J Clin Monit Comput - Increasing signal processing sophistication in the calculation of the respiratory modulation of the photoplethysmogram (DPOP).


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DPOP (POP or Delta-POP) is a non-invasive parameter which measures the strength of respiratory modulations present in the pulse oximetry photoplethysmogram (pleth) waveform. It has been proposed as a non-invasive surrogate parameter for pulse pressure variation (PPV) used in the prediction of the response to volume expansion in hypovolemic patients. Many groups have reported on the DPOP parameter and its correlation with PPV using various semi-automated algorithmic implementations. The study reported here demonstrates the performance gains made by adding increasingly sophisticated signal processing components to a fully automated DPOP algorithm. A DPOP algorithm was coded and its performance systematically enhanced through a series of code module alterations and additions. Each algorithm iteration was tested on data from 20 mechanically ventilated OR patients. Correlation coefficients and ROC curve statistics were computed at each stage. For the purposes of the analysis we split the data into a manually selected 'stable' region subset of the data containing relatively noise free segments and a 'global' set incorporating the whole data record. Performance gains were measured in terms of correlation against PPV measurements in OR patients undergoing controlled mechanical ventilation. Through increasingly advanced pre-processing and post-processing enhancements to the algorithm, the correlation coefficient between DPOP and PPV improved from a baseline value of R = 0.347 to R = 0.852 for the stable data set, and, correspondingly, R = 0.225 to R = 0.728 for the more challenging global data set. Marked gains in algorithm performance are achievable for manually selected stable regions of the signals using relatively simple algorithm enhancements. Significant additional algorithm enhancements, including a correction for low perfusion values, were required before similar gains were realised for the more challenging global data set.

Resumo Limpo

dpop pop deltapop noninvas paramet measur strength respiratori modul present puls oximetri photoplethysmogram pleth waveform propos noninvas surrog paramet puls pressur variat ppv use predict respons volum expans hypovolem patient mani group report dpop paramet correl ppv use various semiautom algorithm implement studi report demonstr perform gain made ad increas sophist signal process compon fulli autom dpop algorithm dpop algorithm code perform systemat enhanc seri code modul alter addit algorithm iter test data mechan ventil patient correl coeffici roc curv statist comput stage purpos analysi split data manual select stabl region subset data contain relat nois free segment global set incorpor whole data record perform gain measur term correl ppv measur patient undergo control mechan ventil increas advanc preprocess postprocess enhanc algorithm correl coeffici dpop ppv improv baselin valu r r stabl data set correspond r r challeng global data set mark gain algorithm perform achiev manual select stabl region signal use relat simpl algorithm enhanc signific addit algorithm enhanc includ correct low perfus valu requir similar gain realis challeng global data set

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