Date of Award


Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

David G. Silverman


The purpose of this investigation was to explore modulation of the photoplethsymographic (PPG) waveform in the setting of simulated hypovolemia as a tool to distinguish regional differences in regulation of the microvasculature. The primary goal was to glean useful physiological and clinical information as it pertains to these regional differences in regulation of microvascular blood flow. This entailed examining the cardiovascular, autonomic nervous, and respiratory systems interplay in the functional hemodynamics of regulation of microvascular blood flow to both central (ear, forehead) and peripheral (finger) sites. We monitored ten healthy volunteers (both men and women age 24-37 ) non-invasively with central and peripheral photoplethysmographs and laser Doppler flowmeters during Lower Body Negative Pressure (LBNP). Waveform amplitude, width, and oscillatory changes were characterized using waveform analysis software (Chart, ADInstruments). Data were analyzed with the Wilcoxon Signed Ranks Test, paired t-tests, and linear regression. Finger PPG amplitude decreased by 34.6 ± 17.6% (p = 0.009) between baseline and the highest tolerated LBNP. In contrast, forehead amplitude changed by only 2.4 ± 16.0% (p=NS). Forehead and finger PPG width decreased by 48.4% and 32.7%, respectively. Linear regression analysis of the forehead and finger PPG waveform widths as functions of time generated slopes of -1.113 (R = -0.727) and -0.591 (R = -0.666), respectively. A 150% increase in amplitude density of the ear PPG waveform was noted within the range encompassing the respiratory frequency (0.19-0.3Hz) (p=0.021) attributable to changes in stroke volume. We also noted autonomic modulation of the ear PPG signal in a different frequency band (0.12 0.18 Hz). The data indicate that during a hypovolemic challenge, healthy volunteers had a relative sparing of central cutaneous blood flow when compared to a peripheral site as indicated by observable and quantifiable changes in the PPG waveform. These results are the first documentation of a local vasodilatation at the level of the terminal arterioles of the forehead that may be attributable to recently documented cholinergic mechanisms on the microvasculature.