Korean Journal of Anesthesiology

The Korean Society of Anesthesiologists (대한마취통증의학회)
권호 표지

Estimation of Continuous Blood Pressure with Amplitude of Photoplethysmogram and Pulse Transit Time of Finger and Toe

상하지 광체적변동파형(Photoplethysmogram)의 진폭과 맥파전도시간을 이용한 지속적 동맥혈압 추정

Seo, Kwang-Suk;Kim, Jung-Soo;Park, Kwang-Suk;Kim, Hyun-Jeong;Yum, Kwang-Won;Goo, Eui-Kyoung;Ahn, Won-Sik
서광석;김정수;박광석;김현정;염광원;구의경;안원식

  • Published : 20070800
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Abstract

Background: The amplitude (AMP) of Photoplethysmogram (PPG) is used as a marker of vasodilatation. The pulse transit time (PTT), which shows a good correlation with blood pressure (BP), is not strong enough to detect the changes in BP. This study examined the sensitivity of the combined effect of the finger and toe AMP, and the PTT of PPG as a marker of the changes in BP during general anesthesia. Methods: Forty patients receiving maxillofacial surgery under general anesthesia were enrolled in this study. During surgery, the intra-arterial BP, ECG, finger and toe PPG signals were measured. Using the R-wave from the ECG, the AMP and PTT was derived from PPG data. The correlation between BP and PPG parameters (AMP and PTT) were compared. New parameters that show high correlation with the BP were found. Regression equations for calculating the BP using the PPG parameters were formulated. Results: The new parameter, log (fingerAMP/toeAMP), showed the highest correlation in each patient (mean correlation coefficient in the systolic BP: －0.846, diastolic BP: －0.858). However, when the data from all 40 patients were combined, the correlation coefficient of the toe PTT was highest (systolic BP: －0.726, diastolic BP: －0.646). The regression equation showed the highest correlation between the actual BP and calculated BP when the toe PTT and log (fingerAMP/toeAMP) were included. Conclusions: The AMP of the toe and finger PPG can be used to estimate the invasive continuous blood pressure.

Keywords

References

  1. Mark JB, Slaughter TF: Cardiovascular monitoring. In: Miller's Anesthesia. 6th ed. Edited by Miller RD: Philadelphia, Elsevier Churchill Livingstone. 2005, pp 1265-362
  2. Scheer B, Perel A, Pfeiffer UJ Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care 2002; 6: 199-204
  3. Wippermann CF, Schranz D, Huth RG: Evaluation of the pulse wave arrival time as a marker for blood pressure changes in critically ill infants and children. J Clin Monit 1995; 11: 324-8 https://doi.org/10.1007/BF01616991
  4. Chen W, Kobayashi T, Ichikawa S, Takeuchi Y, Togawa T: Continuous estimation of systolic blood pressure using the pulse arrival time and intermittent calibration. Med Biol Eng Comput 2000; 38: 569-74 https://doi.org/10.1007/BF02345755
  5. Awad AA, Ghobashy MA, Stout RG, Silverman DG, Shelley KH: How does the plethysmogram derived from the pulse oximeter relate to arterial blood pressure in coronary artery bypass graft patients? Anesth Analg 2001; 93: 1466-71 https://doi.org/10.1097/00000539-200112000-00022
  6. Gribbin B, Steptoe A, Sleight P: Pulse wave velocity as a measure of blood pressure change. Psychophysiology 1976; 13: 86-90 https://doi.org/10.1111/j.1469-8986.1976.tb03344.x
  7. Nitzan M, Khanokh B, Slovik Y: The difference in pulse transit time to the toe and finger measured by photoplethysmography. Physiol Meas 2002; 23: 85-93 https://doi.org/10.1088/0967-3334/23/1/308
  8. Friesen GM, Jannett TC, Jadallah MA, Yates SL, Quint SR, Nagle HT: A comparison of the noise sensitivity of nine QRS detection algorithms. IEEE Trans Biomed Eng 1990; 37: 85-98 https://doi.org/10.1109/10.43620
  9. Chiu YC, Arand PW, Shroff SG, Feldman T, Carroll JD: Determination of pulse wave velocities with computerized algorithms. Am Heart J 1991; 121: 1460-70 https://doi.org/10.1016/0002-8703(91)90153-9
  10. Ballinger GA: Using generalized estimating equations for longitudinal data analysis. Organizational Research Methods 2004; 7: 127-50 https://doi.org/10.1177/1094428104263672
  11. American Society of Anesthesiologists: Standards for basic anesthetic monitoring, ASA standards, guidelines and statements. Park Ridge, IL, American Society of Anesthesiologists. 2005, p 5
  12. Sutin KM, Longaker MT, Wahlander S, Kasabian AK, Capan LM: Acute biceps compartment syndrome associated with the use of a noninvasive blood pressure monitor. Anesth Analg 1996; 83: 1345-6 https://doi.org/10.1097/00000539-199612000-00040
  13. Bickler PE, Schapera A, Bainton CR: Acute radial nerve injury from use of an automatic blood pressure monitor. Anesthesiology 1990; 73: 186-8 https://doi.org/10.1097/00000542-199007000-00030
  14. Gardner RM, Hollingsworth KW: Optimizing the electrocardiogram and pressure monitoring. Crit Care Med 1986; 14: 651-8 https://doi.org/10.1097/00003246-198607000-00016
  15. Weiss BM, Spahn DR, Rahmig H, Rohling R, Pasch T: Radial artery tonometry: moderately accurate but unpredictable technique of continuous non invasive arterial pressure measurement. Br J Anaesth 1996; 76: 405-11 https://doi.org/10.1093/bja/76.3.405
  16. Birch AA, Morris SL: Do the Finapres and Colin radial artery tonometer measure the same blood pressure changes following deflation of thigh cuffs? Physiol Meas 2003; 24: 653-60 https://doi.org/10.1088/0967-3334/24/3/302
  17. Epstein RH, Huffnagle S, Bartkowski RR: Comparative accuracies of a finger blood pressure monitor and an oscillometric blood pressure monitor. J Clin Monit 1991; 7: 161-7 https://doi.org/10.1007/BF01618116
  18. Gibbs NM, Larach DR, Derr JA: The accuracy of Finapres noninvasive mean arterial pressure measurements in anesthetized patients. Anesthesiology 1991; 74: 647-52 https://doi.org/10.1097/00000542-199104000-00004
  19. Kemmotsu O, Ueda M, Otsuka H, Yamamura T, Winter DC, Eckerle JS: Arterial tonometry for noninvasive, continuous blood pressure monitoring during anesthesia. Anesthesiology 1991; 75: 333-40 https://doi.org/10.1097/00000542-199108000-00023
  20. Shelley KH, Murray WB, Chang D: Arterial-pulse oximetry loops: a new method of monitoring vascular tone. J Clin Monit 1997; 13: 223-8 https://doi.org/10.1023/A:1007361020825
  21. Payne RA, Symeonides CN, Webb DJ, Maxwell SR: Pulse transit time measured from the ECG: an unreliable marker of beat-to-beat blood pressure. J Appl Physiol 2006; 100: 136-41 https://doi.org/10.1152/japplphysiol.00657.2005
  22. Luginbuhl M, Reichlin F, Sigurdsson GH, Zbinden AM, Petersen-Felix S: Prediction of the haemodynamic response to tracheal intubation: comparison of laser-Doppler skin vasomotor reflex and pulse wave reflex. Br J Anaesth 2002; 89: 389-97 https://doi.org/10.1093/bja/aef196
  23. Baik SW, Park YS, Yae SY, Jeon GR, Choi BC, Jung DK: Effects of enflurane on pulse transit time. Korean J Anesthesiol 2004; 47: 17-22 https://doi.org/10.4097/kjae.2004.47.1.17