Advertisement

Medical & Biological Engineering & Computing

, Volume 49, Issue 3, pp 337–347 | Cite as

Peripheral photoplethysmography variability analysis of sepsis patients

  • Paul M. MiddletonEmail author
  • Collin H. H. Tang
  • Gregory S. H. Chan
  • Sarah Bishop
  • Andrey V. Savkin
  • Nigel H. Lovell
Original Article

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.

Keywords

Sepsis Photoplethysmography Power spectrum analysis Cardiovascular variability analysis Peripheral circulation 

Notes

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.

References

  1. 1.
    Awad AA, Ghobashy MA, Ouda W, Stout RG, Silverman DG, Shelley KH (2001) Different responses of ear and finger pulse oximeter wave form to cold pressor test. Anesth Analg 92:1483–1486PubMedCrossRefGoogle Scholar
  2. 2.
    Barnett SR, Morin RJ, Kiely DK, Gagnon M, Azhar G, Knight EL, Nelson JC, Lipsitz LA (1999) Effects of age and gender on autonomic control of blood pressure dynamics. Hypertension 33:1195–1200PubMedGoogle Scholar
  3. 3.
    Bendjelid K (2008) The pulse oximetry plethysmographic curve revisited. Curr Opin Crit Care 14:348–353PubMedCrossRefGoogle Scholar
  4. 4.
    Berger RD, Akselrod S, Gordon D, Cohen RJ (1986) An efficient algorithm for spectral analysis of heart rate variability. IEEE Trans Biomed Eng 33:900–904PubMedCrossRefGoogle Scholar
  5. 5.
    Bernardi L, Radaelli A, Solda PL, Coats AJ, Reeder M, Calciati A, Garrard CS, Sleight P (1996) Autonomic control of skin microvessels: assessment by power spectrum of photoplethysmographic waves. Clin Sci 90:345–355PubMedGoogle Scholar
  6. 6.
    Bernardi L, Hayoz D, Wenzel R, Passino C, Calciati A, Weber R, Noll G (1997) Synchronous and baroceptor-sensitive oscillations in skin microcirculation: evidence for central autonomic control. Am J Physiol 273:H1867–H1878PubMedGoogle Scholar
  7. 7.
    Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101:1644–1655PubMedCrossRefGoogle Scholar
  8. 8.
    Buckley JF, Singer M, Clapp LH (2006) Role of KATP channels in sepsis. Cardiovasc Res 72:220–230PubMedCrossRefGoogle Scholar
  9. 9.
    Chen CC, Chong CF, Liu YL, Chen KC, Wang TL (2006) Risk stratification of severe sepsis patients in the emergency department. Emerg Med J 23:281–285PubMedCrossRefGoogle Scholar
  10. 10.
    De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL (2002) Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 166:98–104PubMedCrossRefGoogle Scholar
  11. 11.
    Hagblad J, Lindberg LG, Andersson AK, Bergstrand S, Lindgren M, Ek AC, Folke M, Lindén M (2010) A technique based on laser Doppler flowmetry and photoplethysmography for simultaneously monitoring blood flow at different tissue depths. Med Biol Eng Comput 48:415–422PubMedCrossRefGoogle Scholar
  12. 12.
    Intaglietta M (1991) Arteriolar vasomotion: implications for tissue ischemia. Blood Vessels 28(Suppl 1):1–7PubMedGoogle Scholar
  13. 13.
    James JH, Luchette FA, McCarter FD, Fischer JE (1999) Lactate is an unreliable indicator of tissue hypoxia in injury or sepsis. Lancet 354:505–508PubMedCrossRefGoogle Scholar
  14. 14.
    Jubran A (1999) Pulse oximetry. Crit Care 3:R11–R17PubMedCrossRefGoogle Scholar
  15. 15.
    Kilbourn RG, Traber DL, Szabó C (1997) Nitric oxide and shock. Dis Mon 43:277–348PubMedGoogle Scholar
  16. 16.
    Kim SW, Kim SC, Nam KC, Kang ES, Im JJ, Kim DW (2008) A new method of screening for diabetic neuropathy using laser Doppler and photoplethysmography. Med Biol Eng Comput 46:61–67PubMedCrossRefGoogle Scholar
  17. 17.
    Knotzer H, Maier S, Dünser M, Stadlbauer KH, Ulmer H, Pajk W, Hasibeder WR (2007) Oscillation frequency of skin microvascular blood flow is associated with mortality in critically ill patients. Acta Anaesthesiol Scand 51:701–707PubMedCrossRefGoogle Scholar
  18. 18.
    Krogstad AL, Elam M, Karlsson T, Wallin BG (1995) Atriovenous anastomoses and the thermoregulatory shift between cutaneous vasoconstrictor and vasodilator reflexes. J Auton Nerv Syst 53:215–222PubMedCrossRefGoogle Scholar
  19. 19.
    Landry DW, Oliver JA (1992) The ATP-sensitive K+ channel mediates hypotension in endotoxemia and hypoxic lactic acidosis in dog. J Clin Invest 89:2071–2074PubMedCrossRefGoogle Scholar
  20. 20.
    Landry DW, Oliver JA (2001) The pathogenesis of vasodilatory shock. N Engl J Med 345:588–595PubMedCrossRefGoogle Scholar
  21. 21.
    Lee SW, Hong YS, Park DW, Choi SH, Moon SW, Park JS, Kim JY, Baek KJ (2008) Lactic acidosis not hyperlactatemia as a predictor of in hospital mortality in septic emergency patients. Emerg Med J 25:659–665PubMedCrossRefGoogle Scholar
  22. 22.
    Levy B (2006) Lactate and shock state: the metabolic view. Curr Opin Crit Care 12:315–321PubMedCrossRefGoogle Scholar
  23. 23.
    Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Intensive Care Med 29:530–538PubMedGoogle Scholar
  24. 24.
    Malik M, Bigger JT, Camm AJ, Kleiger RE, Malliani A, Moss AJ, Schwartz PJ (1996) Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Eur Heart J 17:354–381Google Scholar
  25. 25.
    Malliani A, Pagani M, Lombardi F, Cerutti S (1991) Cardiovascular neural regulation explored in the frequency domain. Circulation 84:482–492PubMedGoogle Scholar
  26. 26.
    Middleton PM, Chan GS, O’ Lone E, Steel E, Carroll R, Celler BG, Lovell NH (2008) Spectral analysis of finger photoplethysmographic waveform variability in a model of mild to moderate haemorrhage. J Clin Monit Comput 22:343–353PubMedCrossRefGoogle Scholar
  27. 27.
    Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, Bellamy SL, Christie JD (2009) Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med 37:1670–1677PubMedCrossRefGoogle Scholar
  28. 28.
    Monahan KD (2007) Effects of aging on baroreflex function in humans. Am J Physiol Regul Integr Comp Physiol 293:R3–R12PubMedGoogle Scholar
  29. 29.
    Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, Tomlanovich MC (2004) Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med 32:1637–1642PubMedCrossRefGoogle Scholar
  30. 30.
    Piepoli M, Garrard CS, Kontoyannis DA, Bernardi L (1995) Autonomic control of the heart and peripheral vessels in human septic shock. Intensive Care Med 21:112–119PubMedCrossRefGoogle Scholar
  31. 31.
    Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377PubMedCrossRefGoogle Scholar
  32. 32.
    Rubins U (2008) Finger and ear photoplethysmogram waveform analysis by fitting with Gaussians. Med Biol Eng Comput 46:1271–1276PubMedCrossRefGoogle Scholar
  33. 33.
    Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL (2004) Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 32:1825–1831PubMedCrossRefGoogle Scholar
  34. 34.
    Sasano H, Hayano J, Tsuda T, Katsuya H (1999) Effects of sympathetic nerve blockades on low-frequency oscillations of human earlobe skin blood flow. J Auton Nerv Syst 77:60–67PubMedCrossRefGoogle Scholar
  35. 35.
    Shelley KH (2007) Photoplethysmography: beyond the calculation of arterial oxygen saturation and heart rate. Anesth Analg 105:S31–S36PubMedCrossRefGoogle Scholar
  36. 36.
    Slade E, Tamber PS, Vincent JL (2003) The Surviving Sepsis Campaign: raising awareness to reduce mortality. Crit Care 7(1):1PubMedCrossRefGoogle Scholar
  37. 37.
    Spronk PE, Zandstra DF, Ince C (2004) Bench-to-bedside review: sepsis is a disease of the microcirculation. Crit Care 8:462–468PubMedCrossRefGoogle Scholar
  38. 38.
    Teng XF, Zhang YT (2004) The effect of contacting force on photoplethysmographic signals. Physiol Meas 25:1323–1335PubMedCrossRefGoogle Scholar
  39. 39.
    Tracey KJ (2002) The inflammatory reflex. Nature 420:853–859PubMedCrossRefGoogle Scholar
  40. 40.
    Young JD, Cameron EM (1995) Dynamics of skin blood flow in human sepsis. Intensive Care Med 21:669–674PubMedCrossRefGoogle Scholar

Copyright information

© International Federation for Medical and Biological Engineering 2010

Authors and Affiliations

  • Paul M. Middleton
    • 1
    • 2
    • 3
    • 4
    • 5
    Email author
  • Collin H. H. Tang
    • 2
    • 6
  • Gregory S. H. Chan
    • 2
  • Sarah Bishop
    • 1
  • Andrey V. Savkin
    • 2
  • Nigel H. Lovell
    • 2
    • 7
  1. 1.Prince of Wales Clinical SchoolUniversity of New South WalesKensingtonAustralia
  2. 2.Biomedical Systems Laboratory, School of Electrical Engineering and TelecommunicationsUniversity of New South WalesKensingtonAustralia
  3. 3.Emergency DepartmentPrince of Wales HospitalRandwickAustralia
  4. 4.School of Public HealthUniversity of SydneySydneyAustralia
  5. 5.Ambulance Research InstituteAmbulance Service of NSWSydneyAustralia
  6. 6.Faculty of Mechanical EngineeringUniversiti Teknologi MalaysiaJohorMalaysia
  7. 7.Graduate School of Biomedical EngineeringUniversity of New South WalesKensingtonAustralia

Personalised recommendations