Effect of Blood Volume Shift Simulated via Head-up Tilt on Photoplethysmography Morphology

PPG can provide information on cardiovascular responses to fluid shifts from upper to lower part of body under the condition of orthostatic stress. The current study investigated ability of PPG derived LVET and other PPG derived features to identify progressive central hypovolemia induced by head up tilt (HUT) and evaluated potential use of LVET as early noninvasive indicator of blood loss. Continuous finger PPG, blood pressure, and electrocardiography were recorded simultaneously during 5-minutes of baseline and HUT of 20 degrees, 40 degrees, and 60 degrees from 15 participants (age: 26.5 +/- 3 years; height: 177 +/- 8 cm; weight: 72 +/- 10 kg, mean +/- SD). Beat-by-beat pulse rate (PR), systolic amplitude (SA), systolic time (ST), diastolic time (DT), and PP Interval (PPI) and Ratio of pulse rate over systolic amplitude (PR/SA) were derived for each stage. LVET was derived from each stage. Friedman test followed by post-hoc analysis using TukeyHSD was conducted to highlight the significance of changes induced by HUT. Application of 60 degrees HUT (i.e. moderate category simulated hypovolemia) resulted in a significant change in PR (80 +/- 3 bpm vs 68 +/- 3 bpm, p=0.0008), DT (264 +/- 7 ms vs 303 +/- 4 ms, p=0.0008), ST (110 +/- 6 ms vs 117 +/- 7 ms, p=0.02), PP interval (764 +/- 39 ms vs 869 +/- 25 ms, p=0.0045), PR/SA (112 +/- 16 vs 82 +/- 21, p=0.012), SA (0.875 +/- 0.2 vs 1.69 +/- 0.6, p=0.012) and LVET(292 vs 351ms,p=0.0008) compared to baseline. LVET has a strong association with the change in central blood volume and may be used as a sensitive early marker of progressive hypovolemia. The findings of the study support the hypothesis of differentiating simulated hypovolemia based on PPG