• Aymen A Alian, Nicholas J Galante, Nina S Stachenfeld, David G Silverman, and Kirk H Shelley.
• Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520-8051, USA.
• J Clin Monit Comput. 2011 Dec 1;25(6):387-96.

ObjectiveThe photoplethysmographic (PPG) waveforms are modulated by the respiratory, cardiac and autonomic nervous system. Lower body negative pressure (LBNP) has been used as an experimental tool to simulate loss of central blood volume in humans. The aim of our research is to understanding PPG waveform changes during progressive hypovolemia.MethodsWith IRB approval, 11 volunteers underwent a LBNP protocol at baseline, 30, 75, and 90 mmHg (or until the subject became symptomatic). Subjects were monitored with finger and ear pulse oximeter probes, ECG, and finger arterial blood pressure monitor (FABP). Heart rate variability (HRV) was analyzed to high frequency (HRV-HF) (0.12-0.4 Hz) and low frequency (HRV-LF) (0.04-0.12 Hz). Frequency analysis of PPG waveforms were computed to low (0.04-0.11 Hz) frequency (PPG-LF), intermediate (0.12-0.18 Hz) frequency (PPG-IF), respiratory (0.19-0.3 Hz) frequency (PPG-Resp.) and cardiac (0.75-2.5 Hz) frequency (PPG-Cardiac)during different phases of LBNP protocolResultsHeart rate increased significantly while systolic, mean and pulse pressure of the FABP declined slowly together with significant reductions in HRV-HF (0.12-0.4 Hz) and HRV-LF (0.04-0.12 Hz) power at LBNP(75). There was significant reduction in finger PPG-Cardiac modulation which is consistent with the reduction in the pulse pressure of the FABP. As the LBNP progress there was shift in the amplitude density of the ear PPG-Cardiac to PPG-Resp. Oscillation as an evidence of progressive hypovolemia with reduction in pulse pressure and increase in the respiratory induced variations. At LBNP(75), there were significant increased (>140% increase from the baseline) in ear PPG-IF (0.12-0.18 Hz) in the meantime HRV-HF showed significant reduction (>89%) from the baseline. At the symptomatic phase; there was a shift in ear PPG-IF to PPG-Resp. With an increase in the ear PPG-Resp. Modulation to ≥175% from the baselineConclusionThe pulse oximeter waveform contains a complex mixture of the effect of cardiac, venous, autonomic, and respiratory systems on the central and peripheral circulation. The occurrence of autonomic modulation needs to be taken into account when studying signals that have their origins from central sites (e.g. ear and forehead).

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