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Peripheral photoplethysmography variability analysis of sepsis patients

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Abstract

Sepsis is associated with impairment in autonomic regulatory function. This work investigates the application of heart rate and photoplethysmogram (PPG) waveform variability analysis in differentiating two categories of sepsis, namely systemic inflammatory response syndrome (SIRS) and severe sepsis. Electrocardiogram-derived heart period (RRi) and PPG waveforms, measured from fingertips (Fin-PPG) and earlobes (Ear-PPG), of Emergency Department sepsis patients (n = 28) with different disease severity, were analysed by spectral technique, and were compared to control subjects (n = 10) in supine and 80° head-up tilted positions. Analysis of covariance (ANCOVA) was applied to adjust for the confounding factor of age. Low-frequency (LF, 0.04–0.15 Hz), mid-frequency (MF, 0.09–0.15 Hz) and high-frequency (HF, 0.15–0.60 Hz) powers were computed. The normalised MF power in Ear-PPG (MFnuEar) was significantly reduced in severe sepsis patients with hyperlactataemia (lactate > 2 mmol/l), compared to SIRS patients (P < 0.05). Moreover, in a group of normal controls, MFnuEar was not altered by head-up tilting (P > 0.05), suggesting that there may be a link between 0.1 Hz ear blood flow oscillation and tissue metabolic changes in sepsis, in addition to autonomic factors. The study highlighted the value of PPG spectral analysis in the non-invasive assessment of peripheral vascular regulation in sepsis patients, with potential implications in monitoring the progression of sepsis.

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Acknowledgements

The authors gratefully acknowledge the staffs in Emergency Department, Prince of Wales Hospital, Sydney for their assistance in data collection. This work was supported by the Australian Research Council.

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Authors and Affiliations

  1. Prince of Wales Clinical School, University of New South Wales, Kensington, NSW, 2031, Australia

    Paul M. Middleton & Sarah Bishop

  2. Biomedical Systems Laboratory, School of Electrical Engineering and Telecommunications, University of New South Wales, Kensington, NSW, 2052, Australia

    Paul M. Middleton, Collin H. H. Tang, Gregory S. H. Chan, Andrey V. Savkin & Nigel H. Lovell

  3. Emergency Department, Prince of Wales Hospital, Randwick, NSW, 2031, Australia

    Paul M. Middleton

  4. School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia

    Paul M. Middleton

  5. Ambulance Research Institute, Ambulance Service of NSW, Sydney, Australia

    Paul M. Middleton

  6. Faculty of Mechanical Engineering, Universiti Teknologi Malaysia, Johor, 81310, Malaysia

    Collin H. H. Tang

  7. Graduate School of Biomedical Engineering, University of New South Wales, Kensington, NSW, 2052, Australia

    Nigel H. Lovell

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  1. Paul M. Middleton
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  4. Sarah Bishop
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Correspondence to Paul M. Middleton.

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Middleton, P.M., Tang, C.H.H., Chan, G.S.H. et al. Peripheral photoplethysmography variability analysis of sepsis patients. Med Biol Eng Comput 49, 337–347 (2011). https://doi.org/10.1007/s11517-010-0713-z

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  • DOI: https://doi.org/10.1007/s11517-010-0713-z

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