Towards continuous non-invasive blood pressure measurements—interpretation of the vasculature response to cuff inflation

Frontiers in Physiology

Physiology

João Loureiro¹  Paulo Carvalho¹  Jorge Henriques¹  Gerrit J. Noordergraaf²  Lars Schmitt³  Jens Muehlsteff³  Laura Bogatu³  Igor Paulussen⁴ 

[1] Centre for Informatics and Systems of the University of Coimbra, University of Coimbra, Department of Informatics Engineering, Coimbra, Portugal;Department of Anesthesiology and Pain Management, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands;Department of Patient Care and Measurements, Philips Research, Eindhoven, Netherlands;Department of Patient Care and Measurements, Philips Research, Eindhoven, Netherlands;Department of Anesthesiology and Pain Management, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands;

关键词: blood pressure;    pulse arrival time;    oscillometry;    blood pressure surrogate calibration;    hemodynamic model;    pulse transit time;    NIBP;   

DOI  :  10.3389/fphys.2023.1172688

 received in 2023-02-23, accepted in 2023-05-19,  发布年份 2023

来源: Frontiers

【 摘 要 】

Blood pressure (BP) surrogates, such as pulse transit time (PTT) or pulse arrival time (PAT), have been intensively explored with the goal of achieving cuffless, continuous, and accurate BP inference. In order to estimate BP, a one-point calibration strategy between PAT and BP is typically used. Recent research focuses on advanced calibration procedures exploiting the cuff inflation process to improve calibration robustness by active and controlled modulation of peripheral PAT, as measured via plethysmograph (PPG) and electrocardiogram (ECG) combination. Such methods require a detailed understanding of the mechanisms behind the vasculature’s response to cuff inflation; for this, a model has recently been developed to infer the PAT-BP calibration from measured cuff-induced vasculature changes. The model, while promising, is still preliminary and only partially validated; in-depth analysis and further developments are still needed. Therefore, this work aims to improve our understanding of the cuff-vasculature interaction in this model; we seek to define potential opportunities and to highlight which aspects may require further study. We compare model behaviors with clinical data samples based on a set of observable characteristics relevant for BP inference and calibration. It is found that the observed behaviors are qualitatively well represented with the current simulation model and complexity, with limitations regarding the prediction of the onset of the distal arm dynamics and behavior changes at high cuff pressures. Additionally, a sensitivity analysis of the model’s parameter space is conducted to show the factors that influence the characteristics of its observable outputs. It was revealed that easily controllable experimental variables, such as lateral cuff length and inflation rate, have a significant impact on cuff-induced vasculature changes. An interesting dependency between systemic BP and cuff-induced distal PTT change is also found, revealing opportunities for improved methods for BP surrogate calibration. However, validation via patient data shows that this relation does not hold for all patients, indicating required model improvements to be validated in follow up studies. These results provide promising directions to improve the calibration process featuring cuff inflation towards accurate and robust non-invasive blood pressure estimation.

【 授权许可】

Unknown   
Copyright © 2023 Loureiro, Bogatu, Schmitt, Henriques, Carvalho, Noordergraaf, Paulussen and Muehlsteff.