In-Suit Doppler Technology Assessment

The objective of this program was to perform a technology assessment survey of non-invasive air embolism detection utilizing Doppler ultrasound methodologies. The primary application of this technology will be a continuous monitor for astronauts while performing extravehicular activities (EVA's). The technology assessment was to include: (1) development of a full understanding of all relevant background research; and (2) a survey of the medical ultrasound marketplace for expertise, information, and technical capability relevant to this development. Upon completion of the assessment, LSR was to provide an overview of technological approaches and R&D/manufacturing organizations

Development of limb volume measuring system

The mechanisms underlying the reductions in orthostatic tolerance associated with weightlessness are not well established. Contradictory results from measurements of leg volume changes suggest that altered venomotor tone and reduced blood flow may not be the only contributors to orthostatic intolerance. It is felt that a more accurate limb volume system which is insensitive to environmental factors will aid in better quantification of the hemodynamics of the leg. Of the varous limb volume techniques presently available, the ultrasonic limb volume system has proven to be the best choice. The system as described herein is free from environmental effects, safe, simple to operate and causes negligible radio frequency interference problems. The segmental ultrasonic ultrasonic plethysmograph is expected to provide a better measurement of limb volume change since it is based on cross-sectional area measurements

Toward Automation of the Supine Pressor Test for Preeclampsia

Preeclampsia leads to increased risk of morbidity and mortality for both mother and fetus. Most previous studies have largely neglected mechanical compression of the left renal vein by the gravid uterus as a potential mechanism. In this study, we first used a murine model to investigate the pathophysiology of left renal vein constriction. The results indicate that prolonged renal vein stenosis after 14 days can cause renal necrosis and an increase in blood pressure (BP) of roughly 30 mmHg. The second part of this study aimed to automate a diagnostic tool, known as the supine pressor test (SPT), to enable pregnant women to assess their preeclampsia development risk. A positive SPT has been previously defined as an increase of at least 20 mmHg in diastolic BP when switching between left lateral recumbent and supine positions. The results from this study established a baseline BP increase between the two body positions in nonpregnant women and demonstrated the feasibility of an autonomous SPT in pregnant women. Our results demonstrate that there is a baseline increase in BP of roughly 10-14 mmHg and that pregnant women can autonomously perform the SPT. Overall, this work in both rodents and humans suggests that (1) stenosis of the left renal vein in mice leads to elevation in BP and acute renal failure, (2) nonpregnant women experience a baseline increase in BP when they shift from left lateral recumbent to supine position, and (3) the SPT can be automated and used autonomously

Non-invasive Evaluation of Aortic Stiffness Dependence with Aortic Blood Pressure and Internal Radius by Shear Wave Elastography and Ultrafast Imaging

Elastic properties of arteries have long been recognized as playing a major role in the cardiovascular system. However, non-invasive in vivo assessment of local arterial stiffness remains challenging and imprecise as current techniques rely on indirect estimates such as wall deformation or pulse wave velocity. Recently, Shear Wave Elastography (SWE) has been proposed to non-invasively assess the intrinsic arterial stiffness. In this study, we applied SWE in the abdominal aortas of rats while increasing blood pressure (BP) to investigate the dependence of shear wave speed with invasive arterial pressure and non-invasive arterial diameter measurements. A 15MHz linear array connected to an ultrafast ultrasonic scanner, set non-invasively, on the abdominal aorta of anesthetized rats (N=5) was used. The SWE acquisition followed by an ultrafast (UF) acquisition was repeated at different moment of the cardiac cycle to assess shear wave speed and arterial diameter variations respectively. Invasive arterial BP catheter placed in the carotid, allowed the accurate measurement of pressure responses to increasing does of phenylephrine infused via a venous catheter. The SWE acquisition coupled to the UF acquisition was repeated for different range of pressure. For normal range of BP, the shear wave speed was found to follow the aortic BP variation during a cardiac cycle. A minimum of (5.06$\pm$0.82) m/s during diastole and a maximum of (5.97$\pm$0.90) m/s during systole was measured. After injection of phenylephrine, a strong increase of shear wave speed (13.85$\pm$5.51) m/s was observed for a peak systolic arterial pressure of (190$\pm$10) mmHg. A non-linear relationship between shear wave speed and arterial BP was found. A complete non-invasive method was proposed to characterize the artery with shear wave speed combined with arterial diameter variations. Finally, the results were validated against two parameters the incremental elastic modulus and the pressure elastic modulus derived from BP and arterial diameter variations

A Portable Device for the Measurement of Venous Pulse Wave Velocity

Pulse wave velocity in veins (vPWV) has recently been reconsidered as a potential index of vascular filling, which may be valuable in the clinic for fluid therapy. The measurement requires that an exogenous pressure pulse is generated in the venous blood stream by external pneumatic compression. To obtain optimal measure repeatability, the compression is delivered synchronously with the heart and respiratory activity. We present a portable prototype for the assessment of vPWV based on the PC board Raspberry Pi and equipped with an A/D board. It acquires respiratory and ECG signals, and the Doppler shift from the ultrasound monitoring of blood velocity from the relevant vein, drives the pneumatic cuff inflation, and returns multiple measurements of vPWV. The device was tested on four healthy volunteers (2 males, 2 females, age 33 & PLUSMN;13 years), subjected to the passive leg raising (PLR) manoeuvre simulating a transient increase in blood volume. Measurement of vPWV in the basilic vein exhibited a low coefficient of variation (3.6 & PLUSMN;1.1%), a significant increase during PLR in all subjects, which is consistent with previous findings. This device allows for carrying out investigations in hospital wards on different patient populations as necessary to assess the actual clinical potential of vPWV

Prediction of fluid responsiveness using respiratory variations in left ventricular stroke area by transoesophageal echocardiographic automated border detection in mechanically ventilated patients.

BackgroundLeft ventricular stroke area by transoesophageal echocardiographic automated border detection has been shown to be strongly correlated to left ventricular stroke volume. Respiratory variations in left ventricular stroke volume or its surrogates are good predictors of fluid responsiveness in mechanically ventilated patients. We hypothesised that respiratory variations in left ventricular stroke area (DeltaSA) can predict fluid responsiveness.MethodsEighteen mechanically ventilated patients undergoing coronary artery bypass grafting were studied immediately after induction of anaesthesia. Stroke area was measured on a beat-to-beat basis using transoesophageal echocardiographic automated border detection. Haemodynamic and echocardiographic data were measured at baseline and after volume expansion induced by a passive leg raising manoeuvre. Responders to passive leg raising manoeuvre were defined as patients presenting a more than 15% increase in cardiac output.ResultsCardiac output increased significantly in response to volume expansion induced by passive leg raising (from 2.16 +/- 0.79 litres per minute to 2.78 +/- 1.08 litres per minute; p < 0.01). DeltaSA decreased significantly in response to volume expansion (from 17% +/- 7% to 8% +/- 6%; p < 0.01). DeltaSA was higher in responders than in non-responders (20% +/- 5% versus 10% +/- 5%; p < 0.01). A cutoff DeltaSA value of 16% allowed fluid responsiveness prediction with a sensitivity of 92% and a specificity of 83%. DeltaSA at baseline was related to the percentage increase in cardiac output in response to volume expansion (r = 0.53, p < 0.01).ConclusionDeltaSA by transoesophageal echocardiographic automated border detection is sensitive to changes in preload, can predict fluid responsiveness, and can quantify the effects of volume expansion on cardiac output. It has potential clinical applications

Non-invasive vascular assessment using photoplethysmography

Photoplethysmography (PPG) has become widely accepted as a valuable clinical tool for performing non-invasive biomedical monitoring. The dominant clinical application of PPG has been pulse oximetry, which uses spectral analysis of the peripheral blood supply to establish haemoglobin saturation. PPG has also found success in screening for venous dysfunction, though to a limited degree. Arterial Disease (AD) is a condition where blood flow in the arteries of the body is reduced,a condition known as ischaernia. Ischaernia can result in pain in the affected areas, such as chest pain for an ischearnic heart, but does not always produce symptoms. The most common form of AD is arteriosclerosis, which affects around 5% of the population over 50 years old. Arteriosclerosis, more commonly known as 'hardening of the arteries' is a condition that results in a gradual thickening, hardening and loss of elasticity in the walls of the arteries, reducing overall blood flow. This thesis investigates the possibility of employing PPG to perform vascular assessment, specifically arterial assessment, in two ways. PPG based perfusion monitoring may allow identification of ischaernia in the periphery. To further investigate this premise, prospective experimental trials are performed, firstly to assess the viability of PPG based perfusion monitoring and culminating in the development of a more objective method for determining ABPI using PPG based vascular assessment. A complex interaction between the heart and the connective vasculature, detected at the measuring site, generates the PPG signal. The haemodynamic properties of the vasculature will affect the shape of the PPG waveform, characterising the PPG signal with the properties of the intermediary vasculature. This thesis investigates the feasibility of deriving quantitative vascular parameters from the PPG signal. A quantitative approach allows direct identification of pathology, simplifying vascular assessment. Both forward and inverse models are developed in order to investigate this topic. Application of the models in prospective experimental trials with both normal subjects and subjects suffering PVD have shown encouraging results. It is concluded that the PPG signal contains information on the connective vasculature of the subject. PPG may be used to perform vascular assessment using either perfusion based techniques, where the magnitude of the PPG signal is of interest, or by directly assessing the connective vasculature using PPG, where the shape of the PPG signal is of interest. it is argued that PPG perfusion based techniques for performing the ABPI diagnosis protocol can offer greater sensitivity to the onset of PAD, compared to more conventional methods. It is speculated that the PPG based ABPI diagnosis protocol could provide enhanced PAD diagnosis, detecting the onset of the disease and allowing a treatmenpt lan to be formed soonert han was possible previously. The determination of quantitative vascular parameters using PPG shape could allow direct vascular diagnosis, reducing subjectivity due to interpretation. The prospective trials investigating PPG shape analysis concentrated on PVD diagnosis, but it is speculated that quantitative PPG shaped based vascular assessment could be a powerful tool in the diagnosis of many vascular based pathological conditions

Hemodynamic monitor for rapid, cost-effective assessment of peripheral vascular function

Worldwide, at least 200 million people are affected by peripheral vascular diseases (PVDs), including peripheral arterial disease (PAD), chronic venous insufficiency (CVI) and deep vein thrombosis (DVT). These diseases have considerable socioeconomic impacts due to their high prevalence, cost of investigation, treatment and their effects on quality of life. PVDs are often undiagnosed with up to 60% of patients with PVD remaining asymptomatic. Early diagnosis is essential for effective treatment and reducing socioeconomic costs, particularly in patients with diabetes where early endovascular treatment can prevent lower extremity amputation. However, available diagnostic methods simply do not meet the needs of clinicians. For example, duplex ultrasound or plethysmography are time-consuming methods, costly and require access to highly trained clinicians. Due to the cost and time requirements of such methods, they are often reserved for symptomatic patients. On the other hand, the Ankle Brachial Index (ABI) test is cheap but has poor sensitivity for those patients with diabetes and the elderly, both growing high-risk populations. There is an urgent need for new diagnostic tools to enable earlier intervention. Researchers at the MARCS Institute have developed a novel hemodynamic monitor platform named HeMo, specifically for the assessment of peripheral blood flow in the leg. This development aimed to provide a fast and low-cost diagnosis of both peripheral arterial disease and chronic venous insufficiency. This work first provides a comprehensive literature review of the existing non-invasive diagnostic devices developed since 1677 to highlight the need of development of a new blood monitoring tool. Second, it presents the simplified circuit of the HeMo device and provides series of pilot experiments with HeMo demonstrating its potential for diagnosis of both peripheral arterial disease and chronic venous insufficiency. Third, it presents a quantitative characterisation of the electrical behaviour of the electro-resistive band sensors with the development of an expansion/contraction simulator rig and using spectral analysis. The characterisation of the electro-resistive band was essential to understand the nonlinear electrical behaviour of such sensors and would be of interest for other users and uses of the electro-resistive band sensors. However, in another perspective this sinusoidal linear stretching movement and the presented method shows an example for the application of the presented rig, highlighting that the same technique could be used for characterisation of similar stretchable sensors. Fourth, it shows data from a healthy population, assessing the performance of HeMo compared to light reflection rheography (LRR sensor-VasoScreen 5000) for the assessment of venous function. Fifth, it presents human study data where the performance of HeMo is compared to photoplethysmography (PPG sensor-VasoScreen 5000) for the evaluation of the arterial function. Overall, the presented work here, steps toward development of the final version of a novel hemodynamic monitoring device, and its validation