Advertisement

Non-invasive monitoring using photoplethysmography technology

  • Keisuke Tomita
  • Taka-aki Nakada
  • Taku Oshima
  • Takehiko Oami
  • Tuerxun Aizimu
  • Shigeto Oda
Original Research
  • 38 Downloads

Abstract

We evaluated the accuracy and precision of a novel non-invasive monitoring device in comparison with conventional monitoring methods used in intensive care units (ICU). The study device was developed to measure blood pressure, pulse rate, respiratory rate, and oxygen saturation, continuously with a single sensor using the photoplethysmographic technique. Patients who were monitored with arterial pressure lines in the ICU were enrolled. Systolic and diastolic blood pressure, pulse rate, respiratory rate, and arterial oxygen saturation were measured continuously for 30 min at 5-min intervals using the conventional methods and the study device. The primary outcome variable was blood pressure. Blood pressure measured by the study device highly correlated with the arterial pressure line values (correlation coefficients > 0.95). Percent errors for systolic, diastolic and mean blood pressures were 2.4% and 6.7% and 6.5%, respectively. Percent errors for pulse rate, respiratory rate and oxygen saturation were 3.4%, 5.6% and 1.4%, respectively. The non-invasive, continuous, multi-parameter monitoring device presented high level of agreement with the invasive arterial blood pressure monitoring, along with sufficient accuracy and precision in the measurements of pulse rate, respiratory rate, and oxygen saturation.

Keywords

Non-invasive Continuous monitoring Blood pressure Photoplethysmography Critically ill patients Single sensor 

Notes

Acknowledgements

We thank Mr. Shinji Kondo (K&S Co., Ltd) and Mr. Noriaki Sakakibara (K&S Co., Ltd) for developing the device, and Mr. Yutaka Furukawa, Mr. Minami Nagano, Ms. Eriko Miyazaki, Ms. Shino Tateishi and Ms. Yumiko Yamazaki for supporting data collection.

Author contributions

KT and TN: These authors contributed to the study conceptualization and design, acquisition of data, analysis and interpretation of data, statistical analysis, and drafting and critical revision of the manuscript for important intellectual content. TO and TO: These authors contributed to interpretation of data, drafting and critical revision of the manuscript for important intellectual content. SO: This author contributed to the study conceptualization and critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript.

Funding

This work was supported by AMED (#JPhe1502001) and JSPS KAKENHI (#JP24659232). The funder had no role in the study design, experiments, collection, analysis, interpretation of data, writing of the manuscript, or decision to submit the manuscript for publication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Goldhill DR, Worthington L, Mulcahy A, Tarling M, Sumner A. The patient-at-risk team: identifying and managing seriously ill ward patients. Anaesthesia. 1999;54(9):853–60.CrossRefGoogle Scholar
  2. 2.
    Kause J, Smith G, Prytherch D, Parr M, Flabouris A, Hillman K, Australian and New Zealand Intensive Care Society Clinical Trials Group. A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom—the ACADEMIA study. Resuscitation. 2004;62(3):275–82.  https://doi.org/10.1016/j.resuscitation.2004.05.016.CrossRefPubMedGoogle Scholar
  3. 3.
    Bleyer AJ, Vidya S, Russell GB, Jones CM, Sujata L, Daeihagh P, Hire D. Longitudinal analysis of one million vital signs in patients in an academic medical center. Resuscitation. 2011;82(11):1387–92.  https://doi.org/10.1016/j.resuscitation.2011.06.033.CrossRefPubMedGoogle Scholar
  4. 4.
    Gershengorn HB, Garland A, Kramer A, Scales DC, Rubenfeld G, Wunsch H. Variation of arterial and central venous catheter use in United States intensive care units. Anesthesiology. 2014;120(3):650–64.  https://doi.org/10.1097/ALN.0000000000000008.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bartels K, Esper SA, Thiele RH. Blood pressure monitoring for the anesthesiologist: a practical review. Anesth Analg. 2016;122(6):1866–79.  https://doi.org/10.1213/ANE.0000000000001340.CrossRefPubMedGoogle Scholar
  6. 6.
    Kim WY, Jun JH, Huh JW, Hong SB, Lim CM, Koh Y. Radial to femoral arterial blood pressure differences in septic shock patients receiving high-dose norepinephrine therapy. Shock. 2013;40(6):527–31.  https://doi.org/10.1097/SHK.0000000000000064.CrossRefPubMedGoogle Scholar
  7. 7.
    O’Horo JC, Maki DG, Krupp AE, Safdar N. Arterial catheters as a source of bloodstream infection: a systematic review and meta-analysis. Crit Care Med. 2014;42(6):1334–9.  https://doi.org/10.1097/CCM.0000000000000166.CrossRefPubMedGoogle Scholar
  8. 8.
    Falk PS, Scuderi PE, Sherertz RJ, Motsinger SM. Infected radial artery pseudoaneurysms occurring after percutaneous cannulation. Chest. 1992;101(2):490–5.CrossRefGoogle Scholar
  9. 9.
    Moon SK, Gong JC, Kim JH, Lee KC, Kim HY, Choi EK, Lee MJ. A retained catheter fragment in radial artery caused by accidental catheter transection during arterial catheter removal. J Anesth. 2012;26(4):625–6.  https://doi.org/10.1007/s00540-012-1388-4.CrossRefPubMedGoogle Scholar
  10. 10.
    Martin K, Gertler R. Continuous non-invasive blood pressure measurement for the critically ill patient- is it on its way yet? Minerva Anestesiol. 2013;79(3):221–2.PubMedGoogle Scholar
  11. 11.
    Stenglova A, Benes J. Continuous non-invasive arterial pressure assessment during surgery to improve outcome. Front Med (Lausanne). 2017;4:202.  https://doi.org/10.3389/fmed.2017.00202.CrossRefGoogle Scholar
  12. 12.
    Molnar Z, Benes J, Reuter DA. Intensive care medicine in 2050: perioperative critical care. Intensiv Care Med. 2017;43(8):1138–40.  https://doi.org/10.1007/s00134-017-4703-6.CrossRefGoogle Scholar
  13. 13.
    Bendjelid K. The pulse oximetry plethysmographic curve revisited. Curr Opin Crit Care. 2008;14(3):348–53.  https://doi.org/10.1097/MCC.0b013e3282fb2dc9.CrossRefPubMedGoogle Scholar
  14. 14.
    Saugel B, Fassio F, Hapfelmeier A, Meidert AS, Schmid RM, Huber W. The T-Line TL-200 system for continuous non-invasive blood pressure measurement in medical intensive care unit patients. Intensive Care Med. 2012;38(9):1471–7.  https://doi.org/10.1007/s00134-012-2617-x.CrossRefPubMedGoogle Scholar
  15. 15.
    Wagner JY, Negulescu I, Schofthaler M, Hapfelmeier A, Meidert AS, Huber W, Schmid RM, Saugel B. Continuous noninvasive arterial pressure measurement using the volume clamp method: an evaluation of the CNAP device in intensive care unit patients. J Clin Monit Comput. 2015;29(6):807–13.  https://doi.org/10.1007/s10877-015-9670-2.CrossRefPubMedGoogle Scholar
  16. 16.
    Kim SH, Lilot M, Sidhu KS, Rinehart J, Yu Z, Canales C, Cannesson M. Accuracy and precision of continuous noninvasive arterial pressure monitoring compared with invasive arterial pressure: a systematic review and meta-analysis. Anesthesiology. 2014;120(5):1080–97.  https://doi.org/10.1097/ALN.0000000000000226.CrossRefPubMedGoogle Scholar
  17. 17.
    Kondo S, Shimoyama I, Yoshida A, Yoshizaki H, Hayashi F, Nagao K, Oda S. Minimal invasive estimation of blood pressure for continuous monitoring. Chin Med J (Engl). 2008;84:19–25.Google Scholar
  18. 18.
    Ruiz-Rodriguez JC, Ruiz-Sanmartin A, Ribas V, Caballero J, Garcia-Roche A, Riera J, Nuvials X, de Nadal M, de Sola-Morales O, Serra J, Rello J. Innovative continuous non-invasive cuffless blood pressure monitoring based on photoplethysmography technology. Intensive Care Med. 2013;39(9):1618–25.  https://doi.org/10.1007/s00134-013-2964-2.CrossRefPubMedGoogle Scholar
  19. 19.
    O’Brien E, Atkins N, Stergiou G, Karpettas N, Parati G, Asmar R, Imai Y, Wang J, Mengden T, Shennan A, Working Group on Blood Pressure Monitoring of the European Society of Hypertension. European Society of Hypertension International Protocol revision 2010 for the validation of blood pressure measuring devices in adults. Blood Press Monit. 2010;15(1):23–38.  https://doi.org/10.1097/MBP.0b013e3283360e98.CrossRefPubMedGoogle Scholar
  20. 20.
    Jubran A. Pulse oximetry. Crit Care. 1999;3(2):R11–7.  https://doi.org/10.1186/cc341.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput. 1999;15(2):85–91.CrossRefGoogle Scholar
  22. 22.
    Altman DG, Bland JM. Measurement in medicine: the analysis of method comparison studies. Statistician. 1983;32:307–17.CrossRefGoogle Scholar
  23. 23.
    Critchley LA, Lee A, Ho AM. A critical review of the ability of continuous cardiac output monitors to measure trends in cardiac output. Anesth Analg. 2010;111(5):1180–92.  https://doi.org/10.1213/ANE.0b013e3181f08a5b.CrossRefPubMedGoogle Scholar
  24. 24.
    Chung E, Chen G, Alexander B, Cannesson M. Non-invasive continuous blood pressure monitoring: a review of current applications. Front Med. 2013;7(1):91–101.  https://doi.org/10.1007/s11684-013-0239-5.CrossRefPubMedGoogle Scholar
  25. 25.
    Shin H, Min SD. Feasibility study for the non-invasive blood pressure estimation based on ppg morphology: normotensive subject study. Biomed Eng Online. 2017;16(1):10.  https://doi.org/10.1186/s12938-016-0302-y.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Choudhury AD, Banerjee R, Sinha A, Kundu S. Estimating blood pressure using Windkessel model on Photoplethysmogram. Conf Proc IEEE Eng Med Biol Soc. 2014;2014:4567–70.  https://doi.org/10.1109/EMBC.2014.6944640.CrossRefPubMedGoogle Scholar
  27. 27.
    AAI. Non-invasive sphygmomanometers-part 2: clinical validation of automated measurement type. Arlington: Association for the Advancement of Medical Instrumentation; 2009. pp. 1–21.Google Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Keisuke Tomita
    • 1
  • Taka-aki Nakada
    • 1
  • Taku Oshima
    • 1
  • Takehiko Oami
    • 1
  • Tuerxun Aizimu
    • 2
  • Shigeto Oda
    • 1
  1. 1.Department of Emergency and Critical Care MedicineChiba University Graduate School of MedicineChuoJapan
  2. 2.Center for Frontier Medical EngineeringChiba UniversityChuoJapan

Personalised recommendations