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Innovative continuous non-invasive cuffless blood pressure monitoring based on photoplethysmography technology



To develop and validate a continuous non-invasive blood pressure (BP) monitoring system using photoplethysmography (PPG) technology through pulse oximetry (PO).


This prospective study was conducted at a critical care department and post-anesthesia care unit of a university teaching hospital. Inclusion criteria were critically ill adult patients undergoing invasive BP measurement with an arterial catheter and PO monitoring. Exclusion criteria were arrhythmia, imminent death condition, and disturbances in the arterial or the PPG curve morphology. Arterial BP and finger PO waves were recorded simultaneously for 30 min. Systolic arterial pressure (SAP), mean arterial pressure (MAP), and diastolic arterial pressure (DAP) were extracted from computer-assisted arterial pulse wave analysis. Inherent traits of both waves were used to construct a regression model with a Deep Belief Network-Restricted Boltzmann Machine (DBN-RBM) from a training cohort of patients and in order to infer BP values from the PO wave. Bland–Altman analysis was performed.


A total of 707 patients were enrolled, of whom 135 were excluded. Of the 572 studied, 525 were assigned to the training cohort (TC) and 47 to the validation cohort (VC). After data processing, 53,708 frames were obtained from the TC and 7,715 frames from the VC. The mean prediction biases were −2.98 ± 19.35, −3.38 ± 10.35, and −3.65 ± 8.69 mmHg for SAP, MAP, and DAP respectively.


BP can be inferred from PPG using DBN-RBM modeling techniques. The results obtained with this technology are promising, but its intrinsic variability and its wide limits of agreement do not allow clinical application at this time.

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Fig. 1



Association for the Advancement of Medical Instrumentation


Analysis of variance


Acute Physiology and Chronic Health Evaluation II


Blood pressure


Diastolic arterial pressure


Deep Belief Network-Restricted Boltzmann Machines


General Electric


Mean arterial pressure


Pulse oximetry




Systolic arterial pressure


Sequential Organ Failure Assessment


Training cohort


Validation cohort


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This work was supported in part by Sabirmedical SL (Parc Cientific de Barcelona, Barcelona, Spain), and by “Avanza” grants (Ministry of Industry, Tourism and Trade, Government of Spain, TSI-020100-2009-204 and TSI-020100-2010-625).

Conflicts of interest

J.C. Ruiz-Rodriguez and J. Caballero have received grant support for travel expenses from Sabirmedical SL. J.C. Ruiz-Rodriguez, J. Caballero, A. Ruiz-Sanmartin, J. Riera, S. García-Roche, and J. Rello have collaborated with Sabirmedical SL in other research projects or in an advisory capacity. V. Ribas was the scientific director of Sabirmedical. O. de Sola-Morales was Sabirmedical’s medical and market access director. No other authors report any financial disclosures.

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Correspondence to Juan C. Ruiz-Rodríguez.

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Ruiz-Rodríguez, J.C., Ruiz-Sanmartín, A., Ribas, V. et al. Innovative continuous non-invasive cuffless blood pressure monitoring based on photoplethysmography technology. Intensive Care Med 39, 1618–1625 (2013).

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  • Non-invasive hemodynamic monitoring
  • Blood pressure
  • Photoplethysmography
  • Critical care
  • Machine learning