Using Time-Frequency Analysis of the Photoplethysmographic Waveform to Detect the Withdrawal of 900 mL of Blood

Scully, Christopher G.; Selvaraj, Nandakumar; Romberg, Frederick; Wardhan, Richa; Ryan, John F.; Florian, John P.; Silverman, David G.; Shelley, Kirk H.; Chon, Ki H.

doi:10.1213/ane.0b013e318256486c

Cited by 22 publications

(46 citation statements)

References 17 publications

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“…Lower PPGAmin and higher PPGAvar also correlated with higher amounts of intravenous fluids received which is in line with volume depletion effects on PPG described in previous studies on healthy volunteers [18,19]. Due to the limits of the methodology used in data collection, no true beat to beat variation was calculable of the data.…”

Section: Discussionsupporting

confidence: 86%

Critically ill patients in emergency department may be characterized by low amplitude and high variability of amplitude of pulse photoplethysmography

Pirneskoski

Harjola

Jeskanen

et al. 2013

Scand J Trauma Resusc Emerg Med

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BackgroundThe aim of the present pilot study was to determine if pulse photoplethysmography amplitude (PPGA) could be used as an indicator of critical illness and as a predictor of higher need of care in emergency department patients.MethodsThis was a prospective observational study. We collected vital signs and one minute of pulse photoplethysmograph signal from 251 consecutive patients admitted to a university hospital emergency department. The patients were divided in two groups regarding to the modified Early Warning Score (mEWS): > 3 (critically ill) and ≤ 3 (non-critically ill). Photoplethysmography characteristics were compared between the groups.ResultsSufficient data for analysis was acquired from 212 patients (84.5%). Patients in critically ill group more frequently required intubation and invasive hemodynamic monitoring in the ED and received more intravenous fluids. Mean pulse photoplethysmography amplitude (PPGA) was significantly lower in critically ill patients (median 1.105 [95% CI of mean 0.9946-2.302] vs. 2.476 [95% CI of mean 2.239-2.714], P = 0.0257). Higher variability of PPGA significantly correlated with higher amount of fluids received in the ED (r = 0.1501, p = 0.0296).ConclusionsThis pilot study revealed differences in PPGA characteristics between critically ill and non-critically ill patients. Further studies are needed to determine if these easily available parameters could help increase accuracy in triage when used in addition to routine monitoring of vital signs.

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Section: Discussionsupporting

confidence: 86%

Critically ill patients in emergency department may be characterized by low amplitude and high variability of amplitude of pulse photoplethysmography

Pirneskoski

Harjola

Jeskanen

et al. 2013

Scand J Trauma Resusc Emerg Med

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“…We have demonstrated this potential by respiration rate detection with the VFCDM-FM method [13] and HRV analysis. Assessment of R-R intervals has recently been shown to be an accurate way of detecting episodes of atrial fibrillation [8], and the VFCDM method has recently been shown to be capable of detecting significant levels of blood volume loss from a PPG signal [9, 10]. In the present letter, the proof-of-concept we have shown opens the door to implementing these algorithms on a mobile phone platform using simply the optical recordings of the phone.…”

Section: Discussionmentioning

confidence: 83%

Physiological Parameter Monitoring from Optical Recordings With a Mobile Phone

Scully

Lee

Meyer

et al. 2012

IEEE Trans. Biomed. Eng.

413

264

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We show that a mobile phone can serve as an accurate monitor for several physiological variables, based on its ability to record and analyze the varying color signals of a fingertip placed in contact with its optical sensor. We confirm the accuracy of measurements of breathing rate, cardiac R-R intervals, and blood oxygen saturation, by comparisons to standard methods for making such measurements (respiration belts, ECGs, and pulse-oximeters, respectively). Measurement of respiratory rate uses a previously reported algorithm developed for use with a pulse-oximeter, based on amplitude and frequency modulation sequences within the light signal. We note that this technology can also be used with recently developed algorithms for detection of atrial fibrillation or blood loss.

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“…Hemorrhage is the most prevalent cause of death from injuries sustained on the battlefield and comprises approximately 90% of the causes of Bpotentially survivable[ death (20). The main disadvantage of currently used vital signs is that they are relatively insensitive to small amounts or rates of blood loss (10,23). This scenario leaves the point-of-injury caregiver charged with the difficult task of promptly identifying bleeding casualties in need of rapid evacuation without reliable differences in their clinical presentations or standard vital signs or the benefit of imaging.…”

Section: Discussionmentioning

confidence: 99%

The Value of Noninvasive Measurement of the Compensatory Reserve Index in Monitoring and Triage of Patients Experiencing Minimal Blood Loss

Nadler

Convertino

Gendler

et al. 2014

Shock

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Currently available triage and monitoring tools are often late to detect life-threatening clinically significant physiological aberrations and provide limited data in prioritizing bleeding patients for treatment and evacuation. The Compensatory Reserve Index (CRI) is a novel means of assessing physiologic reserve, shown to correlate with central blood volume loss under laboratory conditions. The purpose of this study was to compare the noninvasive CRI device with currently available vital signs in detecting blood loss. Study subjects were soldiers volunteering for blood donation (n = 230), and the control group was composed of soldiers who did not donate blood (n = 34). Data collected before and after blood donation were compared, receiver operator characteristic curves were generated after either donation or the appropriate time interval, and areas under the curves (AUCs) were compared. Compared with pre-blood loss, blood donation resulted in a mean reduction of systolic blood pressure by 3% (before, 123 mmHg; after, 119 mmHg; P < 0.01). The CRI demonstrated a 16% reduction (before, 0.74; after, 0.62; P < 0.01). Heart rate, diastolic blood pressure, and oxygen saturation remained unchanged. The AUC for change in CRI was 0.81, 0.56 for change in heart rate, 0.53 for change in systolic blood pressure, 0.55 and 0.58 for pulse pressure and shock index, respectively. The AUCs for detecting mild blood loss at a single measurement were 0.73 for heart rate, 0.60 for systolic blood pressure, 0.62 for diastolic blood pressure, 0.45 for pulse oximetry, and 0.84 for CRI. The CRI was better than standard indices in detecting mild blood loss. Single measurement of CRI may enable a more accurate triage, and CRI monitoring may allow for earlier detection of casualty deterioration.

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Using Time-Frequency Analysis of the Photoplethysmographic Waveform to Detect the Withdrawal of 900 mL of Blood

Cited by 22 publications

References 17 publications

Critically ill patients in emergency department may be characterized by low amplitude and high variability of amplitude of pulse photoplethysmography

Critically ill patients in emergency department may be characterized by low amplitude and high variability of amplitude of pulse photoplethysmography

Physiological Parameter Monitoring from Optical Recordings With a Mobile Phone

The Value of Noninvasive Measurement of the Compensatory Reserve Index in Monitoring and Triage of Patients Experiencing Minimal Blood Loss

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