Measuring venous oxygenation using the photoplethysmograph waveform

OBJECTIVE: We investigate the hypothesis that the photoplethysmograph (PPG) waveform can be analyzed to infer regional venous oxygen saturation. METHODS: Fundamental to the successful isolation of the venous saturation is the identification of PPG characteristics that are unique to the peripheral venous system. Two such characteristics have been identified. First, the peripheral venous waveform tends to reflect atrial contraction. Second, ventilation tends to move venous blood preferentially due to the low pressure and high compliance of the venous system. Red (660 nm) and IR (940 nm) PPG waveforms were collected from 10 cardiac surgery patients using an esophageal PPG probe. These waveforms were analyzed using algorithms written in Mathematica. Four time-domain saturation algorithms (ArtSat, VenSat, ArtInstSat, VenInstSat) and four frequency-domain saturation algorithms (RespDC, RespAC, Cardiac, and Harmonic) were applied to the data set. RESULTS: Three of the algorithms for calculating venous saturation (VenSat, VenInstSat, and RespDC) demonstrate significant difference from ArtSat (the conventional time-domain algorithm for measuring arterial saturation) using the Wilcoxon signed-rank test with Bonferroni correction (p < 0.0071). CONCLUSIONS: This work introduces new algorithms for PPG analysis. Three algorithms (VenSat, VenInstSat, and RespDC) succeed in detecting lower saturation blood. The next step is to confirm the accuracy of the measurement by comparing them to a gold standard (i.e., venous blood gas)

Comparison of NIRS, laser Doppler flowmetry, photoplethysmography, and pulse oximetry during vascular occlusion challenges

© 2016 Institute of Physics and Engineering in Medicine. Monitoring changes in blood volume, blood flow, and oxygenation in tissues is of vital importance in fields such as reconstructive surgery and trauma medicine. Near infrared spectroscopy (NIRS), laser Doppler (LDF) flowmetry, photoplethysmography (PPG), and pulse oximetry (PO) contribute to such fields due to their safe and noninvasive nature. However, the techniques have been rarely investigated simultaneously or altogether. The aim of this study was to investigate all the techniques simultaneously on healthy subjects during vascular occlusion challenges. Sensors were attached on the forearm (NIRS and LDF) and fingers (PPG and PO) of 19 healthy volunteers. Different degrees of vascular occlusion were induced by inflating a pressure cuff on the upper arm. The responses of tissue oxygenation index (NIRS), tissue haemoglobin index (NIRS), flux (LDF), perfusion index (PPG), and arterial oxygen saturation (PO) have been recorded and analyzed. Moreover, the optical densities were calculated from slow varying dc PPG, in order to distinguish changes in venous blood volumes. The indexes showed significant changes (p < 0.05) in almost all occlusions, either venous or over-systolic occlusions. However, differentiation between venous and arterial occlusion by LDF may be challenging and the perfusion index (PI) may not be adequate to indicate venous occlusions. Optical densities may be an additional tool to detect venous occlusions by PPG

A feasibility study for the provision of electronic healthcare tools and services in areas of Greece, Cyprus and Italy

Background: Through this paper, we present the initial steps for the creation of an integrated platform for the provision of a series of eHealth tools and services to both citizens and travelers in isolated areas of thesoutheast Mediterranean, and on board ships travelling across it. The platform was created through an INTERREG IIIB ARCHIMED project called INTERMED. Methods: The support of primary healthcare, home care and the continuous education of physicians are the three major issues that the proposed platform is trying to facilitate. The proposed system is based on state-of-the-art telemedicine systems and is able to provide the following healthcare services: i) Telecollaboration and teleconsultation services between remotely located healthcare providers, ii) telemedicine services in emergencies, iii) home telecare services for "at risk" citizens such as the elderly and patients with chronic diseases, and iv) eLearning services for the continuous training through seminars of both healthcare personnel (physicians, nurses etc) and persons supporting "at risk" citizens. These systems support data transmission over simple phone lines, internet connections, integrated services digital network/digital subscriber lines, satellite links, mobile networks (GPRS/3G), and wireless local area networks. The data corresponds, among others, to voice, vital biosignals, still medical images, video, and data used by eLearning applications. The proposed platform comprises several systems, each supporting different services. These were integrated using a common data storage and exchange scheme in order to achieve system interoperability in terms of software, language and national characteristics. Results: The platform has been installed and evaluated in different rural and urban sites in Greece, Cyprus and Italy. The evaluation was mainly related to technical issues and user satisfaction. The selected sites are, among others, rural health centers, ambulances, homes of "at-risk" citizens, and a ferry. Conclusions: The results proved the functionality and utilization of the platform in various rural places in Greece, Cyprus and Italy. However, further actions are needed to enable the local healthcare systems and the different population groups to be familiarized with, and use in their everyday lives, mature technological solutions for the provision of healthcare services

Measuring Venous Oxygen Saturation Using the Photoplethysmograph Waveform

The pulse oximeter is now a standard-of-care monitor. In its most basic form it measures the arterial oxygenation saturation. It accomplishes this through the use of the photoplethysmograph waveform (PPG) at two or more wavelengths. Advances in digital signal processing are allowing for a re-examination of these waveforms. It has been recognized for some time that the movement of venous blood can be detected (1, 2) using the PPG. For the most part, this phenomenon has been seen as a source of artifact which interferes with calculation of arterial saturation. On the other hand, if venous saturation can be reliably measured, interesting new possibilities are opened. We hypothesize that the PPG waveform, obtained non-invasively by modern pulse oximeters, can be analyzed via digital signal processing to infer the venous oxygen saturation

Investigation of oesophageal photoplethysmographic signals and blood oxygen saturation measurements in cardiothoracic surgery patients

Pulse oximeter probes attached to the finger may fail to estimate blood oxygen saturation (SpO2) in patients with compromised peripheral perfusion (e.g. hypothermic cardiopulmonary bypass surgery). The measurement of SpO2 from a central organ such as the oesophagus is suggested as an alternative to overcome this problem. A reflectance oesophageal pulse oximeter probe and a processing system implemented in LabVIEW were developed. The system was evaluated in clinical measurements on 50 cardiothoracic surgery patients. Oesophageal photoplethysmographic (PPG) signals with large amplitudes and high signal-to-noise ratios were measured from various depths within the oesophagus from all the cardiothoracic patients. The oesophageal PPG amplitudes from these patients were in good agreement with previous oesophageal PPG amplitude measurements from healthy anaesthetized patients. The oesophageal pulse oximeter SpO2 results agreed well with the estimated arterial oxygen saturation (SaO2) values inferred from the oxygen tension obtained by blood gas analysis. The mean (+/- SD) of the differences between the oesophageal pulse oximeter SpO2 readings and those from blood gas analysis was 0.02 +/- 0.88%. Also, the oesophageal pulse oximeter was found to be reliable and accurate in five cases of poor peripheral perfusion when a commercial finger pulse oximeter probe failed to estimate oxygen saturation values for at least 10 min. These results suggest that the arterial blood circulation to the oesophagus is less subject to vasoconstriction and decreased PPG amplitudes than are the peripheral sites used for pulse oximetry such as the finger. It is concluded that oesophageal SPO2 monitoring may be of clinical value

The human ear canal: investigation of its suitability for monitoring photoplethysmographs and arterial oxygen saturation

For the last two decades, pulse oximetry has been used as a standard procedure for monitoring arterial oxygen saturation (SpO2). However, SpO2 measurements made from extremities such as the finger, ear lobe and toes become susceptible to inaccuracies when peripheral perfusion is compromised. To overcome these limitations, the external auditory canal has been proposed as an alternative monitoring site for estimating SpO2, on the hypothesis that this central site will be better perfused. Therefore, a dual wavelength optoelectronic probe along with a processing system was developed to investigate the suitability of measuring photoplethysmographic (PPG) signals and SpO2 in the human auditory canal. A pilot study was carried out in 15 healthy volunteers to validate the feasibility of measuring PPGs and SpO2 from the ear canal (EC), and comparative studies were performed by acquiring the same signals from the left index finger (LIF) and the right index finger (RIF) in conditions of induced peripheral vasoconstriction (right hand immersion in ice water). Good quality baseline PPG signals with high signal-to-noise ratio were obtained from the EC, the LIF and the RIF sensors. During the ice water immersion, significant differences in the amplitude of the red and infrared PPG signals were observed from the RIF and the LIF sensors. The average drop in amplitude of red and infrared PPG signals from the RIF was 52.7% and 58.3%. Similarly, the LIF PPG signal amplitudes have reduced by 47.52% and 46.8% respectively. In contrast, no significant changes were seen in the red and infrared EC PPG amplitude measurements, which changed by +2.5% and -1.2% respectively. The RIF and LIF pulse oximeters have failed to estimate accurate SpO2 in seven and four volunteers respectively, while the EC pulse oximeter has only failed in one volunteer. These results suggest that the EC may be a suitable site for reliable monitoring of PPGs and SpO2s even in the presence of peripheral vasoconstriction

Bandwidth enhancement of antennas designed by band-pass filter synthesis due to frequency pulling techniques

A novel antenna design technique is proposed, which offers bandwidth enhancement up to the limits defined by element radiation efficiency. The employed technique is referred as frequency pulling (FP) as it mimics the ‘insertion loss design methodology of band-pass filters’. This is essentially a wideband matching approach pushing the antenna efficiency to the limits set up by radiation efficiency. There are three options towards this trend: (i) first to enhance a single element bandwidth (compact element) exploiting its possibly multiple symmetrical feeding points as distinct resonator ports, (ii) frequency pulled array as to design a small antenna array (less than about 10 elements) where each element acts as a resonator and (iii) second order frequency-pulled array as to build a small array using compact elements of category (i). Similar to the band-pass filter design, all antennas or distinct-port circuits resonate at the same resonant frequency when isolated, cascading two or more of them; FP yields to multiple-overlapping successive resonances in their overall response. Although the proposed technique is general within this first effort, it is applied to simple patch antenna elements exhibiting multiple symmetrical feeding points, namely two—for rectangular, four—for square and five—for pentagonal. The third option is applied to an array of three compact 4-feeding point square elements offering triple bandwidth with respect to the already wideband single element. However, this is achieved at the expense of a significant beam squint. Thus, in general, these wideband compact elements should be used within a classical array design. Further bandwidth enhancement using FP to antenna elements with inherent multiple resonances as patches with slots or truncated edges constitutes our next task. Their inherent wider bandwidth in radiation efficiency is expected to allow multiply higher bandwidths when exploited with our FP technique

Photoperiod-Dependent Expression of MicroRNA in Drosophila.

Like many other insects in temperate regions, Drosophila melanogaster exploits the photoperiod shortening that occurs during the autumn as an important cue to trigger a seasonal response. Flies survive the winter by entering a state of reproductive arrest (diapause), which drives the relocation of resources from reproduction to survival. Here, we profiled the expression of microRNA (miRNA) in long and short photoperiods and identified seven differentially expressed miRNAs (dme-mir-2b, dme-mir-11, dme-mir-34, dme-mir-274, dme-mir-184, dme-mir-184*, and dme-mir-285). Misexpression of dme-mir-2b, dme-mir-184, and dme-mir-274 in pigment-dispersing, factor-expressing neurons largely disrupted the normal photoperiodic response, suggesting that these miRNAs play functional roles in photoperiodic timing. We also analyzed the targets of photoperiodic miRNA by both computational predication and by Argonaute-1-mediated immunoprecipitation of long- and short-day RNA samples. Together with global transcriptome profiling, our results expand existing data on other Drosophila species, identifying genes and pathways that are differentially regulated in different photoperiods and reproductive status. Our data suggest that post-transcriptional regulation by miRNA is an important facet of photoperiodic timing

Opening the envelope: Efficient envelope-based PPG denoising algorithm

Photoplethysmography (PPG) signals obtained from the skin’s surface offer valuable insights into blood volume fluctuations. With the rising interest in continuous non-invasive physiological monitoring, PPG has garnered significant attention. However, PPG signals are often affected by various forms of noise, impeding reliable feature extraction. Robust data pre-processing approaches are vital for both retrospective and real-time analysis. Existing denoising methods, including recent machine learning techniques, often suffer from implementation challenges, computational inefficiency, and limited interpretability. Addressing this challenge, we propose a novel PPG denoising algorithm. The algorithm was evaluated using a dataset representing approximately 81,015.99 min or 1360.27 h of PPG data collected from 31 patients. The evaluation involved the calculation and analysis of five key metrics: Signal-to-Noise Ratio (SNR), Variance, Total Variation (TV), Shannon entropy, and Instances-per-second (IPS). Our results demonstrate a notable increase in SNR after denoising, indicating effective noise reduction while preserving signal content. Variance and TV values showed a reduction post-denoising, suggesting smoother and less variable signals, validating the noise suppression efficacy. Additionally, Shannon entropy exhibited a decrease after denoising, indicating successful noise reduction and enhanced signal regularity. The nonparametric Wilcoxon signed-rank test (a = 0.05) was employed to assess the statistical significance of the observed differences of these metrics before and after denoising. Furthermore, the computational speed analysis revealed the EPDA’s potential for efficient processing of large datasets and real-time applications. This comprehensive evaluation approach allows for a thorough understanding of the EPDA’s effectiveness in denoising PPG data, fostering advancements in non-invasive physiological monitoring and promoting the broader adoption of PPG-based healthcare technologies