A Novel Approach Using Time–Frequency Analysis of Pulse-Oximeter Data to Detect Progressive Hypovolemia in Spontaneously Breathing Healthy Subjects

Accurate and early detection of blood volume loss would greatly improve intraoperative and trauma care. This study has attempted to determine early diagnostic and quantitative markers for blood volume loss by analyzing photoplethysmogram (PPG) data from ear, finger, and forehead sites with our high-resolution time-frequency spectral (TFS) technique in spontaneously breathing healthy subjects (n=11) subjected to lower body negative pressure (LBNP). The instantaneous amplitude modulations (AM) present in heart rate (AM_HR) and breathing rate (AM_BR) band frequencies of PPG signals were calculated from the high-resolution TFS. Results suggested that the changes (P <; 0.05) in AM_BR and especially in AM_HR values can be used to detect the blood volume loss at an early stage of 20% LBNP tolerance when compared to the baseline values. The mean percent decrease in AM_HR values at 100% LBNP tolerance was 78.3%, 72.5%, and 33.9% for ear, finger, and forehead PPG signals, respectively. The mean percent increase in AM_BR values at 100% LBNP tolerance was 99.4% and 19.6% for ear and finger sites, respectively; AM_BR values were not attainable for forehead PPG signal. Even without baseline AM_HR values, our results suggest that hypovolemia detection is possible with specificity and sensitivity greater than 90% for the ear and forehead locations when LBNP tolerance is 100%. Therefore, the TFS analysis of noninvasive PPG waveforms is promising for early diagnosis and quantification of hypovolemia at levels not identified by vital signs in spontaneously breathing subjects.