Andrew; Shaltis, P.; McCombie, Devin B.; Asada, H. Harry; Warner, David S.; Warner, Mark A.

doi:10.1097/aln.0b013e31816c89e1

Cited by 312 publications

(243 citation statements)

References 77 publications

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“…Similarly, the pulse oximeter trace can be an accurate indicator of the presence or absence of pulsatile flow distal to a cuff, so long as sufficient time is allowed when inflating ⁄ deflating the cuff [2]. Additional delay is added to the oximeter method by the processing of the oximetry signal, although the photoplethysmogram trace can also give information about the shape of the arterial waveform and the volaemic status of the patient [5,6].…”

Section: Discussionmentioning

confidence: 99%

“…In such situations, the anaesthetist may rely on clinical signs of adequate end-organ perfusion such as the patient's colour and responsiveness, or may attempt to obtain an indication of the patient's BP by feeling for the radial arterial pulse or observing the pulse oximeter whilst the NIBP cuff inflates or deflates, the disappearance ⁄ return of a palpable pulsation or oximetry trace indicating systolic arterial pressure. Limited data have been published on the accuracy of these methods for estimating BP [1,2], and none that we are aware of in the obstetric setting or during regional anaesthesia. Our aim was therefore to study the usefulness of arterial palpation and pulse oximetry for estimating the NIBP machine-derived systolic pressure, in the context of obstetric regional anaesthesia.…”

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confidence: 99%

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Ability of radial arterial palpation and observation of the pulse oximetry trace to estimate non‐invasive systolic pressure in healthy volunteers and in women undergoing spinal anaesthesia for elective caesarean section*

Sabharwal¹,

Strickland²,

Yentis

2010

Anaesthesia

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We assessed the ability of palpating the radial arterial pulse and observing the oximeter trace to estimate the automated non-invasive systolic pressure reading in 20 healthy female volunteers and 20 parturients undergoing spinal anaesthesia for elective caesarean section. Using real-time values of cuff pressure during inflation ⁄ deflation, the pressure was recorded when the manually palpated radial arterial pulse or pulse oximeter waveform disappeared and reappeared. The actual measured systolic pressure was noted and the results compared using Bland-Altman analysis. In the volunteers, the bias ⁄ precision for radial arterial palpation was )12.9 ⁄ 22.1 mmHg (inflation) and )9.7 ⁄ 16.7 mmHg (deflation), and for oximetry 29.5 ⁄ 18.8 mmHg (inflation) and )20.7 ⁄ 21.7 mmHg (deflation). In the parturients, the bias ⁄ precision was )19.0 ⁄ 47.6 mmHg (inflation) and )15.5 ⁄ 51.0 mmHg (deflation) for arterial palpation, and 22.6 ⁄ 16.1 mmHg (inflation) and )14.2 ⁄ 19.9 mmHg (deflation) for oximetry. Our results suggest that neither method is accurate at estimating the non-invasive systolic pressure, with all except oximetry (inflation) underestimating it by approximately 10-20 mmHg and with poor precision.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Ability of radial arterial palpation and observation of the pulse oximetry trace to estimate non‐invasive systolic pressure in healthy volunteers and in women undergoing spinal anaesthesia for elective caesarean section*

Sabharwal¹,

Strickland²,

Yentis

2010

Anaesthesia

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“…This cardiac-synchronous pulsatile component is assumed to depend solely on the arterial inflow of blood into a monitoring site such as the finger or earlobe [4]. As the ac PPG signal is similar in morphology to the arterial blood pressure waveform [5], it has been suggested that they are both influenced by similar vascular mechanisms [6]. Therefore, the PPG signal has been explored as a method to extract further circulatory and cardiovascular information from patients [1].…”

Section: Introductionmentioning

confidence: 99%

Investigation of peripheral photoplethysmographic morphology changes induced during a hand-elevation study

Hickey

Phillips

Kyriacou

2015

J Clin Monit Comput

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Abstract A hand-elevation study was carried out in the laboratory in order to alter peripheral blood flow with the aim of increasing understanding of factors affecting the morphology of peripheral photoplethysmographic signals. Photoplethysmographic (PPG) signals were recorded from twenty healthy volunteer subjects during a hand-elevation study in which the right hand was raised and lowered relative to heart level, while the left hand remained static. Red and infrared (IR) PPG signals were obtained from the right and left index fingers using a custom-made PPG processing system. PPG features were identified using a feature-detection algorithm based on the first derivative of the PPG signal. The systolic PPG amplitude, the reflection index, crest time, pulse width at half height, and delta T were calculated from 20 s IR PPG signals from three positions of the right hand with respect to heart level (-50, 0, ?50 cm) in 19 volunteers. PPG features were found to change with hand elevation. On lowering the hand to 50 cm below heart level, ac systolic PPG amplitudes from the finger decreased by 68.32 %, while raising the arm increased the systolic amplitude by 69.99 %. These changes in amplitude were attributed to changes in hydrostatic pressure and the venoarterial reflex. Other morphological variables, such as crest time, were found to be statistically significantly different across hand positions, indicating increased vascular resistance on arm elevation than on dependency. It was hypothesized that these morphological PPG changes were influenced by changes in downstream venous resistance, rather than arterial, or arteriolar, resistance. Changes in hand position relative to heart level can significantly affect the morphology of the peripheral ac PPG waveform. These alterations are due to a combination of physical effects and physiological responses to changes in hand position, which alter vascular resistance. Care should be taken when interpreting morphological data derived from PPG signals and methods should be standardized to take these effects into account. Permanent repository link

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“…Less light is detected when a larger volume of blood is crossing the photodetector. Thus, the photodetector is able to detect the pulsatile flow in the arteries [45,46]. The HR can subsequently be calculated by an algorithm [44].…”

Section: Mobile Applicationsmentioning

confidence: 99%

Mobile health in cardiology: a review of currently available medical apps and equipment for remote monitoring

Treskes

Velde

Barendse

et al. 2016

Expert Review of Medical Devices

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Introduction: Recent developments in implantable cardioverter-defibrillators (ICDs) and smartphone technology have increased the possibilities for remote monitoring. It is the purpose of this review to give an overview of these new possibilities. Areas covered: Remote monitoring in ICD allows for early detection of lead fractures and remote follow-up of patients. Possible limitations are the lack of standardization and the possible unsafety of the data stored on the ICD. Secondly, remote monitoring of health parameters using smartphone compatible wearables and smartphone medical apps is addressed. Possible limitations include the fact that the majority of smartphone apps are unregulated by the regulatory authorities and privacy issues such as selling of appgenerated data to third parties. Lastly, clinical studies with smartphone apps are discussed. Expert commentary: New technologies in ICDs and smartphones have the potential to be used for remote monitoring. However, unreliability of smartphone technology, inadequate legislation and lack of reimbursement impede implementation. ARTICLE HISTORY

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Utility of the Photoplethysmogram in Circulatory Monitoring

Cited by 312 publications

References 77 publications

Ability of radial arterial palpation and observation of the pulse oximetry trace to estimate non‐invasive systolic pressure in healthy volunteers and in women undergoing spinal anaesthesia for elective caesarean section*

Ability of radial arterial palpation and observation of the pulse oximetry trace to estimate non‐invasive systolic pressure in healthy volunteers and in women undergoing spinal anaesthesia for elective caesarean section*

Investigation of peripheral photoplethysmographic morphology changes induced during a hand-elevation study

Mobile health in cardiology: a review of currently available medical apps and equipment for remote monitoring

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