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Background and Objectives: In a significant portion of surgeries, bloodpressure (BP) is often measured non-invasively in an intermittent manner. Thispractice has a risk of missing clinically relevant BP changes between twoadjacent intermittent BP measurements. This study proposes a method tonon-invasively estimate systolic blood pressure (SBP) with high accuracy inpatients undergoing surgery. Methods: Continuous arterial BP,electrocardiography (ECG), and photoplethysmography (PPG) signals were acquiredfrom 29 patients undergoing surgery. After extracting 9 features from the PPGand ECG signals, we dynamically selected features upon each intermittentmeasurement (every 10 min) of SBP based on feature robustness and the principleof correlation-based feature selection. Finally, multiple linear regressionmodels were built to combine these features to estimate SBP every 30 s.Results: Compared to the reference SBP, the proposed method achieved a mean ofdifference at 0.08 mmHg, a standard deviation of difference at 7.97 mmHg, and acorrelation coefficient at 0.89 (p < 0.001). Conclusions: This studydemonstrates the feasibility of non-invasively estimating SBP every 30 s withhigh accuracy during surgery by using ECG, PPG, and intermittent SBPmeasurements every 10 min, which meets the standard of the Association for theAdvancement of Medical Instrumentation. The proposed method has the potentialto enhance BP monitoring in the operating room, improving patient outcomes andexperiences.

Systolic blood pressure estimation using ECG and PPG in patients undergoing surgery