title: Calculation of the Respiratory Modulation of the Photoplethysmogram (DPOP) Incorporating a Correction for Low Perfusion.
abstract: DPOP quantifies respiratory modulations in the photoplethysmogram. It has been proposed as a noninvasive surrogate for pulse pressure variation (PPV) used in the prediction of the response to volume expansion in hypovolemic patients. The correlation between DPOP and PPV may degrade due to low perfusion effects. We implemented an automated DPOP algorithm with an optional correction for low perfusion. These two algorithm variants (DPOPa and DPOPb) were tested on data from 20 mechanically ventilated OR patients split into a benign "stable region" subset and a whole record "global set." Strong correlation was found between DPOP and PPV for both algorithms when applied to the stable data set: R = 0.83/0.85 for DPOPa/DPOPb. However, a marked improvement was found when applying the low perfusion correction to the global data set: R = 0.47/0.73 for DPOPa/DPOPb. Sensitivities, Specificities, and AUCs were 0.86, 0.70, and 0.88 for DPOPa/stable region; 0.89, 0.82, and 0.92 for DPOPb/stable region; 0.81, 0.61, and 0.73 for DPOPa/global region; 0.83, 0.76, and 0.86 for DPOPb/global region. An improvement was found in all results across both data sets when using the DPOPb algorithm. Further, DPOPb showed marked improvements, both in terms of its values, and correlation with PPV, for signals exhibiting low percent modulations.
authors.affiliation: Covidien Respiratory & Monitoring Solutions, Edinburgh EH26 0PJ, UK.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Addison
authors.affiliation: Covidien Respiratory & Monitoring Solutions, Edinburgh EH26 0PJ, UK.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: Covidien Respiratory & Monitoring Solutions, Edinburgh EH26 0PJ, UK.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: McGonigle
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
authors.forename: Alberto A
authors.identifier: 0000-0001-7897-8322
authors.initials: AA
authors.lastname: Uribe
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA ; Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
authors.forename: Sergio D
authors.initials: SD
authors.lastname: Bergese