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18 pages, 5371 KiB  
Article
PPG Signals-Based Blood-Pressure Estimation Using Grid Search in Hyperparameter Optimization of CNN–LSTM
by Nurul Qashri Mahardika T, Yunendah Nur Fuadah, Da Un Jeong and Ki Moo Lim
Diagnostics 2023, 13(15), 2566; https://doi.org/10.3390/diagnostics13152566 - 1 Aug 2023
Cited by 15 | Viewed by 5127
Abstract
Researchers commonly use continuous noninvasive blood-pressure measurement (cNIBP) based on photoplethysmography (PPG) signals to monitor blood pressure conveniently. However, the performance of the system still needs to be improved. Accuracy and precision in blood-pressure measurements are critical factors in diagnosing and managing patients’ [...] Read more.
Researchers commonly use continuous noninvasive blood-pressure measurement (cNIBP) based on photoplethysmography (PPG) signals to monitor blood pressure conveniently. However, the performance of the system still needs to be improved. Accuracy and precision in blood-pressure measurements are critical factors in diagnosing and managing patients’ health conditions. Therefore, we propose a convolutional long short-term memory neural network (CNN–LSTM) with grid search ability, which provides a robust blood-pressure estimation system by extracting meaningful information from PPG signals and reducing the complexity of hyperparameter optimization in the proposed model. The multiparameter intelligent monitoring for intensive care III (MIMIC III) dataset obtained PPG and arterial-blood-pressure (ABP) signals. We obtained 75,226 signal segments, with 60,180 signals allocated for training data, 12,030 signals allocated for the validation set, and 15,045 signals allocated for the test data. During training, we applied five-fold cross-validation with a grid-search method to select the best model and determine the optimal hyperparameter settings. The optimized configuration of the CNN–LSTM layers consisted of five convolutional layers, one long short-term memory (LSTM) layer, and two fully connected layers for blood-pressure estimation. This study successfully achieved good accuracy in assessing both systolic blood pressure (SBP) and diastolic blood pressure (DBP) by calculating the standard deviation (SD) and the mean absolute error (MAE), resulting in values of 7.89 ± 3.79 and 5.34 ± 2.89 mmHg, respectively. The optimal configuration of the CNN–LSTM provided satisfactory performance according to the standards set by the British Hypertension Society (BHS), the Association for the Advancement of Medical Instrumentation (AAMI), and the Institute of Electrical and Electronics Engineers (IEEE) for blood-pressure monitoring devices. Full article
(This article belongs to the Special Issue Biomedical Signal Processing and Analysis)
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<p>The proposed general block diagram system.</p>
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<p>The proposed preprocessing method.</p>
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<p>One-dimensional wavelet decomposition. The PPG signals are passed into the LPF to produce an approximation component and are passed into HPF to produce the detail component. In one-dimensional wavelet decomposition, eight-level decomposition generated nine sub-bands, which consisted of one approximation component and eight detail component sub-bands.</p>
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<p>Blood-pressure values distribution.</p>
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<p>The proposed LSTM architecture.</p>
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<p>The proposed LSTM–autoencoder architecture.</p>
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<p>The proposed 1D CNN–LSTM architecture.</p>
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<p>Bland–Altman plots of the proposed LSTM model: (<b>a</b>) systolic blood pressure and (<b>b</b>) diastolic blood pressure. Error histogram predicted systolic blood pressure (<b>c</b>) and diastolic blood pressure (<b>d</b>).</p>
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<p>Bland–Altman plots of the proposed LSTM–autoencoder model (<b>a</b>) systolic blood pressure and (<b>b</b>) diastolic blood pressure. Error histogram predicted systolic blood pressure (<b>c</b>) and diastolic blood pressure (<b>d</b>).</p>
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<p>Bland–Altman plots of the proposed CNN–LSTM model (<b>a</b>) systolic blood pressure and (<b>b</b>) diastolic blood pressure. Error histogram predicted systolic blood pressure (<b>c</b>) and diastolic blood pressure (<b>d</b>).</p>
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16 pages, 6343 KiB  
Article
Clinical Study of Continuous Non-Invasive Blood Pressure Monitoring in Neonates
by Anoop Rao, Fatima Eskandar-Afshari, Ya’el Weiner, Elle Billman, Alexandra McMillin, Noa Sella, Thomas Roxlo, Junjun Liu, Weyland Leong, Eric Helfenbein, Alan Walendowski, Arthur Muir, Alexandria Joseph, Archana Verma, Chandra Ramamoorthy, Anita Honkanen, Gabrielle Green, Keith Drake, Rathinaswamy B. Govindan, William Rhine and Xina Quanadd Show full author list remove Hide full author list
Sensors 2023, 23(7), 3690; https://doi.org/10.3390/s23073690 - 2 Apr 2023
Cited by 2 | Viewed by 46269
Abstract
The continuous monitoring of arterial blood pressure (BP) is vital for assessing and treating cardiovascular instability in a sick infant. Currently, invasive catheters are inserted into an artery to monitor critically-ill infants. Catheterization requires skill, is time consuming, prone to complications, and often [...] Read more.
The continuous monitoring of arterial blood pressure (BP) is vital for assessing and treating cardiovascular instability in a sick infant. Currently, invasive catheters are inserted into an artery to monitor critically-ill infants. Catheterization requires skill, is time consuming, prone to complications, and often painful. Herein, we report on the feasibility and accuracy of a non-invasive, wearable device that is easy to place and operate and continuously monitors BP without the need for external calibration. The device uses capacitive sensors to acquire pulse waveform measurements from the wrist and/or foot of preterm and term infants. Systolic, diastolic, and mean arterial pressures are inferred from the recorded pulse waveform data using algorithms trained using artificial neural network (ANN) techniques. The sensor-derived, continuous, non-invasive BP data were compared with corresponding invasive arterial line (IAL) data from 81 infants with a wide variety of pathologies to conclude that inferred BP values meet FDA-level accuracy requirements for these critically ill, yet normotensive term and preterm infants. Full article
(This article belongs to the Section Biomedical Sensors)
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Figure 1
<p>(<b>a</b>) Boppli sensor schematic: illustration of the sensor and wearable, continuous, non-invasive BP device for neonates (cross-sectional at the top; aerial view at the bottom); (<b>b</b>) Boppli sensor placement around the foot of an infant.</p>
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<p>Overview of the working of the sensor and steps to infer blood pressure.</p>
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<p>Bland–Altman plots for SBP, DBP, and MAP: (<b>a</b>) values averaged over each individual for 81 test patients; and (<b>b</b>) all data values without averaging. Bland–Altman plots represent a scatter plot of average versus difference of BP readings constructed for SBP, DBP, and MAP. Points are color coded by patient weight. Red dotted lines indicate 2 * SD of the calculated values. Green dotted lines indicate targets based on FDA guidelines for accuracy of MAE ≤ 5 mmHg and 2 * SD ≤ 2 * 8 mmHg. The figures were generated using JMP software version 16.2.0.</p>
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<p>Predicted BP values vs. ground truth values. The blue line represents an unconstrained linear fit to the data. The green line is a linear fit constrained by a zero-intercept. The grey line is the identity (ID) fit where the predicted values equal the ground truth values. The figures were generated using JMP software version 16.2.0.</p>
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<p>Effect of gestational age (GA) on efficacy. Groups categorized by prematurity are compared through mean diamonds (green) and Tukey–Kramer circles (black). EPT (&lt;28 wks GA), MPT (28–37 wks GA), FT (≥38 wks GA). Overlap between diamonds and circles indicates there is no significant difference between groups. Mean diamonds are contained within the FDA guidelines for accuracy (dotted green lines). Targets for 95% confidence levels are indicated with dashed green lines. Points are color-coded by patient weight.</p>
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<p>Effect of sex on efficacy. Female and male patient subsets are compared through mean diamonds (green) and Tukey–Kramer circles (black). Minimal overlap between diamonds and circles indicates there is a significant difference between the two groups. Mean diamonds are contained within the FDA guidelines for accuracy (dotted green lines). Targets for 95% confidence levels are indicated with dashed green lines. Points are color-coded by patient weight.</p>
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<p>Effect of sex on efficacy. Female and male patient subsets are compared through mean diamonds (green) and Tukey–Kramer circles (black). Minimal overlap between diamonds and circles indicates there is a significant difference between the two groups. Mean diamonds are contained within the FDA guidelines for accuracy (dotted green lines). Targets for 95% confidence levels are indicated with dashed green lines. Points are color-coded by patient weight.</p>
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10 pages, 1024 KiB  
Article
The Effect of Intermittent versus Continuous Non-Invasive Blood Pressure Monitoring on the Detection of Intraoperative Hypotension, a Sub-Study
by Marije Wijnberge, Björn van der Ster, Alexander P. J. Vlaar, Markus W. Hollmann, Bart F. Geerts and Denise P. Veelo
J. Clin. Med. 2022, 11(14), 4083; https://doi.org/10.3390/jcm11144083 - 14 Jul 2022
Cited by 2 | Viewed by 1647
Abstract
Intraoperative hypotension is associated with postoperative complications. However, in the majority of surgical patients, blood pressure (BP) is measured intermittently with a non-invasive cuff around the upper arm (NIBP-arm). We hypothesized that NIBP-arm, compared with a non-invasive continuous alternative, would result in missed [...] Read more.
Intraoperative hypotension is associated with postoperative complications. However, in the majority of surgical patients, blood pressure (BP) is measured intermittently with a non-invasive cuff around the upper arm (NIBP-arm). We hypothesized that NIBP-arm, compared with a non-invasive continuous alternative, would result in missed events and in delayed recognition of hypotensive events. This was a sub-study of a previously published cohort study in adult patients undergoing surgery. The detection of hypotension (mean arterial pressure below 65 mmHg) was compared using two non-invasive methods; intermittent oscillometric NIBP-arm versus continuous NIBP measured with a finger cuff (cNIBP-finger) (Nexfin, Edwards Lifesciences). cNIBP-finger was used as the reference standard. Out of 350 patients, 268 patients (77%) had one or more hypotensive events during surgery. Out of the 286 patients, 72 (27%) had one or more missed hypotensive events. The majority of hypotensive events (92%) were detected with NIBP-arm, but were recognized at a median of 1.2 (0.6–2.2) minutes later. Intermittent BP monitoring resulted in missed hypotensive events and the hypotensive events that were detected were recognized with a delay. This study highlights the advantage of continuous monitoring. Future studies are needed to understand the effect on patient outcomes. Full article
(This article belongs to the Section Anesthesiology)
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<p>Boxplots demonstrating median delay time per NIBP-arm sample interval. The NIBP-arm sample interval was the sample interval the patient experienced for the majority of surgical time. To illustrate, if a patient had a duration of surgery of 120 min and 10 min were sampled at an interval of 2 min and the remaining 110 min were sampled at an interval of 3 min, we listed this as a sample interval of 3 min. The round dots represent outliers within the presented scale. The asterisk represents an outlier outside of the presented scale; it represents a 9.7 min delay in detection time.</p>
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20 pages, 2469 KiB  
Article
Advances in Non-Invasive Blood Pressure Monitoring
by Xina Quan, Junjun Liu, Thomas Roxlo, Siddharth Siddharth, Weyland Leong, Arthur Muir, So-Min Cheong and Anoop Rao
Sensors 2021, 21(13), 4273; https://doi.org/10.3390/s21134273 - 22 Jun 2021
Cited by 40 | Viewed by 36850
Abstract
This paper reviews recent advances in non-invasive blood pressure monitoring and highlights the added value of a novel algorithm-based blood pressure sensor which uses machine-learning techniques to extract blood pressure values from the shape of the pulse waveform. We report results from preliminary [...] Read more.
This paper reviews recent advances in non-invasive blood pressure monitoring and highlights the added value of a novel algorithm-based blood pressure sensor which uses machine-learning techniques to extract blood pressure values from the shape of the pulse waveform. We report results from preliminary studies on a range of patient populations and discuss the accuracy and limitations of this capacitive-based technology and its potential application in hospitals and communities. Full article
(This article belongs to the Collection Sensing Technologies for Diagnosis, Therapy and Rehabilitation)
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Graphical abstract

Graphical abstract
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<p>Boppli<sup>TM</sup> device to monitor the blood pressure of infants in critical care.</p>
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<p>Schematic of operating principle of PyrAmes’ capacitive sensor technology.</p>
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<p>Comparison of normalized invasive arterial line data (red) taken simultaneously with normalized PyrAmes sensor data (blue).</p>
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<p>Proof-of-concept results for a single person convolutional neural network algorithm trained on cuff data collected from March through May and then tested in September and October.</p>
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<p>Results from convolutional neural network model trained with cuff data from Study 1 and tested with an ambulatory blood pressure monitor for 4 other ambulatory subjects (SBP values color coded by individual).</p>
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<p>Plots of convolutional neural network model outputs vs. invasive arterial line ground truth values of mean arterial pressure (MAP), systolic (SBP), and diastolic (DBP) blood pressure values averaged over each individual. The points are color coded for the patients’ age in days.</p>
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<p>Bland-Altman plots of BP-model-3 results for mean arterial (MAP), systolic (SBP), and diastolic (DBP) blood pressure values in mmHg averaged over each individual. The <span class="html-italic">x</span>-axis is the average of the model and reference blood pressure values. The <span class="html-italic">y</span>-axis is the difference between the model and reference values. The points are color coded for the patients’ weight in kilograms. The red solid line indicates the overall error of the model (Mean Difference (MD)). The dotted red lines indicate 1.96 × the standard deviation (sd). The green dotted lines indicate the MD limits for accuracy of ±5 mmHg per guidelines from the US Food and Drug Administration.</p>
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<p>Comparison of invasive arterial line (blue) and BP-model-3 (red) mean arterial pressure (MAP) values as a function of time. Each data point is averaged over a one-minute interval. The curves are a spline fit with lambda = 1 × 10<sup>−6</sup>.</p>
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