Respiratory Physiology and the Impact of Different Modes of Ventilation on the Photoplethysmographic Waveform 英文参考文献.docVIP

Sensors 2012, 12, 2236-2254; doi:10.3390/s120202236 OPEN ACCESS sensors ISSN 1424-8220 /journal/sensors Review Respiratory Physiology and the Impact of Different Modes of Ventilation on the Photoplethysmographic Waveform Aymen A. Alian and Kirk H. Shelley * Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208051, New Haven, CT 06520, USA; E-Mail: aymen.alian@ * Author to whom correspondence should be addressed; E-Mail: kirk.shelley@; Tel.: +1-203-785-2802. Received: 13 December 2011; in revised form: 7 February 2012 / Accepted: 8 February 2012 / Published: 16 February 2012 Abstract: The photoplethysmographic waveform sits at the core of the most used, and arguably the most important, clinical monitor, the pulse oximeter. Interestingly, the pulse oximeter was discovered while examining an artifact during the development of a noninvasive cardiac output monitor. This article will explore the response of the pulse oximeter waveform to various modes of ventilation. Modern digital signal processing is allowing for a re-examination of this ubiquitous signal. The effect of ventilation on the photoplethysmographic waveform has long been thought of as a source of artifact. The primary goal of this article is to improve the understanding of the underlying physiology responsible for the observed phenomena, thereby encouraging the utilization of this understanding to develop new methods of patient monitoring. The reader will be presented with a review of respiratory physiology followed by numerous examples of the impact of ventilation on the photoplethysmographic waveform. Keywords: clinical monitoring; photoplethysmographic waveform; respiratory physiology; pulse oximeter waveform 1. Introduction Assessment of fluid responsiveness is an important issue in the fluid management of critically ill patients. A fluid challenge in patients with borde