Non-invasive hemodynamic monitoring by electrical impedance tomography

The monitoring of central hemodynamic parameters such as cardiac output (CO) and pulmonary artery pressure (PAP) is of paramount clinical importance to assess the health status of the cardiovascular system. However, their measurement requires the insertion of a pulmonary artery catheter, a highly invasive procedure associated with non-negligible morbidity and mortality rates. In this thesis, we investigated the clinical potential of electrical impedance tomography (EIT) - a radiation-free medical imaging technique - as a non-invasive alternative for the measurement of CO and PAP. In a first phase, we investigated the potential of EIT for the measurement of CO. This measurement is implicitly based on the hypothesis that the EIT heart signal (the ventricular component of the EIT signals) is induced by ventricular blood volume changes. This hypothesis has never been formally investigated, and the exact origins of the EIT heart signal remain subject to interpretation. Therefore, using a model, we investigated the genesis of this signal by identifying its various sources and their respective contributions. The results revealed that the EIT heart signal is dominated by cardioballistic effects (heart motion). However, although of prominently cardioballistic origin, the amplitude of the signal has shown to be strongly correlated to stroke volume (r = 0.996, p < 0.001; error of 0.57 +/- 2.19 mL). We explained these observations by the quasi-incompressibility of myocardial tissue and blood. We further identified several factors and conditions susceptible to affect the accuracy of the measurement. Finally, we investigated the influence of the EIT sensor belt position on the measured heart signal. We observed that small belt displacements - likely to occur in clinical settings during patient handling - can induce errors of up to 30 mL on stroke volume estimation. In a second phase, we investigated the feasibility of a novel method for the non-invasive measurement of PAP by EIT. The method is based on the physiological relation linking the PAP to the velocity of propagation of the pressure waves in the pulmonary arteries. We hypothesized that the variations of this velocity, and therefore of the PAP, could be measured by EIT. In a bioimpedance model of the human thorax, we demonstrated the feasibility of our method in various types of pulmonary hypertensive disorders. Our EIT-derived parameter has shown to be particularly well-suited for predicting early changes in pulmonary hemodynamics due to its physiological link with arterial compliance. Finally, we validated experimentally our method in 14 subjects undergoing hypoxia-induced PAP changes. Significant correlation coefficients (range: [0.70, 0.98], average: 0.89) and small standard errors of the estimate (range: [0.9, 6.3] mmHg, average: 2.4 mmHg) were found between our EIT-derived systolic PAP and reference systolic PAP values obtained by Doppler echocardiography. In conclusion, there is a promising outlook for EIT in non-invasive hemodynamic monitoring. Our observations provide novel insights for the interpretation and understanding of EIT heart signals, and detail the physiological and metrological requirements for an accurate measurement of CO by EIT. Our novel PAP monitoring method, validated in vivo, allows a reliable tracking of PAP changes, thereby paving the way towards the development of a new branch of non-invasive hemodynamic monitors based on the use of EIT

Noninvasive Stroke Volume Monitoring by Electrical Impedance Tomography

In clinical practice it is of vital importance to track the health of a patient's cardiovascular system via the continuous measurement of hemodynamic parameters. Cardiac output (CO) and the related stroke volume (SV) are two such parameters of central interest as they are closely linked with oxygen delivery and the health of the heart. Many techniques exist to measure CO and SV, ranging from highly invasive to noninvasive ones. However, none of the noninvasive approaches are reliable enough in clinical settings. To overcome this limitation, we investigated the feasibility and practical applicability of noninvasively measuring SV via electrical impedance tomography (EIT), a safe and low-cost medical imaging modality. In a first step, the unclear origins of cardiosynchronous EIT signals were investigated in silico on a 4D bioimpedance model of the human thorax. Our simulations revealed that the EIT heart signal is dominated by ventricular activity, giving hope for a heart amplitude-based SV estimation. We further showed via simulations that this approach seems feasible in controlled scenarios but also suffers from some limitations. That is, EIT-based SV estimation is impaired by electrode belt displacements and by changes in lung conductivity (e.g. by respiration or liquid redistribution). We concluded that the absolute measurement of SV by EIT is challenging, but trending - that is following relative changes - of SV is more promising. In a second step, we investigated the practical applicability of this approach in three experimental studies. First, EIT was applied on 16 mechanically ventilated patients in the intensive care unit (ICU) receiving a fluid challenge to improve their hemodynamic situation. We showed that the resulting relative changes in SV could be tracked using the EIT lung amplitude, while this was not possible via the heart amplitude. The second study, performed on patients in the operating room (OR), had to be prematurely terminated due to too low variations in SV and technical challenges of EIT in the OR. Finally, the third experimental study aimed at testing an improved measurement setup that we designed after having identified potential limitations of available clinical EIT systems. This setup was tested in an experimental protocol on 10 healthy volunteers undergoing bicycle exercises. Despite the use of subject-specific 3D EIT, neither the heart nor the lung amplitudes could be used to assess SV via EIT. Changes in electrode contact and posture seem to be the main factors impairing the assessment of SV. In summary, based on in silico and in vivo investigations, we revealed various challenges related to EIT-based SV estimation. While our simulations showed that trending of SV via the EIT heart amplitude should be possible, this could not be confirmed in any of the experimental studies. However, in the ICU, where sufficiently controlled EIT measurements were possible, the EIT lung amplitude showed potential to trend changes in SV. We concluded that EIT amplitude-based SV estimation can easily be impaired by various factors such as electrode contact or small changes in posture. Therefore, this approach might be limited to controlled environments with the least possible changes in ventilation and posture. Future research should scrutinize the lung amplitude-based approach in dedicated simulations and clinical trials

Measuring Impedance in Congestive Heart Failure

The aim of this study is to explore methods to detect fluid retention in the lungs by measuring the thoracic impedance, so we can monitor congestion heart failure patients, and physicians can early detect acute episodes. In order to acquire the data we will measure the thoracic impedance where we can determinate the accumulation of fluid in the lungs. Materials, such as blood or muscle, have a higher conductivity in comparison to bones or fat, and a lung filled with liquid has a higher conductivity than an air filled one. The purpose of the work is to develop a small and portable device to extract thorax impedance of the patient, it should be low cost and friendly to use so it can be operated by a big range of social classes and also have a low power consumption for portable use. The possibility that a patient can monitor his own body fluid by himself at home and be observed remotely by a doctor, would help to reduce drastically the number of hospitalizations and, consequently, improve the lifestyle of people diagnosed with heart failure

The Assessment and Reduction of Motion Artifact in Dry Contact Biopotential Electrodes

The connecting interface between biopotential monitoring systems and the human body is the electrode. Conventional medical electrodes use gel to improve skin-electrode contact and glue to provide secure attachment of the electrode to the skin. However, this type of electrode is neither reusable nor user-friendly when implemented in wearable monitoring systems. For wearable monitoring systems, the best type of electrode to use, as seen from the point of view of user comfort and ease of use of the wearable system, is the un-gelled electrode. The un-gelled electrode foregoes conductive gel and attachment glue and instead uses body moisture and clothing pressure to provide contact and secure attachment. The drawback of un-gelled electrodes is that they are susceptible to the wearer’s movements, namely, to motion artifact.Solving the issue of motion artifact will improve signal quality and reliability for wearable systems and, due to integration and reusability, would reduce costs. These two factors, when combined, would enable the widespread use of wearable monitoring systems in both the medical context and the consumer-user context. One effect of this will be a reduction in load and costs on health care systems due to improved preventive monitoring and better monitoring of patients in the recovery and rehabilitation phase. A second effect, combined with the information exchanging channels between individuals, will be unforeseen developments in health science due to what can be called the crowdsourcing of some aspect of physical and mental health and fitness.This thesis aims to further state-of-the art wearable physiological monitoring by aiding motion artifact research and electrode design. To accomplish this aim, investigations into the programmable and repeatable generation of electrode movement in order to generate motion artifact, the effect of impedance current frequency on the relationship between skin-electrode interface impedance and electrode movement and motion artifact, the effect of using an electrode support structure and how its design affects the motion artifact, and the effects of garment parameters such as tightness are presented in this thesis.A system that generates known and programmable motion of the electrode under controlled circumstances was designed, tested, and after the verification of system functionality, used in subsequent investigations. The presented system generates accurate motion of the electrode and the electrode motion can be observed as both motion artifact and skin-electrode impedance changes.A real time impedance spectroscopy study of 24 impedance current frequencies between 25 Hz and 1 MHz was done on electrodes subject to accurately known motion generated by the designed system in order to find the impedance current frequencies most suited to motion artifact studies.During this research, a hypothesis was formed that states that an electrode with a structural design that restricts epidermis deformation by trapping the epidermis under the electrode area can reduce motion artifact. Different electrode support structures were designed in order to test this hypothesis. The electrodes with support structures were subjected to system-generated motion and the resulting data were analyzed for the verification of support structure functionality and the hypothesis.Electrodes that were supported by a tight garment-mimicking elastic straps were studied under subjectgenerated movement and at various clothing tightness levels. The same study was used to understand the effect of using padding between the garment and the electrode.The motion artifact generation system was seen to be successful in accurately generating electrode motion, thus motion artifact, which was programmable and repeatable. The electrode mounting force monitoring proved to be an important functionality as the mounting force was seen to affect the motion artifact.Skin-electrode impedance was found to correlate well with electrode motion in current frequencies between 17 kHz and 1 MHz. While the correlation between impedance and motion artifact was lower than the correlation between impedance and electrode motion, it was also highest in this frequency band.Electrode support structure design is seen to be an important factor to consider when designing the electrode, and the electrodes that came closest to fulfilling the design criteria of the hypothesis were the best functioning electrodes. The hypothesis is seen to be promising and electrodes that distributed skin deformation over a large area and/or restrict epidermis deformation were found to reduce motion artifact.In the presented studies, the pressures under those electrodes that were found to be the most effective in reducing motion artifact differed between experiments yet stayed in a range between 5 mmHg -36 mmHg (0.66 kPa – 4.80 kPa). A simple guideline is that the electrode should be attached firmly but not so firmly that it becomes uncomfortable. This guideline fitted well with the pressure levels found for each experiment.The presented Motion Artifact Generation and Assessment System can be used for research or commercial purposes, furthering the research on motion artifact and aiding in the successful design of motion artifact resilient electrodes. The issue of which are the best current frequencies to use to measure skin-electrode interface impedance in motion artifact research has been clarified. Possible means of reducing motion artifact at its origin by using structural electrode designs that restrict epidermis deformation is hypothesized and proven worthy of further research. The importance of garment design and guidelines for use are given and tightness recommendations presented. The thesis presents methodology for the furthering of the understanding of motion artifact and electrode design that will eventually make wearable monitoring systems widespread over a large range of applications and a large number of users

Aerospace medicine and biology: A continuing bibliography with indexes (supplement 388)

This bibliography lists 132 reports, articles and other documents introduced into the NASA Scientific and Technical Information Database. Subject coverage includes: aerospace medicine and physiology, life support systems and man/system technology, protective clothing, exobiology and extraterrestrial life, planetary biology, and flight crew behavior and performance

Actas de SABI2020

Los temas salientes incluyen un marcapasos pulmonar que promete complementar y eventualmente sustituir la conocida ventilación mecánica por presión positiva (intubación), el análisis de la marchaespontánea sin costosos equipamientos, las imágenes infrarrojas y la predicción de la salud cardiovascular en temprana edad por medio de la biomecánica arterial

Diseño e implementación de un sistema de EIS basado en FPGA programada desde LabView

El proyecto realizado describe des de la implementación hasta la validación, a partir de medidas experimentales, del software necesario para realizar un analizador de impedancia basado en FPGA programada des de LabView con el objetivo final de medir espectros de impedancia eléctrica en tiempo real. Para realizar dichas medidas, se ha implementado un sistema cerrado encargado tanto de la generación de las señales como de la medida y el procesado de estas. Además se ha incluido un software de control para poder modificar los parámetros del sistema a gusto del usuario. Finalmente se ha procedido a la realización de medidas experimentales para asegurar y demostrar el buen funcionamiento del sistema.This project describes from the implementation to the validation, from experimental measurements, of the necessary software to implement an impedance analyzer based on FPGA programmed from LabView with the final objective of measuring the electrical impedance spectrum in real time. To obtain those measurements, a closed system in charge of the signal generation, signal measurement and processing has been implemented. Moreover, it has been included a control software to modify the system parameters. Finally, I’ve proceeded to experimentally make measurements to ensure and demonstrate the good behaviour of the whole system.El projecte realitzat descriu des de la implementació fins a la validació, a partir de mesures experimentals, del software necessari per a realitzar un analitzador de impedància basat en FPGA programada des de LabView amb el objectiu final de mesurar espectres d’impedància elèctrica en temps real. Per tal de realitzar dites mesures, s’ha implementat un sistema tancat encarregat tant de la generació de les senyals com de la mesura i processament d’aquestes. A més s’ha inclòs un software de control per poder modificar els paràmetres del sistema a gust de l’usuari. Finalment s’ha procedit a la realització de mesures experimentals per assegurar i demostrar el bon funcionament del sistema

Methods for Doppler Radar Monitoring of Physiological Signals

Unobtrusive health monitoring includes advantages such as long-term monitoring of rarely occurring conditions or of slow changes in health, at reasonable costs. In addition, the preparation of electrodes or other sensors is not needed. Currently, the main limitation of remote patient monitoring is not in the existing communication infrastructure but the lack of reliable, easy-to-use, and well-studied sensors.The aim of this thesis was to develop methods for monitoring cardiac and respiratory activity with microwave continuous wave (CW) Doppler radar. When considering cardiac and respiration monitoring, the heart and respiration rates are often the first monitored parameters. The motivation of this thesis, however, is to measure not only rate-related parameters but also the cardiac and respiratory waveforms, including the chest wall displacement information.This dissertation thoroughly explores the signal processing methods for accurate chest wall displacement measurement with a radar sensor. The sensor prototype and measurement setup choices are reported. The contributions of this dissertation encompass an I/Q imbalance estimation method and a nonlinear demodulation method for a quadrature radar sensor. Unlike the previous imbalance estimation methods, the proposed method does not require the use of laboratory equipment. The proposed nonlinear demodulation method, on the other hand, is shown to be more accurate than other methods in low-noise cases. In addition, the separation of the cardiac and respiratory components with independent component analysis (ICA) is discussed. The developed methods were validated with simulations and with simplified measurement setups in an office environment. The performance of the nonlinear demodulation method was also studied with three patients for sleep-time respiration monitoring. This is the first time that whole-night measurements have been analyzed with the method in an uncontrolled environment. Data synchronization between the radar sensor and a commercial polysomnographic (PSG) device was assured with a developed infrared (IR) link, which is reported as a side result.The developed methods enable the extraction of more useful information from a radar sensor and extend its application. This brings Doppler radar sensors one step closer to large-scale commercial use for a wide range of applications, including home health monitoring, sleep-time respiration monitoring, and measuring gating signals for medical imaging