Clinical applications of photoplethysmography in paediatric intensive care

Abstract

Objective: The photoplethysmographic wave is displayed by most pulse oximeters. It may be used as a non-invasive alternative to invasive arterial blood pressure trace analysis for continuous haemodynamic monitoring in selected situations.
Patients and setting: Four cardiac patients treated in a tertiary neonatal-paediatric intensive care unit.
Measurements: Simultaneous monitoring of the photoplethysmographic wave, ECG, and invasive blood pressure.
Results and conclusions: Photoplethysmography allows for monitoring pulse rate in patients with (possible) heart rate/pulse rate dissociation (pacemaker dependency, pulsatile ventricular assist device); monitoring sudden changes in heart beat volume, which are unrelated to respiration (pulseless electrical activity, pulsus alternans); and monitoring respiratory-dependent fluctuations of the plethysmographic wave (heart failure, hypovolaemia, asthma, upper airway obstruction, pericardial effusion). Deterioration, slowly evolving over time, may be detected by this method.