Medical & Biological Engineering & Computing

, Volume 49, Issue 8, pp 859–866 | Cite as

Fingertip photoplethysmographic waveform variability and systemic vascular resistance in intensive care unit patients

  • Paul M. MiddletonEmail author
  • Gregory S. H. Chan
  • Elizabeth Steel
  • Philip Malouf
  • Christopher Critoph
  • Gordon Flynn
  • Emma O’Lone
  • Branko G. Celler
  • Nigel H. Lovell
Original Article


Low frequency variability in the fingertip photoplethysmogram (PPG) waveform has been utilized for inferring sympathetic vascular control, but its relationship with a quantitative measure of vascular tone has not been established. In this study, we examined the association between fingertip PPG waveform variability (PPGV) and systemic vascular resistance (SVR) obtained from thermodilution cardiac output (CO) and intra-arterial pressure measurements in 48 post cardiac surgery intensive care unit patients. Among the hemodynamic measurements, both CO (P < 0.05) and SVR (P < 0.0001) had statistically significant relationships with the normalized low frequency power (LFnu) of PPGV. The LFnu of baseline PPGV had moderate but significant positive correlation with SVR (r = 0.54, P < 0.0001), and a value below 52.5 nu was able to identify SVR < 900 dyn s cm−5 with sensitivity of 59% and specificity of 95%. The results have provided quantitative evidence to confirm the link between fingertip PPGV and sympathetic vascular control. Suppression of LF vasomotor waves leading to dominance of respiration-related HF fluctuations in the fingertip circulation was a specific (though not sensitive) marker of systemic vasodilatation, which could be potentially utilized for the assessment of critical care patients.


Photoplethysmography Power spectrum analysis Sympathetic nervous system 



The authors wish to thank all the staff members in the intensive care unit of Prince of Wales Hospital (Sydney, Australia) for their help and support offered to this study. This work was supported by the Australian Research Council.


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Copyright information

© International Federation for Medical and Biological Engineering 2011

Authors and Affiliations

  • Paul M. Middleton
    • 1
    • 2
    Email author
  • Gregory S. H. Chan
    • 2
    • 3
  • Elizabeth Steel
    • 4
  • Philip Malouf
    • 4
  • Christopher Critoph
    • 4
  • Gordon Flynn
    • 4
  • Emma O’Lone
    • 4
  • Branko G. Celler
    • 2
  • Nigel H. Lovell
    • 2
    • 3
  1. 1.Ambulance Research InstituteAmbulance Service of New South WalesSydneyAustralia
  2. 2.Biomedical Systems Laboratory, School of Electrical Engineering and TelecommunicationsUniversity of New South WalesSydneyAustralia
  3. 3.Graduate School of Biomedical EngineeringUniversity of New South WalesSydneyAustralia
  4. 4.Intensive Care UnitPrince of Wales HospitalSydneyAustralia

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