Cited by 289Non-Invasive Vital Sign MonitoringHemodynamic Monitoring and TherapyCardiovascular Health and Disease Prevention

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Photoplethysmography

Alian, Aymen A., Shelley, Kirk H.·2014·Best Practice & Research Clinical Anaesthesiology

DOI 10.1016/j.bpa.2014.08.006

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Abstract

The photoplethysmographic (PPG) waveform, also known as the pulse oximeter waveform, is one of the most commonly displayed clinical waveforms. First described in the 1930s, the technology behind the waveform is simple. The waveform, as displayed on the modern pulse oximeter, is an amplified and highly filtered measurement of light absorption by the local tissue over time. It is optimized by medical device manufacturers to accentuate its pulsatile components. Physiologically, it is the result of a complex, and not well understood, interaction between the cardiovascular, respiratory, and autonomic systems. All modern pulse oximeters extract and display the heart rate and oxygen saturation derived from the PPG measurements at multiple wavelengths. "As is," the PPG is an excellent monitor for cardiac arrhythmia, particularly when used in conjunction with the electrocardiogram (ECG). With slight modifications in the display of the PPG (either to a strip chart recorder or slowed down on the monitor screen), the PPG can be used to measure the ventilator-induced modulations which have been associated with hypovolemia. Research efforts are under way to analyze the PPG using improved digital signal processing methods to develop new physiologic parameters. It is hoped that when these new physiologic parameters are combined with a more modern understanding of cardiovascular physiology (functional hemodynamics) the potential utility of the PPG will be expanded. The clinical researcher's objective is the use of the PPG to guide early goal-directed therapeutic interventions (fluid, vasopressors, and inotropes), in effect to extract from the simple PPG the information and therapeutic guidance that was previously only obtainable from an arterial pressure line and the pulmonary artery catheter.

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Authors: Alian, A. A., & Shelley, K. H.
Affiliations: Yale University (US)
Corresponding author: Shelley, Kirk H.
ORCID: Alian, Aymen A.
Shelley, Kirk H.
Venue: Best Practice & Research Clinical Anaesthesiology
Publisher: Elsevier BV
Published: 2014-12
Volume: 28
Issue: 4
Pages: 395-406
ISSN: 1521-6896 (ISSN-L)
1753-3740
DOI: 10.1016/j.bpa.2014.08.006
OpenAlex: W4245509891
Cited by: 289
References: 83
Citations by year: 2026: 18 · 2025: 45 · 2024: 36 · 2023: 44 · 2022: 37 · 2021: 25 · 2020: 20 · 2019: 21 · 2018: 17 · 2017: 8 · 2016: 7 · 2015: 9
FWCI: 4.15
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
doi.org/10.15223/policy-017 (stm-asf)
doi.org/10.15223/policy-037 (stm-asf)
doi.org/10.15223/policy-012 (stm-asf)
doi.org/10.15223/policy-029 (stm-asf)
doi.org/10.15223/policy-004 (stm-asf)
Locations: Best practice & research. Clinical anaesthesiology (publishedVersion)
PubMed (publishedVersion)
Topics: Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords: photoplethysmography, pulse oximetry, arrhythmia monitoring, oxygen saturation, heart rate, hypovolemia, early goal-directed therapy, fluid management, vasopressors, inotropic agents
MeSH terms: Hemodynamics, Humans, Oximetry, Photoplethysmography, Hypovolemia

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