An implantable optical blood pressure sensor based on pulse transit time

In-vivo blood pressure sensing with bi-filler nanocomposite

Conductive elastomers present desirable qualities for sensing pressure in-vivo, such as high piezoresistance in tiny volumes, conformability and, biocompatibility. Many electrically conductive nanocomposites however, are susceptible to electrical drift following repeated stress cycles and chemical aging. Here we propose an innovative approach to stabilize nanocomposite percolation network against incomplete recovery to improve reproducibility and facilitate sensor calibration. We decouple the tunnelling-percolation network of highly-oriented pyrolytic graphite (HOPG) nanoparticles from the incomplete viscoelastic recovery of the polydimethylsiloxane (PDMS) matrix by inserting minute amounts of insulating SiO2 nanospheres. SiO2 nanospheres effectively reduce the number of nearest neighbours at each percolation node switching off the parallel electrical pathways that might become activated under incomplete viscoelastic relaxation. We varied the size of SiO2 nanospheres and their filling fraction to demonstrate nearly complete piezoresistance recovery when SiO2 and HOPG nanoparticles have equal diameters (≈400 nm) and SiO2 and HOPG volume fractions are 1 % and 29.5 % respectively. We demonstrate an in-vivo blood pressure sensor based on this bi-filler composite.

Emerging Optoelectronic Devices Based on Microscale LEDs and Their Use as Implantable Biomedical Applications

Thin-film microscale light-emitting diodes (LEDs) are efficient light sources and their integrated applications offer robust capabilities and potential strategies in biomedical science. By leveraging innovations in the design of optoelectronic semiconductor structures, advanced fabrication techniques, biocompatible encapsulation, remote control circuits, wireless power supply strategies, etc., these emerging applications provide implantable probes that differ from conventional tethering techniques such as optical fibers. This review introduces the recent advancements of thin-film microscale LEDs for biomedical applications, covering the device lift-off and transfer printing fabrication processes and the representative biomedical applications for light stimulation, therapy, and photometric biosensing. Wireless power delivery systems have been outlined and discussed to facilitate the operation of implantable probes. With such wireless, battery-free, and minimally invasive implantable light-source probes, these biomedical applications offer excellent opportunities and instruments for both biomedical sciences research and clinical diagnosis and therapy.

In Vivo Evaluation of a Subcutaneously Injectable Implant with a Low-Power Photoplethysmography ASIC for Animal Monitoring

Photoplethysmography is an extensively-used, portable, and noninvasive technique for measuring vital parameters such as heart rate, respiration rate, and blood pressure. The deployment of this technology in veterinary medicine has been hindered by the challenges in effective transmission of light presented by the thick layer of skin and fur of the animal. We propose an injectable capsule system to circumvent these limitations by accessing the subcutaneous tissue to enable reliable signal acquisition even with lower light brightness. In addition to the reduction of power usage, the injection of the capsule offers a less invasive alternative to surgical implantation. Our current prototype combines two application-specific integrated circuits (ASICs) with a microcontroller and interfaces with a commercial light emitting diode (LED) and photodetector pair. These ASICs implement a signal-conditioning analog front end circuit and a frequency-shift keying (FSK) transmitter respectively. The small footprint of the ASICs is the key in the integration of the complete system inside a 40-mm long glass tube with an inner diameter of 4 mm, which enables its injection using a custom syringe similar to the ones used with microchip implants for animal identification. The recorded data is transferred wirelessly to a computer for post-processing by means of the integrated FSK transmitter and a software-defined radio. Our optimized LED duty cycle of 0.4% at a sampling rate of 200 Hz minimizes the contribution of the LED driver (only 0.8 mW including the front-end circuitry) to the total power consumption of the system. This will allow longer recording periods between the charging cycles of the batteries, which is critical given the very limited space inside the capsule. In this work, we demonstrate the wireless operation of the injectable system with a human subject holding the sensor between the fingers and the in vivo functionality of the subcutaneous sensing on a pilot study performed on anesthetized rat subjects.

Local Pulse Wave Velocity: Theory, Methods, Advancements, and Clinical Applications

Local pulse wave velocity (PWV) is evolving as one of the important determinants of arterial hemodynamics, localized vessel stiffening associated with several pathologies, and a host of other cardiovascular events. Although PWV was introduced over a century ago, only in recent decades, due to various technological advancements, has emphasis been directed toward its measurement from a single arterial section or from piecewise segments of a target arterial section. This emerging worldwide trend in the exploration of instrumental solutions for local PWV measurement has produced several invasive and noninvasive methods. As of yet, however, a univocal opinion on the ideal measurement method has not emerged. Neither have there been extensive comparative studies on the accuracy of the available methods. Recognizing this reality, makes apparent the need to establish guideline-recommended standards for the measurement methods and reference values, without which clinical application cannot be pursued. This paper enumerates all major local PWV measurement methods while pinpointing their salient methodological considerations and emphasizing the necessity of global standardization. Further, a summary of the advancements in measuring modalities and clinical applications is provided. Additionally, a detailed discussion on the minimally explored concept of incremental local PWV is presented along with suggestions of future research questions.

Recent Developments for Flexible Pressure Sensors: A Review

Flexible pressure sensors are attracting great interest from researchers and are widely applied in various new electronic equipment because of their distinct characteristics with high flexibility, high sensitivity, and light weight; examples include electronic skin (E-skin) and wearable flexible sensing devices. This review summarizes the research progress of flexible pressure sensors, including three kinds of transduction mechanisms and their respective research developments, and applications in the fields of E-skin and wearable devices. Furthermore, the challenges and development trends of E-skin and wearable flexible sensors are also briefly discussed. Challenges of developing high extensibility, high sensitivity, and flexible multi-function equipment still exist at present. Exploring new sensing mechanisms, seeking new functional materials, and developing novel integration technology of flexible devices will be the key directions in the sensors field in future.

Advances in Materials for Recent Low-Profile Implantable Bioelectronics

The rapid development of micro/nanofabrication technologies to engineer a variety of materials has enabled new types of bioelectronics for health monitoring and disease diagnostics. In this review, we summarize widely used electronic materials in recent low-profile implantable systems, including traditional metals and semiconductors, soft polymers, biodegradable metals, and organic materials. Silicon-based compounds have represented the traditional materials in medical devices, due to the fully established fabrication processes. Examples include miniaturized sensors for monitoring intraocular pressure and blood pressure, which are designed in an ultra-thin diaphragm to react with the applied pressure. These sensors are integrated into rigid circuits and multiple modules; this brings challenges regarding the fundamental material’s property mismatch with the targeted human tissues, which are intrinsically soft. Therefore, many polymeric materials have been investigated for hybrid integration with well-characterized functional materials such as silicon membranes and metal interconnects, which enable soft implantable bioelectronics. The most recent trend in implantable systems uses transient materials that naturally dissolve in body fluid after a programmed lifetime. Such biodegradable metallic materials are advantageous in the design of electronics due to their proven electrical properties. Collectively, this review delivers the development history of materials in implantable devices, while introducing new bioelectronics based on bioresorbable materials with multiple functionalities.

Photonic sensing of arterial distension

Most cardiovascular diseases, such as arteriosclerosis and hypertension, are directly linked to pathological changes in hemodynamics, i.e. the complex coupling of blood pressure, blood flow and arterial distension. To improve the current understanding of cardiovascular diseases and pave the way for novel cardiovascular diagnostics, innovative tools are required that measure pressure, flow, and distension waveforms with yet unattained spatiotemporal resolution. In this context, miniaturized implantable solutions for continuously measuring these parameters over the long-term are of particular interest. We present here an implantable photonic sensor system capable of sensing arterial wall movements of a few hundred microns in vivo with sub-micron resolution, a precision in the micrometer range and a temporal resolution of 10 kHz. The photonic measurement principle is based on transmission photoplethysmography with stretchable optoelectronic sensors applied directly to large systemic arteries. The presented photonic sensor system expands the toolbox of cardiovascular measurement techniques and makes these key vital parameters continuously accessible over the long-term. In the near term, this new approach offers a tool for clinical research, and as a perspective, a continuous long-term monitoring system that enables novel diagnostic methods in arteriosclerosis and hypertension research that follow the trend in quantifying cardiovascular diseases by measuring arterial stiffness and more generally analyzing pulse contours.

Integrating Sphere Finger-Photoplethysmography: Preliminary Investigation towards Practical Non-Invasive Measurement of Blood Constituents

The aim of this study was to compare conventional photoplethysmography (PPG) in a finger with PPG using an integrating sphere (_ISPPG) to enhance scattered light collection. Two representative wavelengths were used; 1160 nm, a window through the absorption spectra of water and alcohol, and 1600 nm around where water absorption is high and there is an absorption peak of blood glucose. Simultaneous transmission-type measurements were made with conventional PPG and with _ISPPG for each wavelength in the tips of index fingers of both hands in a total of 10 healthy young male and female volunteers (21.7 ± 1.6 years old). During a 5 min period in which subjects were in a relaxed state we determined the signal-to-noise ratio, SNR, and the PPG detectability (or sensitivity) by the two techniques. SNR during the test period was significantly higher with _ISPPG as compared with conventional PPG, especially for the 1600 nm wavelength. PPG signals with 1600 nm could scarcely be detected by conventional PPG, while they could be detected with good sensitively by _ISPPG. We conclude that under controlled conditions _ISPPG has better SNR and higher sensitivity than conventional transmission PPG, especially in wavelength regions where water absorption is high but where there is potential for practical measurement of blood constituents including glucose.

Implantable pulse oximetry on subcutaneous tissue

Blood oxygen saturation is one of the most prominent measurement parameters in daily clinical routine. However up to now, it is not possible to continuously monitor this parameter reliably in mobile patients. High-risk patients suffering from cardiovascular diseases could benefit from long-term monitoring of blood oxygen saturation. In this paper, we present a minimally invasive, implantable patient monitor which is capable of monitoring vital signs. The capability of this multimodal sensor to subcutaneously determine blood pressure, pulse and ECG has been demonstrated earlier. This paper focuses on monitoring of blood oxygen saturation. Even though the signal amplitudes are much weaker than for standard extracorporeal measurements, photoplethysmographic signals were recorded with high quality in vivo directly on subcutaneous muscle tissue. For the first time, it has been shown that blood oxygen saturation can be measured with an implantable, but extravascular sensor. The sensor was implanted for two weeks in a sheep and did not cause any complications. This opens new perspectives for home monitoring of patients with cardiovascular diseases.

Lock-in amplification for implantable multiwavelength pulse oximeters

Standard as well as multiwavelength pulse oximetry as established methods for measuring blood oxygen saturation or fractions of dyshemoglobins suffer from different kinds of interference and noise. Employing lock-in technique as a read-out approach for multiwavelength pulse oximetry is proposed here and strongly decreases such signal disturbance. An analog lock-in amplifier was designed to modulate multiple LEDs simultaneously and to separate the signals detected by a single photodiode. In vivo measurements show an improved signal-to-noise ratio of photoplethysmographic signals and a suppression of interference by means of the lock-in approach. This allows the detection of higher order overtones and, therefore, more detailed data for pulse wave analysis, especially for implantable sensors directly applied at arteries.

Stretchable optoelectronic circuits embedded in a polymer network

Stretchable optoelectronic circuits, incorporating chip-level LEDs and photodiodes in a silicone membrane, are demonstrated. Due to its highly miniaturized design and tissue-like mechanical properties, such an optical circuit can be conformally applied to the epidermis and be used for measurement of photoplethysmograms. This level of optical functionality in a stretchable substrate is potentially of great interest for personal health monitoring.

Pulse transit time as a surrogate measure of changes in systolic arterial pressure in children during sleep

Pulse transit time has been proposed as a surrogate measure of systolic arterial pressure, as it is dependent upon arterial stiffness. Past research has shown that pulse transit time has a significant inverse relationship to systolic arterial pressure in adults; however, studies in children are limited. This study aimed to explore the relationship between systolic arterial pressure and pulse transit time in children during sleep. Twenty-five children (13.1 ± 1.6 years, 48% male) underwent overnight polysomnography (PSG) with a simultaneous recording of continuous systolic arterial pressure and photoplethysmography. Pulse transit time was calculated as the time delay between the R-wave peak of the electrocardiogram (ECG) to the 50% point of the upstroke of the corresponding photoplethysmography waveform; 500 beats of simultaneous systolic arterial pressure and pulse transit time were analysed in each sleep stage for each child. Pulse transit time was normalized to each subject's mean wake pulse transit time. The ability of pulse transit time to predict systolic arterial pressure change was determined by linear mixed-effects modelling. Significant negative correlations between pulse transit time and systolic arterial pressure were found for individual children for each sleep stage [mean correlations for cohort: non-rapid eye movement (NREM) sleep 1 and 2 r = -0.57, slow wave sleep (SWS) r = -0.76, REM r = -0.65, P < 0.01 for all]. Linear mixed-model analysis demonstrated that changes in pulse transit time were a significant predictor of changes in systolic arterial pressure for each sleep stage (P < 0.001). The model of pulse transit time-predicted systolic arterial pressure closely tracked actual systolic arterial pressure changes over time. This study demonstrated that pulse transit time was accurate in tracking systolic arterial pressure changes over time. Thus, the use of pulse transit time as a surrogate measure of changes in systolic arterial pressure in children is a valid, non-invasive and inexpensive method with many potential applications.

Wireless blood pressure monitoring with a novel implantable device: long-term in vivo results

PURPOSE

Devices constantly tracking the blood pressure (BP) of hypertensive patients are highly desired to facilitate effective patient management and to reduce hospitalization. We report on experiences gathered in a pilot study that was designed to evaluate the prototype of a newly developed, minimally invasive implantable sensor system for long-term BP monitoring.

METHODS

The device was implanted in the femoral artery (FA) of 12 sheep via standard FA catheterization under fluoroscopic control. Accuracy of the recorded blood pressure was determined by comparison with a reference catheter, which was positioned in the contralateral FA immediately after implantation. Regular follow-up included angiography, computed tomography (CT), and control of functionality and position of the BP sensor. Animals were euthanized after 6 months. FA segments with in situ pressure sensor underwent macroscopic and histopathologic examinations.

RESULTS

All implantations of the novel sensor device in the FA were successful and uneventful. High-quality BP recordings were documented. Bland-Altman plots indicate very good agreement. Comparison with measurements taken from the reference sensor revealed mean differences and standard deviations of -0.56 ± 0.85, 0.29 ± 1.44, and 0.85 ± 2.27 mmHg (diastolic, systolic, and pulse pressure, respectively) after exclusion of one outlier. CT uncovered deficiencies in cable stability that were addressed in a redesign. No thrombus formation, necrosis, or apoptosis were detected.

CONCLUSIONS

The pilot study proved the technical feasibility of wireless BP measurement in the FA via a novel miniature sensor device.

Radiative transport in large arteries

A refined model for the photon energy distribution in a living artery is established by solving the radiative transfer equation in a cylindrical geometry, using the Monte Carlo method. Combining this model with the most recent experimental values for the optical properties of flowing blood and the biomechanics of a blood-filled artery subject to a pulsatile pressure, we find that the optical intensity transmitted through large arteries decreases linearly with increasing arterial distension. This finding provides a solid theoretical foundation for measuring photoplethysmograms.

Implantable acceleration plethysmography for blood pressure determination

This paper presents an implantable accelerometer which detects plethysmograms directly at an artery. The sensor provides a new method for continuous blood pressure monitoring. In vivo measurements indicate that the accelerometer is well suited for determining the Pulse Transit Time (PTT) and the Reflected Wave Transit Time (RWTT). Both parameters show a high correlation with the systolic blood pressure. By varying the blood pressure, it was seen that RWTT more closely agrees with theory than PTT. Through several blood pressure sweeps the RWTT, as detected by the accelerometer, coincided very well with the systolic blood pressure, with a correlation coefficient of 0.96 and mean deviation of 4.3% for 1800 pulses.