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Photoplethysmographic characterization of vascular tone mediated changes in arterial pressure: an observational study

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Abstract

To determine whether a classification based on the contour of the photoplethysmography signal (PPGc) can detect changes in systolic arterial blood pressure (SAP) and vascular tone. Episodes of normotension (SAP 90–140 mmHg), hypertension (SAP > 140 mmHg) and hypotension (SAP < 90 mmHg) were analyzed in 15 cardiac surgery patients. SAP and two surrogates of the vascular tone, systemic vascular resistance (SVR) and vascular compliance (Cvasc = stroke volume/pulse pressure) were compared with PPGc. Changes in PPG amplitude (foot-to-peak distance) and dicrotic notch position were used to define 6 classes taking class III as a normal vascular tone with a notch placed between 20 and 50% of the PPG amplitude. Class I-to-II represented vasoconstriction with notch placed > 50% in a small PPG, while class IV-to-VI described vasodilation with a notch placed < 20% in a tall PPG wave. 190 datasets were analyzed including 61 episodes of hypertension [SAP = 159 (151–170) mmHg (median 1st–3rd quartiles)], 84 of normotension, SAP = 124 (113–131) mmHg and 45 of hypotension SAP = 85(80–87) mmHg. SAP were well correlated with SVR (r = 0.78, p < 0.0001) and Cvasc (r = 0.84, p < 0.0001). The PPG-based classification correlated well with SAP (r = − 0.90, p < 0.0001), SVR (r = − 0.72, p < 0.0001) and Cvasc (r = 0.82, p < 0.0001). The PPGc misclassified 7 out of the 190 episodes, presenting good accuracy (98.4% and 97.8%), sensitivity (100% and 94.9%) and specificity (97.9% and 99.2%) for detecting episodes of hypotension and hypertension, respectively. Changes in arterial pressure and vascular tone were closely related to the proposed classification based on PPG waveform.

Clinical Trial Registration NTC02854852.

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Authors and Affiliations

  1. Department of Anesthesiology, Hospital Privado de Comunidad, 7600, Mar del Plata, Buenos Aires, Argentina

    Gerardo Tusman & Cecilia M. Acosta

  2. Department of Anesthesiology and Intensive Care Medicine, Klinikum Osnabrueck, Osnabrueck, Germany

    Sven Pulletz

  3. Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany

    Stephan H. Böhm

  4. Bioengineering Laboratory, Electronic Department, School of Engineering, Mar del Plata University, Mar del Plata, Argentina

    Adriana Scandurra & Jorge Martinez Arca

  5. Instituto Tecnológico Buenos Aires (ITBA), Buenos Aires, Argentina

    Matías Madorno

  6. Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

    Fernando Suarez Sipmann

  7. CIBERES, Madrid, Spain

    Fernando Suarez Sipmann

  8. Department of Critical Care, Hospital Universitario de La Princesa, Madrid, Spain

    Fernando Suarez Sipmann

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  1. Gerardo Tusman
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  2. Cecilia M. Acosta
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  7. Matías Madorno
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  8. Fernando Suarez Sipmann
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Correspondence to Gerardo Tusman.

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No potential conflicts of interest exist except for Matías Madorno who is partner and manager of MBMed S.A; a company that produce respiratory monitoring equipments.

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Informed consent was obtained from all individual participant included in the study.

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Tusman, G., Acosta, C.M., Pulletz, S. et al. Photoplethysmographic characterization of vascular tone mediated changes in arterial pressure: an observational study. J Clin Monit Comput 33, 815–824 (2019). https://doi.org/10.1007/s10877-018-0235-z

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  • DOI: https://doi.org/10.1007/s10877-018-0235-z

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