The Effect of Venous Pulsation on the Forehead Pulse Oximeter Wave Form as a Possible Source of Error in Spo2 Calculation

Shelley, Kirk H.; Tamai, Doris; Jablonka, Denis H.; Gesquiere, Michael; Stout, Robert G.; Silverman, David G.

doi:10.1213/01.ane.0000145063.01043.4b

Cited by 84 publications

(50 citation statements)

References 7 publications

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“…Furthermore, we showed that the baseline modulation manifested itself more strongly in the forehead than in the finger, which is in line with the finding by Shelley et al [17]. In fact, the increase in BV from the ABP signal to the finger and forehead PPG signals might be caused by the presence of venous component in the PPG signals [17,28]. Finally, we showed that BV was a factor confounding the agreement between PPV and PAV.…”

Section: Discussionsupporting

confidence: 90%

Finger and forehead photoplethysmography-derived pulse-pressure variation and the benefits of baseline correction

Sun

Peeters

Bezemer

et al. 2018

J Clin Monit Comput

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To non-invasively predict fluid responsiveness, respiration-induced pulse amplitude variation (PAV) in the photoplethysmographic (PPG) signal has been proposed as an alternative to pulse pressure variation (PPV) in the arterial blood pressure (ABP) signal. However, it is still unclear how the performance of the PPG-derived PAV is site-dependent during surgery. The aim of this study is to compare finger-and forehead-PPG derived PAV in their ability to approach the value and trend of ABP-derived PPV. Furthermore, this study investigates four potential confounding factors, (1) baseline variation, (2) PPV, (3) ratio of respiration and heart rate, and (4) perfusion index, which might affect the agreement between PPV and PAV. In this work, ABP, finger PPG, and forehead PPG were continuously recorded in 29 patients undergoing major surgery in the operating room. A total of 91.2 h data were used for analysis, from which PAV and PPV were calculated and compared. We analyzed the impact of the four factors using a multiple linear regression (MLR) analysis. The results show that compared with the ABP-derived PPV, finger-derived PAV had an agreement of 3.2 ± 5.1%, whereas forehead-PAV had an agreement of 12.0 ± 9.1%. From the MLR analysis, we found that baseline variation was a factor significantly affecting the agreement between PPV and PAV. After correcting for respiration-induced baseline variation, the agreements for finger-and foreheadderived PAV were improved to reach an agreement of − 1.2 ± 3.8% and 3.3 ± 4.8%, respectively. To conclude, finger-derived PAV showed better agreement with ABP-derived PPV compared to forehead-derived PAV. Baseline variation was a factor that significantly affected the agreement between PPV and PAV. By correcting for the baseline variation, improved agreements were obtained for both the finger and forehead, and the difference between these two agreements was diminished. The tracking abilities for both finger-and forehead-derived PAV still warrant improvement for wide use in clinical practice. Overall, our results show that baseline-corrected finger-and forehead-derived PAV may provide a non-invasive alternative for PPV.

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Section: Discussionsupporting

confidence: 90%

Finger and forehead photoplethysmography-derived pulse-pressure variation and the benefits of baseline correction

Sun

Peeters

Bezemer

et al. 2018

J Clin Monit Comput

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“…We label these algorithms VenSat, RespDC and RespAC, and describe them in detail below. In the case of peripheral venous pulsations, it has been found that during diastole, the natural venous pulsations can cause volume changes in the venous compartment to dominate those in the arterial compartment [2]. This should lead to lower overall oxygen saturation during this period between consecutive beats.…”

Section: Measuring Venous Oxygen Saturation Via Physiological Sourcesmentioning

confidence: 99%

“…The movement of venous blood can be detected using the PPG. For the most part, this phenomenon has been seen as a source of artifact which interferes with the calculation of arterial saturation [1,2]. If venous saturation can be reliably measured, interesting new possibilities are opened.…”

Section: Introductionmentioning

confidence: 99%

Measuring venous oxygenation using the photoplethysmograph waveform

Walton

Kyriacou

Silverman

et al. 2010

J Clin Monit Comput

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This is the accepted version of the paper.This version of the publication may differ from the final published version. ABSTRACT. Objective. We investigate the hypothesis that the photoplethysmograph (PPG) waveform can be analyzed to infer regional venous oxygen saturation. Methods. Fundamental to the successful isolation of the venous saturation is the identification of PPG characteristics that are unique to the peripheral venous system. Two such characteristics have been identified. First, the peripheral venous waveform tends to reflect atrial contraction. Second, ventilation tends to move venous blood preferentially due to the low pressure and high compliance of the venous system. Red (660 nm) and IR (940 nm) PPG waveforms were collected from 10 cardiac surgery patients using an esophageal PPG probe. These waveforms were analyzed using algorithms written in Mathematica. Four time-domain saturation algorithms (ArtSat, VenSat, ArtInstSat, VenInstSat) and four frequency-domain saturation algorithms (RespDC, RespAC, Cardiac, and Harmonic) were applied to the data set. Results. Three of the algorithms for calculating venous saturation (VenSat, VenInstSat, and RespDC) demonstrate significant difference from ArtSat (the conventional time-domain algorithm for measuring arterial saturation) using the Wilcoxon signed-rank test with Bonferroni correction (p < 0.0071). Conclusions. This work introduces new algorithms for PPG analysis. Three algorithms (VenSat, VenInstSat, and RespDC) succeed in detecting lower saturation blood. The next step is to confirm the accuracy of the measurement by comparing them to a gold standard (i.e., venous blood gas). Permanent repository linkKEY WORDS. pulse oximeter, waveform analysis, plethysmograph, non-invasive monitoring, venous oxygen saturation.

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“…78,79 Venous oxygenation Multiple authors have described the presence of venous ''interference'' in the PPG signal. 11,80,81 The venous contribution to the PPG signal should not, however, be thought of as interference. Rather, it provides additional information, the utility of which has yet to be fully understood.…”

Section: 6470-72mentioning

confidence: 99%

Advances in photoplethysmography: beyond arterial oxygen saturation

Bartels

Thiele

2015

Can J Anesth/J Can Anesth

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Purpose Photoplethysmography permits continuous measurement of heart rate and peripheral oxygen saturation and has been widely used to inform clinical decisions. Recently, a myriad of noninvasive hemodynamic monitoring devices using this same technology have been increasingly available. This narrative review aims to summarize the principles that form the basis for the function of these devices as well as to comment on trials evaluating their accuracy and clinical application. Principal findings Advanced monitoring devices extend photoplethysmography technology beyond measuring oxygen concentration and heart rate. Quantification of respiratory variation of the photoplethysmographic waveform reflects respiratory variation of the arterial pressure waveform and can be used to gauge volume responsiveness. Both the volume-clamp and physiocal techniques are extensions of conventional photoplethysmography and permit continuous measurement of finger arterial blood pressure. Finger arterial pressure waveforms can subsequently inform estimations of cardiac output. Conclusions Although respiratory variations of the plethysmographic waveform correlate only modestly with the arterial blood pressure waveform, fluid responsiveness can be relatively consistently assessed using both approaches. Continuous blood pressure measurements obtained using the volume-clamp technique may be as accurate as conventional brachial noninvasive blood pressure measurements. Most importantly, clinical comparative effectiveness studies are still needed in order to determine if these technologies can be translated into improvement of relevant patient outcomes. RésuméObjectif La photopléthysmographie permet la mesure continue de la fréquence cardiaque et de la saturation en oxygène périphérique, et elle est largement utilisée pour les prises de décisions cliniques. Depuis peu, un très grand nombre de dispositifs non invasifs de surveillance hémodynamique utilisant la même technologie envahit le marché. Cette synthèse narrative vise à résumer les principes à la base du fonctionnement de ces dispositifs et à commenter les essais évaluant leur exactitude ainsi que leurs applications cliniques. Constatations principales Les dispositifs de surveillance avancée étendent la technologie de photopléthysmographie au-delà de la mesure de la concentration en oxygène et de la fréquence cardiaque. La quantification de la variation respiratoire du tracé photopléthysmographique reflète la variation respiratoire du tracé de pression artérielle et peut servir à jauger la réactivité au volume. Les deux techniques de compression volumique (volume-clamp) au doigt et la technique physiocal sont des prolongements de Author contributions Karsten Bartels wrote approximately 50% of the manuscript and critically edited the remainder. Robert H. Thiele wrote approximately 50% of the manuscript and critically edited the remainder.

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The Effect of Venous Pulsation on the Forehead Pulse Oximeter Wave Form as a Possible Source of Error in Spo2 Calculation

Cited by 84 publications

References 7 publications

Finger and forehead photoplethysmography-derived pulse-pressure variation and the benefits of baseline correction

Finger and forehead photoplethysmography-derived pulse-pressure variation and the benefits of baseline correction

Measuring venous oxygenation using the photoplethysmograph waveform

Advances in photoplethysmography: beyond arterial oxygen saturation

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