Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently impacts an object or when an object pierces the skull and ...enters brain tissue. Secondary injuries after traumatic brain injury (TBI) can lead to impairments on cerebral oxygenation and autoregulation. Considering that secondary brain injuries often take place within the first hours after the trauma, noninvasive monitoring might be helpful in providing early information on the brain's condition. Near-infrared spectroscopy (NIRS) is an emerging noninvasive monitoring modality based on chromophore absorption of infrared light with the capability of monitoring perfusion of the brain. This review investigates the main applications of NIRS in TBI monitoring and presents a thorough revision of those applications on oxygenation and autoregulation monitoring. Databases such as PubMed, EMBASE, Web of Science, Scopus, and Cochrane library were utilized in identifying 72 publications spanning between 1977 and 2020 which were directly relevant to this review. The majority of the evidence found used NIRS for diagnosis applications, especially in oxygenation and autoregulation monitoring (59%). It was not surprising that nearly all the patients were male adults with severe trauma who were monitored mostly with continue wave NIRS or spatially resolved spectroscopy NIRS and an invasive monitoring device. In general, a high proportion of the assessed papers have concluded that NIRS could be a potential noninvasive technique for assessing TBI, despite the various methodological and technological limitations of NIRS.
Photoplethysmography (PPG) is a non-invasive photometric technique that measures the volume changes in arterial blood. Recent studies have reported limitations in developing and optimising PPG-based ...sensing technologies due to unavailability of the fundamental information such as PPG-pathlength and penetration depth in a certain region of interest (ROI) in the human body. In this paper, a robust computational model of a dual wavelength PPG system was developed using Monte Carlo technique. A three-dimensional heterogeneous volume of a specific ROI (i.e., human finger) was exposed at the red (660 nm) and infrared (940 nm) wavelengths in the reflectance and transmittance modalities of PPG. The optical interactions with the individual pulsatile and non-pulsatile tissue-components were demonstrated and the optical parameters (e.g., pathlength, penetration depth, absorbance, reflectance and transmittance) were investigated. Results optimised the source-detector separation for a reflectance finger-PPG sensor. The analysis with the recorded absorbance, reflectance and transmittance confirmed the maximum and minimum impact of the dermis and bone tissue-layers, respectively, in the formation of a PPG signal. The results presented in the paper provide the necessary information to develop PPG-based transcutaneous sensors and to understand the origin of the ac and dc components of the PPG signal.
In the last decades, photoplethysmography (PPG) has been used as a noninvasive technique for monitoring arterial oxygen saturation by pulse oximetry (PO), whereas near-infrared spectroscopy (NIRS) ...has been employed for monitoring tissue blood perfusion. While NIRS offers more parameters to evaluate oxygen delivery and consumption in deep tissues, PO only assesses the state of oxygen delivery. For a broader assessment of blood perfusion, this paper explores the utilization of dual-wavelength PPG by using the pulsatile (ac) and continuous (dc) PPG for the estimation of arterial oxygen saturation (SpO2) by conventional PO. Additionally, the Beer-Lambert law is applied to the dc components only for the estimation of changes in deoxyhemoglobin (HHb), oxyhemoglobin (HbO2), and total hemoglobin (tHb) as in NIRS. The system was evaluated on the forearm of 21 healthy volunteers during induction of venous occlusion (VO) and total occlusion (TO). A reflectance PPG probe and NIRS sensor were applied above the brachioradialis, PO sensors were applied on the fingers, and all the signals were acquired simultaneously. While NIRS and forearm SpO2 indicated VO, SpO2 from the finger did not exhibit any significant drop from baseline. During TO, all the indexes indicated the change in blood perfusion. HHb, HbO2, and tHb changes estimated by PPG presented high correlation with the same parameters obtained by NIRS during VO (r 2 = 0.960, r 2 = 0.821, and r 2 = 0.974, respectively) and during TO (r 2 = 0.988, r 2 = 0.940, and r 2 = 0.938, respectively). The system demonstrated the ability to extract valuable information from PPG signals for a broader assessment of tissue blood perfusion.
Photoplethysmography (PPG) is a photometric technique used for the measurement of volumetric changes in the blood. The recent interest in new applications of PPG has invigorated more fundamental ...research regarding the origin of the PPG waveform, which since its discovery in 1937, remains inconclusive. A handful of studies in the recent past have explored various hypotheses for the origin of PPG. These studies relate PPG to mechanical movement, red blood cell orientation or blood volume variations. Objective: Recognising the significance and need to corroborate a theory behind PPG formation, the present work rigorously investigates the origin of PPG based on a realistic model of light-tissue interactions. Approach: A three-dimensional comprehensive Monte Carlo model of finger-PPG was developed and explored to quantify the optical entities pertinent to PPG (e.g. absorbance, reflectance, and penetration depth) as the functions of multiple wavelengths and source-detector separations. Complementary to the simulations, a pilot in vivo investigation was conducted on eight healthy volunteers. PPG signals were recorded using a custom-made multiwavelength sensor with an adjustable source-detector separation. Main results: Simulated results illustrate the distribution of photon-tissue interactions in the reflectance PPG geometry. The depth-selective analysis quantifies the contributions of the dermal and subdermal tissue layers in the PPG wave formation. A strong negative correlation (r = −0.96) is found between the ratios of the simulated absorbances and measured PPG amplitudes. Significance: This work quantified for the first time the contributions of different tissue layers and sublayers in the formation of the PPG signal.
Introduction:
Heart Rate Variability (HRV) and Pulse Rate Variability (PRV), are non-invasive techniques for monitoring changes in the cardiac cycle. Both techniques have been used for assessing the ...autonomic activity. Although highly correlated in healthy subjects, differences in HRV and PRV have been observed under various physiological conditions. The reasons for their disparities in assessing the degree of autonomic activity remains unknown.
Methods:
To investigate the differences between HRV and PRV, a whole-body cold exposure (CE) study was conducted on 20 healthy volunteers (11 male and 9 female, 30.3 ± 10.4 years old), where PRV indices were measured from red photoplethysmography signals acquired from central (ear canal, ear lobe) and peripheral sites (finger and toe), and HRV indices from the ECG signal. PRV and HRV indices were used to assess the effects of CE upon the autonomic control in peripheral and core vasculature, and on the relationship between HRV and PRV. The hypotheses underlying the experiment were that PRV from central vasculature is less affected by CE than PRV from the peripheries, and that PRV from peripheral and central vasculature differ with HRV to a different extent, especially during CE.
Results:
Most of the PRV time-domain and Poincaré plot indices increased during cold exposure. Frequency-domain parameters also showed differences except for relative-power frequency-domain parameters, which remained unchanged. HRV-derived parameters showed a similar behavior but were less affected than PRV. When PRV and HRV parameters were compared, time-domain, absolute-power frequency-domain, and non-linear indices showed differences among stages from most of the locations. Bland-Altman analysis showed that the relationship between HRV and PRV was affected by CE, and that it recovered faster in the core vasculature after CE.
Conclusion:
PRV responds to cold exposure differently to HRV, especially in peripheral sites such as the finger and the toe, and may have different information not available in HRV due to its non-localized nature. Hence, multi-site PRV shows promise for assessing the autonomic activity on different body locations and under different circumstances, which could allow for further understanding of the localized responses of the autonomic nervous system.
Heart rate variability has been largely used for the assessment of cardiac autonomic activity, due to the direct relationship between cardiac rhythm and the activity of the sympathetic and ...parasympathetic nervous system. In recent years, another technique, pulse rate variability, has been used for assessing heart rate variability information from pulse wave signals, especially from photoplethysmography, a non-invasive, non-intrusive, optical technique that measures the blood volume in tissue. The relationship, however, between pulse rate variability and heart rate variability is not entirely understood, and the effects of cardiovascular changes in pulse rate variability have not been thoroughly elucidated. In this review, a comprehensive summary of the applications in which pulse rate variability has been used, with a special focus on cardiovascular health, and of the studies that have compared heart rate variability and pulse rate variability is presented. It was found that the relationship between heart rate variability and pulse rate variability is not entirely understood yet, and that pulse rate variability might be influenced not only due to technical aspects but also by physiological factors that might affect the measurements obtained from pulse-to-pulse time series extracted from pulse waves. Hence, pulse rate variability must not be considered as a valid surrogate of heart rate variability in all scenarios, and care must be taken when using pulse rate variability instead of heart rate variability. Specifically, the way pulse rate variability is affected by cardiovascular changes does not necessarily reflect the same information as heart rate variability, and might contain further valuable information. More research regarding the relationship between cardiovascular changes and pulse rate variability should be performed to evaluate if pulse rate variability might be useful for the assessment of not only cardiac autonomic activity but also for the analysis of mechanical and vascular autonomic responses to these changes.
Haemorheology has been long identified as an early biomarker of a wide range of diseases, especially cardiovascular diseases. This study investigates for the first time the suitability of ...Photoplethysmography (PPG) as a non-invasive diagnostic method for haemorheological changes. The sensitivity of both PPG components (AC and DC) to changes in haemorheology were rigorously investigated in an in vitro experimental setup that mimics the human circulation. A custom-made reflectance PPG sensor, a pressure transducer and an ultrasonic Doppler flowmeter were used to map changes in flow dynamics and optical responses in an arterial model. The study investigated the effect of shear rates by varying fluid pumping frequencies using 4 set-points and the effect of clot formation using a chemical trigger. Both PPG
amplitudes and PPG
levels showed significant (p < 0.001) changes during the increase in shear rates and an immediate change after thromboplastin activation. The findings highlight that PPG has the potential to be used as a simple non-invasive method for the detection of blood characteristics, including disaggregation, radial migration and cross-linking fibrin formations. Such capability will enable the assessment of the effects of clotting-activators and anticoagulants (including non-pharmacological methods) and might aid in the early non-invasive assessment of cardiovascular pathologies.
BACKGROUND:Pulse oximetry is a noninvasive photometric technique that provides information about arterial blood oxygen saturation (SpO2) and heart rate and has widespread clinical applications. This ...is accomplished via peripheral pulse oximetry probes mainly attached to the finger, toe, or earlobe. The direct application of pulse oximetry to an organ, such as the esophagus, liver, bowel, stomach or free flap, might provide an indication of how well perfused an organ or a free flap is. Also, the placement of a pulse oximetry probe at a more central site, such as the esophagus, might be more reliable at a time when conventional peripheral pulse oximetry fails.
METHODS:The focus of this article is the development and in vivo applications of new custom-made photoplethysmographic (PPG) and pulse oximetry optical and fiberoptic probes and instrumentation in an effort to investigate their suitability for the estimation of arterial blood oxygen saturation at different organs and tissues. The article will cover examples of application areas including real-time PPG and SpO2 monitoring for the esophagus and solid organs, including free flaps, using custom-made probes.
RESULTS:Clinical studies have successfully demonstrated the feasibility of acquiring PPGs and estimating arterial blood oxygen saturation values from a variety of organs and tissues.
CONCLUSIONS:The technological developments and the measurements presented in this work pave the way to a new era of pulse oximetry where direct and continuous monitoring of blood oxygen saturation of internal organs and tissues (esophagus, bowel, liver, stomach, free flaps) could be possible.
In this paper, we present the design, development, and validation of a 'modular photoplethysmography (PPG) system called ZenPPG. This portable, dual-channel system has the capability to produce "raw" ...PPG signals at two different wavelengths using commercial and/or custom-made PPG sensors. The system consists of five modules, each consisting of circuitry required to perform specific tasks, and are all interconnected by a system bus. The ZenPPG system also facilitates the acquisition of other physiological signals on-demand including electrocardiogram (ECG), respiration, and temperature signals. This report describes the technical details and the evaluation of the ZenPPG along with results from a pilot in vivo study on healthy volunteers. The results from the technical evaluations demonstrate the superiority and flexibility of the system. Also, the systems' compatibility with commercial pulse oximetry sensors such as the Masimo reusable sensors was demonstrated, where good quality raw PPG signals were recorded with the signal-to-noise ratio (SNR) of 50.65 dB. The estimated arterial oxygen saturation (SpO 2 ) values from the system were also in close agreement with commercial pulse oximeters, although the accuracy of the reported SpO 2 value is dependent on the calibration function used. Future work is targeted toward the development of variations of each module, including the laser driver and fiber optic module, onboard data acquisition and signal processing modules. The availability of this system will help researchers from a wide range of disciplines to customize and integrate the ZenPPG system to their research needs and will most definitely enhance research in related fields.
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