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Macrocirculation is not the sole determinant of respiratory induced variations in the reflection mode photoplethysmographic signal
Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Biomedicine and Surgery. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences.
2003 (English)In: Physiological Measurement, ISSN 0967-3334, E-ISSN 1361-6579, Vol. 24, no 4, 925-937 p.Article in journal (Refereed) Published
Abstract [en]

Photoplethysmography (PPG) is a non-invasive optical technique sensitive to variations in blood volume and perfusion in the tissue. Reflection mode PPG may have clinical advantages over transmission mode PPG. To improve clinical usefulness and further development of the reflection mode PPG, studies on factors that modify the signal are warranted. We studied the coherence between the respiratory induced intensity variations (RIIV) of the PPG signal and respiratory synchronous pressure variations in central venous pressure (CVP), peripheral venous pressure (PVP) and arterial blood pressure (ABP) during positive pressure ventilation on 12 patients under anaesthesia and on 12 patients with spontaneous breathing. During positive pressure ventilation the coherence between all signals was high. Inspiration was followed first by an increase in CVP, then by increases in ABP and PVP and lastly by RIIV indicating less back-scattered light. In spontaneously breathing patients the coherence was high, but the phases between the signals were changed. During inspiration, ABP decreased slightly before CVP, followed by a decrease in RIIV and PVP. The phase relation between RIIV and respiratory induced variation in macrocirculation changed with ventilatory mode, but not in a uniform way, indicating the influence of mechanisms other than macrocirculation involved in generating the RIIV signal.

Place, publisher, year, edition, pages
2003. Vol. 24, no 4, 925-937 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26705DOI: 10.1088/0967-3334/24/4/009Local ID: 11297OAI: oai:DiVA.org:liu-26705DiVA: diva2:247255
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Respiratory monitoring using reflection mode photoplethysmography: clinical and physiological aspects
Open this publication in new window or tab >>Respiratory monitoring using reflection mode photoplethysmography: clinical and physiological aspects
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Photoplethysmography (PPG) is a non-invasive optical technique for monitoring variations in blood volume and blood flow in skin and other tissues. Light from a light-emitting diode is absorbed, scattered and reflected from the skin, and detected by a photodetector as a plethysmogram. The plethysmogram contains variations of different frequencies. The most clinically utilised is the pulse synchronous variation in the PPG application pulse oximetry, but there is also a respiratory rate synchronous variation (PPGt).

The aims of this work were to evaluate PPG as a clinical method for detection of breaths during anaesthesia, postoperative and intensive care, and to investigate possible circulatory factors in the physiological background of the respiratory synchronous part of the reflection mode PPG signal.

It was concluded that respiratory variations in reflection mode PPG derived from the forearm could be detected with high sensitivity and specificity. PPG, was not significantly affected by awake or anaesthetised state, though indirect signs of reduced sympathetic tone in the anaesthetic state were present, or by spontaneous or positive pressure ventilation. There were no significant differences between men and women or between young and old subjects. Circulatory pressure variations in phase with respiration were present on both the arterial and venous side and they showed the same degree of variation, as did PPG when provoking respiration. Squared coherence, cross-correlation and visual techniques for evaluating time differences were equally good.

Respiratory monitoring in the clinical setting is challenging and no golden standard exists. Methods based on airflow are mostly considered advantageous in detecting apnoea, but are less well tolerated by patients. The results indicate that PPG has a potential as a tool for monitoring respiratory rate. It is non-invasive, well tolerated and can be used for continuous monitoring.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2005. 70 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 898
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-31535 (URN)17335 (Local ID)91-8529-905-7 (ISBN)17335 (Archive number)17335 (OAI)
Public defence
2005-05-26, Elsa Brändström-salen, Universitetssjukhuset, Linköping, 12:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-09-27Bibliographically approved

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Nilsson, LenaJohansson, AndersKalman, Sigga

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