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J Clin Monit Comput. 2011 Dec;25(6):377-85. doi: 10.1007/s10877-011-9316-y. Epub 2011 Nov 4.

Impact of central hypovolemia on photoplethysmographic waveform parameters in healthy volunteers. Part 1: time domain analysis.

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Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520-8051, USA.



Our study sought to explore changes in photoplethysmographic (PPG) waveform param- eters, during lower body negative pressure (LBNP) which simulated hypovolemia, in spontaneously breathing volunteers. We hypothesize that during progressive LBNP; there will be a preservation of ear PPG parameters and a decrease in finger PPG parameters.


With IRB approval, 11 volunteers underwent a LBNP protocol at baseline, 30, 75, and 90 mm Hg (or until the subject became symptomatic). Subjects were monitored with finger and ear pulse oximeter probes, an ECG, and a finger arterial blood pressure monitor. The square root of the mean of the squared differences between adjacent NN intervals (RMSSD) which is the time domain analysis of the heart rate variability (HRV) was measured. PPG waveforms were analyzed for height, area, width 50, maximum and minimum slope. Data are presented as median and inter-quartile range. Friedman ANOVA and Wilcoxon tests were used to identify changes in hemo- dynamic and PPG parameters, P < 0.017 was considered statistically significant.


There were no significant changes in the blood pressure variables at LBNP(30), but at and beyond LBNP(75), the decreases in systolic, mean and pulse pressure were significant as was the increase in diastolic pressure. Heart rate increased significantly at LBNP(30), reaching a maximum of 75.4% above baseline at the symptomatic phase while RMSSD showed significant reduction at LBNP(75). Finger PPG height, area, width 50, and maximum slope decreased significantly at LBNP(30) and during symptomatic phase they showed a reduction of 59.4, 76.9, 27.4 and 51.6%, respectively. Ear PPG height, area, width 50 and maximum slope did not change significantly until the LBNP(75), reached. During symptomatic phase, the respective declines reached 39.3, 61.0, 21.4 and 34.9%.


PPG waveform parameters may prove to be sensitive and specific as early indicators of blood loss. These PPG changes were observed before profound decreases in arterial blood pressure. The relative sparing of central cutaneous blood flow is consistent with the increased parasympathetic innervation of central structures.

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