Estimation of instantaneous venous blood saturation using the photoplethysmograph waveform.

Non-invasive estimation of regional venous saturation (SxvO2) using a conventional pulse oximeter could provide a means of obtaining clinically relevant information. This study was carried out in order to investigate the hypothesis that SxvO2 could be estimated by utilising the modulations created by positive pressure ventilation in the photoplethysmograph (PPG) signals. The modulations caused by the mechanical ventilator were extracted from oesophageal PPG signals obtained from 12 patients undergoing cardiothoracic surgery. The signals analysed in this work were acquired in a previous study. For the purpose of this analysis the raw PPG signal was considered to have three major components, ac PPG signal (cardiac related component), a static component or dc PPG signal (created mostly by the absorption of light by surrounding tissue) and the ventilator modulation component. These components were then used to estimate instantaneous arterial blood oxygen saturation (SpO2) and SxvO2 by utilising time-frequency analysis technique of smoothed-pseudo Wigner-Ville distribution (SPWVD). The results showed that there was no significant difference in the traditionally-derived (time-domain) arterial saturation and the instantaneous arterial saturation. However, the instantaneous venous saturation was found to be significantly lower than the estimated time-domain and instantaneous arterial saturation (P = < 0.001, n = 12).

Estimation of venous oxygenation saturation using the finger Photoplethysmograph (PPG) waveform.

In this study, finger photoplethysmograph data obtained from twelve patients undergoing cardiothoracic surgery were analyzed in order to estimate the venous saturation utilizing the modulations created by the positive pressure ventilation in the AC Photoplethysmograph (PPG) signals. The PPG signals were analyzed in the time-domain using a conventional pulse oximetry algorithm to produce estimations of arterial oxygen saturation. The instantaneous arterial and venous saturations were estimated by utilizing time-frequency analysis technique of Smoothed-pseudo Wigner-Ville Distribution (SPWVD). The results showed that there was no significant difference in the traditionally-derived (time-domain) arterial saturation and the instantaneous arterial saturation. However, the instantaneous venous saturation was found to be significantly lower than the time-domain estimated and instantaneous arterial saturation (P=<0.001).

Empirical mode decomposition analysis of HRV data from patients undergoing local anaesthesia (brachial plexus block).

Spectral analysis of heart rate variability (HRV) is used for the assessment of cardiovascular autonomic control. In this study, a data-driven adaptive technique called empirical mode decomposition (EMD) and the associated Hilbert spectrum has been used to evaluate the effect of local anaesthesia on HRV parameters in a group of 14 patients undergoing axillary brachial plexus block. The normalized amplitude Hilbert spectrum was used to calculate the error index associated with the instantaneous frequency. The amplitude and the frequency values were corrected in the region where the error was higher than twice standard deviation. The intrinsic mode function (IMF) components were assigned to the LF and the HF part of the signal by making use of the centre frequency and the standard deviation spectral extension estimated from the marginal spectrum of the IMF components. The optimal range of the stopping criterion was found to be between 4 and 9 for the HRV data. The statistical analysis showed that the LF/HF ratio decreased within an hour of the application of the brachial plexus block compared to the values at the start of the procedure. These changes were observed in 13 of the 14 patients included in this study.

HRV analysis in local anesthesia using Continuous Wavelet Transform (CWT).

Spectral analysis of Heart Rate Variability (HRV) is used for the assessment of cardiovascular autonomic control. In this study Continuous Wavelet Transform (CWT) has been used to evaluate the effect of local anesthesia on HRV parameters in a group of fourteen patients undergoing axillary brachial plexus block. A new method which takes signal characteristics into account has been presented for the estimation of the variable boundaries associated with the low and the high frequency band of the HRV signal. The variable boundary method might be useful in cases when the power related to respiration component extends beyond the traditionally excepted range of the high frequency band (0.15-0.4 Hz). The statistical analysis (non-parametric Wilcoxon signed rank test) showed that the LF/HF ratio decreased within an hour of the application of the brachial plexus block compared to the values fifteen minutes prior to the application of the block. These changes were observed in thirteen of the fourteen patients included in this study.

Time-frequency analysis of HRV data from locally anesthetized patients.

Spectral analysis of Heart Rate Variability (HRV) can be used for the assessment of cardiovascular autonomic control. In this study Smoothed-Pseudo Wigner-Ville Distribution (SPWVD) has been used to evaluate the effect of local anesthesia on HRV parameters in a group of fourteen patients undergoing brachial plexus block (local anesthesia) using the transarterial technique. Instead of using the fixed boundaries of the LF (0.04-0.15 Hz) and the HF (0.15-0.4 Hz) components, the center frequency and the standard deviation spectral extension was used to estimate the boundaries related to the two components of the HRV signal. The boundaries related to the HF component of the signal were estimated using the cross-spectrum between the HRV signal and the respiration signal. The LF component boundaries were estimated directly from the time-frequency representation of the HRV signal. The statistical analysis showed that the (LF)/HF amplitude ratio decreased within an hour of the application of the brachial plexus block compared to the values at the start of the procedure. These changes were observed in eleven of the fourteen patients included in this study.

Empirical mode decomposition (EMD) analysis of HRV data from locally anesthetized patients.

Spectral analysis of Heart Rate Variability (HRV) is used for the assessment of cardiovascular autonomic control. In this study data driven adaptive technique Empirical Mode Decomposition (EMD) and the associated Hilbert spectrum has been used to evaluate the effect of local anesthesia on HRV parameters in a group of fourteen patients undergoing brachial plexus block (local anesthesia) using transarterial technique. The confidence limit for the stopping criteria was establish and the S value that gave the smallest squared deviation from the mean was considered optimal. The normalized amplitude Hilbert spectrum was used to calculate the error index associated with the instantaneous frequency. The amplitude and the frequency values were corrected in the region where the error was higher than twice the standard deviation. The Intrinsic Mode Function (IMF) components were assigned to the Low Frequency (LF) and the High Frequency (HF) part of the signal by making use of the center frequency and the standard deviation spectral extension estimated from the marginal spectrum of the IMF components. The analysis procedure was validated with the help of a simulated signal which consisted of two components in the LF and the HF region of the HRV signal with varying amplitude and frequency. The optimal range of the stopping criterion was found to be between 4 and 9 for the HRV data. The statistical analysis showed that the LF/HF amplitude ratio decreased within an hour of the application of the brachial plexus block compared to the values at the start of the procedure. These changes were observed in thirteen of the fourteen patients included in this study.

Evaluation of two detrending techniques for application in Heart Rate Variability.

The performance of two different algorithms of detrending the RR-interval before Heart Rate Variability (HRV) analysis has been evaluated using both, simulated signals and real RR-interval time series. The first algorithm is based on the Smoothness Prior Approach (SPA) and the second algorithm is implemented using Wavelet Packet (WP) analysis. The calculated time and frequency domain parameters obtained from real signals after detrending and the results obtained from simulated signals suggest that the WP method performed better than the SPA. The WP method provided more attenuation of the slow varying trend and was able to preserve the other signal components better than the SPA method. Also the SPA method was computationally slower and it might be not appropriate with long signals.

Changes in Heart Rate Variability in patients under local anesthesia.

Spectral analysis of Heart Rate Variability (HRV) is widely used for the assessment of cardiovascular autonomic control. Several studies have shown the effect of anesthetic agents on HRV parameters. In this study a systematic approach of HRV analysis has been employed. The effect caused by the ectopic beats on the spectral measurements has been investigated and results are presented. A detrending method using Wavelet Packets has been developed which was able to remove slow varying trend from HRV signals without causing significant changes in the low frequency (LF) and high frequency (HF) component of the HRV signal. Using this methodology electrocardiogram (ECG) signals from 14 patients undergoing local anesthesia (brachial plexus block) were analyzed with parametric Autoregressive (AR) method. The results showed that the LF/HF ratio values calculated from the HRV signal decreases within an hour of the application of the brachial plexus block compared to the values at the start of the procedure. This change was noticed in approximately 80% of the patients.

Filtering techniques for the removal of ventilator artefact in oesophageal pulse oximetry.

The oesophagus has been shown to be a reliable site for monitoring blood oxygen saturation (SpO(2)). However, the photoplethysmographic (PPG) signals from the lower oesophagus are frequently contaminated by a ventilator artefact making the estimation of SpO(2) impossible. A 776th order finite impulse response (FIR) filter and a 695th order interpolated finite impulse response (IFIR) filter were implemented to suppress the artefact. Both filters attenuated the ventilator artefact satisfactorily without distorting the morphology of the PPG when processing recorded data from ten cardiopulmonary bypass patients. The IFIR filter was the better since it conformed more closely to the desired filter specifications and allowed real-time processing. The average improvements in signal-to-noise ratio (SNR) achieved by the FIR and IFIR filters for the fundamental component of the red PPG signals with respect to the fundamental component of the artefact were 57.96 and 60.60 dB, respectively. The corresponding average improvements achieved by the FIR and IFIR filters for the infrared PPG signals were 54.83 and 60.96 dB, respectively. Both filters were also compared with their equivalent tenth order Butterworth filters. The average SNR improvements for the FIR and IFIR filters were significantly higher than those for the Butterworth filters.