Clinical applications of photoplethysmography in paediatric intensive care.

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.