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


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.


Sepsis Photoplethysmography Power spectrum analysis Cardiovascular variability analysis Peripheral circulation 



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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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

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