Early detection of spontaneous blood loss using amplitude modulation of Photoplethysmogram

Estimating Surgical Blood Loss Volume Using Continuously Monitored Vital Signs

Background: There are currently no effective and accurate blood loss volume (BLV) estimation methods that can be implemented in operating rooms. To improve the accuracy and reliability of BLV estimation and facilitate clinical implementation, we propose a novel estimation method using continuously monitored photoplethysmography (PPG) and invasive arterial blood pressure (ABP). Methods: Forty anesthetized York Pigs (31.82 ± 3.52 kg) underwent a controlled hemorrhage at 20 mL/min until shock development was included. Machine-learning-based BLV estimation models were proposed and tested on normalized features derived by vital signs. Results: The results showed that the mean ± standard deviation (SD) for estimating BLV against the reference BLV of our proposed random-forest-derived BLV estimation models using PPG and ABP features, as well as the combination of ABP and PPG features, were 11.9 ± 156.2, 6.5 ± 161.5, and 7.0 ± 139.4 mL, respectively. Compared with traditional hematocrit computation formulas (estimation error: 102.1 ± 313.5 mL), our proposed models outperformed by nearly 200 mL in SD. Conclusion: This is the first attempt at predicting quantitative BLV from noninvasive measurements. Normalized PPG features are superior to ABP in accurately estimating early-stage BLV, and normalized invasive ABP features could enhance model performance in the event of a massive BLV.

A Novel AMARS Technique for Baseline Wander Removal Applied to Photoplethysmogram

A new digital filter, AMARS (aligning minima of alternating random signal) has been derived using trigonometry to regulate signal pulsations inline. The pulses are randomly presented in continuous signals comprising frequency band lower than the signal's mean rate. Frequency selective filters are conventionally employed to reject frequencies undesired by specific applications. However, these conventional filters only reduce the effects of the rejected range producing a signal superimposed by some baseline wander (BW). In this work, filters of different ranges and techniques were independently configured to preprocess a photoplethysmogram, an optical biosignal of blood volume dynamics, producing wave shapes with several BWs. The AMARS application effectively removed the encountered BWs to assemble similarly aligned trends. The removal implementation was found repeatable in both ear and finger photoplethysmograms, emphasizing the importance of BW removal in biosignal processing in retaining its structural, functional and physiological properties. We also believe that AMARS may be relevant to other biological and continuous signals modulated by similar types of baseline volatility.