Electrical Impedance Plethysmography Versus Tonometry To Measure the Pulse Wave Velocity in Peripheral Arteries in Young Healthy Volunteers: a Pilot Study

The leading cause of health loss and deaths worldwide are cardiovascular diseases. A predictor of cardiovascular diseases and events is the arterial stiffness. The pulse wave velocity (PWV) can be used to estimate arterial stiffness non-invasively. The tonometer is considered as the gold standard for measuring PWV. This approach requires manual probe fixation above the artery and depends on the skills of the operator. Electrical impedance plethysmography (IPG) is an interesting alternative using skin surface sensing electrodes, that is miniaturizable, cost-effective and allows measurement of deeper arteries. The aim of this pilot study was to explore if IPG can be a suitable technique to measure pulse wave velocity in legs as an alternative for the tonometer technique. The PWV was estimated by differences in the ECG-gated pulse arrival times (PAT) at the a. femoralis, a. popliteal, a. tibialis dorsalis and a. dorsalis pedis in nine healthy young adults using IPG and the SphygmoCor tonometer as a reference. The estimated PWV results from bioimpedance and the tonometer were fairly in agreement, and the beat-to-beat variability in PAT was similar. This pilot study indicates that the use of IPG may be a good alternative for estimating PWV in the legs.

Monitoring the quality of frozen-thawed venous segments using bioimpedance spectroscopy

OBJECTIVE

Storage at temperatures as low as -80 °C and below (cryopreservation) is considered a method for long-term preservation of cells and tissues, and especially blood vessel segments, which are to be used for clinical operations such as transplantation. However, the freezing and thawing processes themselves can induce injuries to the cells and tissue by damaging the structure and consequently functionality of the cryopreserved tissue. In addition, the level of damage is dependent on the rate of cooling and warming used during the freezing-thawing process. Current methods for monitoring the viability and integrity of cells and tissues after going through the freezing-thawing cycle are usually invasive and destructive to the cells and tissues. Therefore, employing monitoring methods which are not destructive to the cryopreserved tissues, such as bioimpedance measurement techniques, is necessary. In this study we aimed to design a bioimpedance measurement setup to detect changes in venous segments after freezing-thawing cycles in a noninvasive manner.

APPROACH

A bioimpedance spectroscopy measurement technique with a two-electrode setup was employed to monitor ovine jugular vein segments after each cycle during a process of seven freezing-thawing cycles.

MAIN RESULTS

The results demonstrated changes in the impedance spectra of the measured venous segments after each freezing-thawing cycle.

SIGNIFICANCE

This indicates that bioimpedance spectroscopy has the potential to be developed into a novel method for non-invasive and non-destructive monitoring of the viability of complex tissue after cryopreservation.

Electrodermal responses to discrete stimuli measured by skin conductance, skin potential, and skin susceptance

BACKGROUND/AIM

Presently, electrodermal activity (EDA) is the preferred term for changes in electrical properties of the skin. Change in the skin conductance responses (SCRs) and skin potential responses (SPRs) due to external stimuli have previously been investigated in a number of studies, but very little for skin susceptance responses (SSRs) recorded simultaneously at the same skin site. This study aimed to investigate the association between the three parameters of EDA, skin conductance (SC), skin potential (SP), and skin susceptance (SS) responses generated by different types of psychological stimuli.

METHODS

SCRs, SPRs, and SSRs were recorded from 20 healthy test subjects simultaneously at the same skin area. EDA responses were induced by five different external stimuli, which were shown in the form of PowerPoint slides on a PC monitor that situated in front of participants.

RESULTS

All stimuli evoked EDA responses, but with significantly different magnitudes, dependent on stimulus type. Both SC and SP waveforms yielded positive responses with respect to the stimuli; however, SS showed negative response and its role was found to be significant at low frequency (20 Hz).

CONCLUSIONS

This study illustrated that different discrete stimuli showed different passive and active electrodermal responses at the same skin site. SCRs, SPRs, and SSRs were dependent on the stimulus type, and the highest response was associated with the sound stimulus, which can be attributed to orienting response or startle reflex. In addition, it was found that the SSRs have a significant contribution at 20 Hz. In spite of a high correlation found between average amplitude values of SCRs and SSRs, no significant association was seen between average amplitudes values of SPRs and SSRs, and between SCRs and SPRs.

VAVD vacuum may cause bubble transgression in membrane oxygenators

Background:

Vacuum-assisted venous drainage (VAVD) is widely used to enhance venous blood return from patients undergoing cardiopulmonary bypass (CPB). This vacuum can accidentally reach the oxygenator of the heart-lung machine and draw gas bubbles into the blood. This is known as bubble transgression (BT) and may cause air emboli in the arterial blood line. In order to avoid BT and minimize the risk of patient injury, knowledge of oxygenator tolerance to vacuum load is critical. Thus, the main aim of this thesis was to investigate how much vacuum a membrane oxygenator can withstand before BT appears.

Methods:

We investigated four different adult oxygenators: Quadrox-i, Affinity Fusion, Capiox RX25 and Inspire 6M. They were tested in an in vitro setup where VAVD vacuum was allowed to reach the oxygenator through a non-occlusive roller pump. An ultrasonic clinical bubble counter, Gampt BCC 200, was used to count bubbles on the arterial line when the arterial pump was restarted.

Results:

We observed a significant increase in bubble count for two of the oxygenators, caused by -30 mmHg of VAVD vacuum in the blood reservoir (Affinity Fusion and Inspire 6M). Massive air ingress was shown in two of the oxygenators, caused by -30 mmHg of VAVD vacuum in the reservoir (Capiox RX25) and -40 mmHg of VAVD vacuum in the reservoir (Affinity Fusion).

Conclusion:

VAVD vacuum may cause bubble transgression in an oxygenator. This was shown for all the oxygenators in this test. VAVD vacuum may cause visible massive air ingress in an oxygenator. This was shown for two of the oxygenators in this test (Capiox RX25 and Affinity Fusion). An alarm triggering on negative pressure in the oxygenator or a pressure relief valve might improve safety when using VAVD.

In vivo characterization of ischemic small intestine using bioimpedance measurements

The standard clinical method for the assessment of viability in ischemic small intestine is still visual inspection and palpation. This method is non-specific and unreliable, and requires a high level of clinical experience. Consequently, viable tissue might be removed, or irreversibly damaged tissue might be left in the body, which may both slow down patient recovery. Impedance spectroscopy has been used to measure changes in electrical parameters during ischemia in various tissues. The physical changes in the tissue at the cellular and structural levels after the onset of ischemia lead to time-variant changes in the electrical properties. We aimed to investigate the use of bioimpedance measurement to assess if the tissue is ischemic, and to assess the ischemic time duration. Measurements were performed on pigs (n = 7) using a novel two-electrode setup, with a Solartron 1260/1294 impedance gain-phase analyser. After induction of anaesthesia, an ischemic model with warm, full mesenteric arterial and venous occlusion on 30 cm of the jejunum was implemented. Electrodes were placed on the serosal surface of the ischemic jejunum, applying a constant voltage, and measuring the resulting electrical admittance. As a control, measurements were done on a fully perfused part of the jejunum in the same porcine model. The changes in tan δ (dielectric parameter), measured within a 6 h period of warm, full mesenteric occlusion ischemia in seven pigs, correlates with the onset and duration of ischemia. Tan δ measured in the ischemic part of the jejunum differed significantly from the control tissue, allowing us to determine if the tissue was ischemic or not (P < 0.0001, F = (1,75.13) 188.19). We also found that we could use tan δ to predict ischemic duration. This opens up the possibility of real-time monitoring and assessment of the presence and duration of small intestinal ischemia.

Myocardial tissue CO2 tension detects coronary blood flow reduction after coronary artery bypass in real-time†

BACKGROUND

Coronary stenosis after coronary artery bypass grafting (CABG) may lead to myocardial ischaemia and is clinically difficult to diagnose. In a CABG model, we aimed at defining variables that detect hypoperfusion in real-time and correlate with impaired regional ventricular function by monitoring myocardial tissue metabolism.

METHODS

Off-pump CABG was performed in 10 pigs. Graft blood flow was reduced in 18 min intervals to 75, 50, and 25% of baseline flow with reperfusion between each flow reduction. Myocardial tissue Pco2 (Pt(CO2)), Po2, pH, glucose, lactate, and glycerol from the graft supplied region and a control region were obtained. Regional cardiac function was assessed as radial strain.

RESULTS

In comparison with baseline, myocardial pH decreased during 75, 50, and 25% flow reduction (-0.15; -0.22; -0.37, respectively, all P<0.05) whereas Pt(CO2) increased (+4.6 kPa; +7.8 kPa; +12.9 kPa, respectively, all P<0.05). pH and Pt(CO2) returned to baseline upon reperfusion. Lactate and glycerol increased flow-dependently, while glucose decreased. Regional ventricular contractile function declined significantly. All measured variables remained normal in the control region. Pt(CO2) correlated strongly with tissue lactate, pH, and contractile function (R=0.86, R=-0.91, R=-0.70, respectively, all P<0.001). New conductometric Pt(CO2) sensors were in agreement with established fibre-optic probes. Cardiac output was not altered.

CONCLUSIONS

Myocardial pH and Pt(CO2) monitoring can quantify the degree of regional tissue hypoperfusion in real-time and correlated well with cellular metabolism and contractile function, whereas cardiac output did not. New robust conductometric Pt(CO2) sensors have the potential to serve as a clinical cardiac monitoring tool during surgery and postoperatively.