Respiratory variations in the photoplethysmographic waveform: acute hypovolaemia during spontaneous breathing is not detected

Abstract

Recent studies using photoplethysmographic (PPG) signals from pulse oximeters have shown potential to assess hypovolaemia during spontaneous breathing. This signal is heavily filtered and reports are based on respiratory variations in the small pulse synchronous variation of PPG. There are stronger respiratory variations such as respiratory synchronous variation (PPGr) in the baseline of the unfiltered PPG signal. We hypothesized that PPGr would increase during hypovolaemia during spontaneous breathing. Hemodynamic and respiratory data were recorded together with PPG infrared signals from the finger, ear and forearm from 12 healthy male volunteers, at rest and during hypovolaemia created by the application of a lower body negative pressure (LBNP) of 15, 30 and 60 cmH2O. Hemodynamic and respiratory values changed significantly. From rest to the LBNP of 60 cmH2O systolic blood pressure fell from median (IQR) 116 (16) to 101 (23) mmHg, the heart rate increased from 58 (16) to 73 (16) beats min−1, and the respiratory rate increased from 9.5 (2.0) to 11.5 (4.0) breaths min−1. The amplitude of PPGr did not change significantly at any measurement site. The strongest effect was seen at the ear, where the LBNP of 60 cmH2O gave an amplitude increase from 1.0 (0.0) to 1.31 (2.24) AU. PPG baseline respiratory variations cannot be used for detecting hypovolaemia in spontaneously breathing subjects.