Validation of the pulse decomposition analysis algorithm using central arterial blood pressure

Abstract

BackgroundThere is a significant need for continuous noninvasive blood pressure (cNIBP) monitoring, especially for anesthetized surgery and ICU recovery. cNIBP systems could lower costs and expand the use of continuous blood pressure monitoring, lowering risk and improving outcomes.The test system examined here is the CareTaker® and a pulse contour analysis algorithm, Pulse Decomposition Analysis (PDA). PDA’s premise is that the peripheral arterial pressure pulse is a superposition of five individual component pressure pulses that are due to the left ventricular ejection and reflections and re-reflections from only two reflection sites within the central arteries.The hypothesis examined here is that the model’s principal parameters P2P1 and T13 can be correlated with, respectively, systolic and pulse pressures.MethodsCentral arterial blood pressures of patients (38 m/25 f, mean age: 62.7 y, SD: 11.5 y, mean height: 172.3 cm, SD: 9.7 cm, mean weight: 86.8 kg, SD: 20.1 kg) undergoing cardiac catheterization were monitored using central line catheters while the PDA parameters were extracted from the arterial pulse signal obtained non-invasively using CareTaker system.ResultsQualitative validation of the model was achieved with the direct observation of the five component pressure pulses in the central arteries using central line catheters. Statistically significant correlations between P2P1 and systole and T13 and pulse pressure were established (systole: R square: 0.92 (p < 0.0001), diastole: R square: 0.78 (p < 0.0001). Bland-Altman comparisons between blood pressures obtained through the conversion of PDA parameters to blood pressures of non-invasively obtained pulse signatures with catheter-obtained blood pressures fell within the trend guidelines of the Association for the Advancement of Medical Instrumentation SP-10 standard (standard deviation: 8 mmHg(systole: 5.87 mmHg, diastole: 5.69 mmHg)).ConclusionsThe results indicate that arterial blood pressure can be accurately measured and tracked noninvasively and continuously using the CareTaker system and the PDA algorithm. The results further support the physical model that all of the features of the pressure pulse envelope, whether in the central arteries or in the arterial periphery, can be explained by the interaction of the left ventricular ejection pressure pulse with two centrally located reflection sites.

Cardiorespiratory interactions: Noncontact assessment using laser Doppler vibrometry

“…It is possible that some of these peaks might reflect mechanical activity referred from more distal sites—perhaps including gross BCG influences, although it should be noted that none of the major BCG components (see Figure ), if adjusted for the time between R wave and LDV carotid B point, could be readily mapped onto the LDV carotid pulse waveform. Other investigators, using different measurement techniques, have also described the presence of multiple reflection and rereflection waves in the central BP pulse (Baruch, Kalantari, Gerdt, & Adkins, ; Berger, Li, Laskey, & Noordbergraaf, ; Wang, Xu, Feng, Meng, & Wang, ).…”

Age Dependence of Arterial Pulse Wave Parameters Extracted From Dynamic Blood Pressure and Blood Volume Pulse Waves

“…the slope of f (4) i ) at the point corresponding to the systolic maximum of PW is 1) positive, this point is considered as a point for the late systolic peak P 2 and the last zero-crossing of f (4) i from positive to negative before P 2 as early systolic peak P 1 .…”

“…The arterial PW observed at a peripheral measurement point such as a finger is a superposition of a percussion wave induced by the heartbeat and its reflections from the impedance discontinuities of the main artery, aorta [4]. The propagation velocity of these waves, both percussion wave and its reflections, depends on arterial elasticity which is an important indicator of the vascular health, especially the degree of atherosclerosis, which characteristically results in arterial stiffening.…”

Photoplethysmogram Signal Morphology-Based Stress Assessment

“…It has been found [7] that the timing of local minima in the second derivative of hemodynamic signal coincide with the positions of three pulse components -forward and two reflected waves, and the delays of two reflected waves from the renal and iliac sites in the central arteries correlate with arterial blood pressure [8]. In this work, the relationship between human mental stress and PPG morphological parameters extracted from the analysis of bandpass filtered higher-order derivatives of the PPG signal is investigated.…”