Finger and forehead photoplethysmography-derived pulse-pressure variation and the benefits of baseline correction

S. Sun (Corresponding author), Wouter Peeters, R. Bezemer, X. Long, I.W.F. Paulussen, R.M. Aarts, G.J. Noordergraaf

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To non-invasively predict fluid responsiveness, respiration-induced pulse amplitude variation (PAV) in the photoplethysmographic (PPG) signal has been proposed as an alternative to pulse pressure variation (PPV) in the arterial blood pressure (ABP) signal. However, it is still unclear how the performance of the PPG-derived PAV is site-dependent during surgery. The aim of this study is to compare finger- and forehead-PPG derived PAV in their ability to approach the value and trend of ABP-derived PPV. Furthermore, this study investigates four potential confounding factors, (1) baseline variation, (2) PPV, (3) ratio of respiration and heart rate, and (4) perfusion index, which might affect the agreement between PPV and PAV. In this work, ABP, finger PPG, and forehead PPG were continuously recorded in 29 patients undergoing major surgery in the operating room. A total of 91.2 h data were used for analysis, from which PAV and PPV were calculated and compared. We analyzed the impact of the four factors using a multiple linear regression (MLR) analysis. The results show that compared with the ABP-derived PPV, finger-derived PAV had an agreement of 3.2 ± 5.1%, whereas forehead-PAV had an agreement of 12.0 ± 9.1%. From the MLR analysis, we found that baseline variation was a factor significantly affecting the agreement between PPV and PAV. After correcting for respiration-induced baseline variation, the agreements for finger- and forehead-derived PAV were improved to reach an agreement of −1.2 ± 3.8% and 3.3 ± 4.8%, respectively. To conclude, finger-derived PAV showed better agreement with ABP-derived PPV compared to forehead-derived PAV. Baseline variation was a factor that significantly affected the agreement between PPV and PAV. By correcting for the baseline variation, improved agreements were obtained for both the finger and forehead, and the difference between these two agreements was diminished. The tracking abilities for both finger- and forehead-derived PAV still warrant improvement for wide use in clinical practice. Overall, our results show that baseline-corrected finger- and forehead-derived PAV may provide a non-invasive alternative for PPV.
Original languageEnglish
Pages (from-to)65–75
Number of pages11
JournalJournal of Clinical Monitoring and Computing
Issue number1
Publication statusPublished - 15 Feb 2019


  • Fluid responsiveness
  • Major surgery
  • Photoplethysmography
  • Pulse pressure variation
  • Site dependency
  • Volume status
  • Blood Pressure
  • Heart Rate
  • Humans
  • Middle Aged
  • Photoplethysmography/methods
  • Male
  • Regression Analysis
  • Forehead
  • Arterial Pressure
  • Time Factors
  • Fingers
  • Operating Rooms
  • Signal Processing, Computer-Assisted
  • Female
  • Aged
  • Respiration


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