Delayed control of haemorrhage or blood loss has been recognised as a major contributor to preventable trauma deaths, but early detection of internal bleeding is difficult due to unreliability of heart rate (HR) and blood pressure (BP) as markers of volume status. This thesis explores a novel method of early blood loss detection using a noninvasive finger photoplethysmographic (PPG) pulse oximetry waveform that is normally utilised in pulse oximeters for estimating arterial oxygen saturation. Graded head-up tilt (n = 13) and blood donation (n = 43) in human volunteers were selected as experimental models of mild to moderate blood loss. From the tilt study, a novel method for automatically detecting left ventricular ejection time (LVET) from the finger PPG waveform has been developed and verified by comparison with the LVET measured from aortic flow velocity. PPG waveform derived LVET (LVETp) and pulse transit time (PTT) were strongly correlated with aortic LVET and pre-ejection period respectively (median r = 0.954 and 0.964) and with the decrease in central blood volume indicated by the sine of the tilt angle (median r = -0.985 and 0.938), outperforming R-R interval (RRI) and BP in detecting mild central hypovolaemia. In the blood donation study, progressive blood loss was characterised by falling LVETp and rising PTT (p < 0.01). A new way of identifying haemorrhagic phases by monitoring changes and trends in LVETp, PTT and RRI has been proposed based on the results from the two studies. The utility of frequency spectrum analysis of PPG waveform variability (PPGV) in characterising blood loss has also been examined. A new technique of PPGV analysis by computing the coherence-weighted cross-spectrum has been proposed. It has been shown that the spectral measures of finger PPGV exhibited significant changes (p < 0.01) with blood donation and were mildly correlated with systemic vascular resistance in intensive care unit patients (r from 0.53 to 0.59, p < 0.0001), therefore may be useful for identification of different haemorrhagic phases. In conclusion, this thesis has established finger PPG waveform as a potentially useful noninvasive tool for early detection of blood loss.

Delayed control of haemorrhage or blood loss has been recognised as a major contributor to preventable trauma deaths, but early detection of internal bleeding is difficult due to unreliability of heart rate (HR) and blood pressure (BP) as markers of volume status. This thesis explores a novel method of early blood loss detection using a noninvasive finger photoplethysmographic (PPG) pulse oximetry waveform that is normally utilised in pulse oximeters for estimating arterial oxygen saturation. Graded head-up tilt (n = 13) and blood donation (n = 43) in human volunteers were selected as experimental models of mild to moderate blood loss. From the tilt study, a novel method for automatically detecting left ventricular ejection time (LVET) from the finger PPG waveform has been developed and verified by comparison with the LVET measured from aortic flow velocity. PPG waveform derived LVET (LVETp) and pulse transit time (PTT) were strongly correlated with aortic LVET and pre-ejection period respectively (median r = 0.954 and 0.964) and with the decrease in central blood volume indicated by the sine of the tilt angle (median r = -0.985 and 0.938), outperforming R-R interval (RRI) and BP in detecting mild central hypovolaemia. In the blood donation study, progressive blood loss was characterised by falling LVETp and rising PTT (p < 0.01). A new way of identifying haemorrhagic phases by monitoring changes and trends in LVETp, PTT and RRI has been proposed based on the results from the two studies. The utility of frequency spectrum analysis of PPG waveform variability (PPGV) in characterising blood loss has also been examined. A new technique of PPGV analysis by computing the coherence-weighted cross-spectrum has been proposed. It has been shown that the spectral measures of finger PPGV exhibited significant changes (p < 0.01) with blood donation and were mildly correlated with systemic vascular resistance in intensive care unit patients (r from 0.53 to 0.59, p < 0.0001), therefore may be useful for identification of different haemorrhagic phases. In conclusion, this thesis has established finger PPG waveform as a potentially useful noninvasive tool for early detection of blood loss.

High blood pressure is a major public health issue. However, there are many physical and non-physical factors that affect the measurement of blood pressure (BP) over very short time spans. Therefore, it is very difficult to write a mathematical equation which includes all relevant factors needed to estimate accurate BP values. As a result, a possible solution to overcome these limitations is the use of an artificial neural network (ANN). The aim of this research is to design and implement a new ANN approach, which correlates the arterial pulse waveform shape to BP values, for estimation of BP in a single heartbeat. To test the feasibility of this approach, a pilot study was performed on an arterial pulse waveform dataset obtained from 11 patients with normal BP and 11 patients with hypertension. It was found that the proposed method can accurately estimate BP in single heartbeats and satisfy the requirements of the ANSI/AAMI standard for non-invasive measurement of BP.

Abstract This thesis describes the laser Doppler technique based on a self-mixing effect in a diode laser to noninvasive cardiovascular pulse detection in a human wrist above the radial artery. The main applications of self-mixing interferometry described in this thesis in addition to pulse detection are arterial pulse shape and autonomic regulation measurements. The elastic properties of the arterial wall are evaluated and compared to pulse wave velocity variation at different pressure conditions inside the radial artery. The main advantages of self-mixing interferometry compared to conventional interferometers are that the measurement set up is simple, because basically only one optical component, the laser diode, is needed. The use of fewer components decreases the price of the device, thus making it inexpensive to use. Moreover, an interferometer can be implemented in a small size and it is easy to control because only one optical axis has to be adjusted. In addition, an accuracy, which corresponds to half of the wavelength of the light source, can be achieved. These benefits make this technique interesting for application to the measurement of different parameters of the cardiovascular pulse. In this thesis, measurement of three different parameters from cardiovascular pulsation in the wrist is studied. The first study considers arterial pulse shape measurement. It was found that an arterial pulse shape reconstructed from the Doppler signal correlates well to the pulse shape of a blood pressure pulse measured with a commercial photoplethysmograph. The second study considers measurement of autonomic regulation using the Doppler technique. It was found that the baroreflex part of autonomic regulation can be measured from the displacement of the arterial wall, which is affected by blood pressure variation inside the artery. In the third study, self-mixing interferometry is superimposed to evaluate the elastic properties of the arterial wall. It was found that the elastic modulus of the arterial wall increases as blood pressure increases. Correlations between measurements and theoretical values were found but deviation in measured values was large. It was noticed that the elastic modulus of the arterial wall and pulse wave velocity behave similarly as a function of blood pressure. When the arterial pressure increases, both the elastic modulus and pulse wave velocity reach higher values than in lower pressure.

Student Number :9900127Y - MSc (Eng) dissertation - Faculty of Engineering and the Built Environment / Arterial pulse wave analysis studies the wave shape of the blood pressure pulse. The pulse wave provides more information than the extreme systolic and dia- stolic pressures, measured with a cuff sphygmomanometer. The aim of the research is to investigate the design issues in a pulse wave analysis system, and to compare these to a commercially available system. The system was compared and validated by measuring the pulse wave at the radial artery (wrist) using the non-invasive technique of arterial tonometry. The design conformed to the IEC-601 safety standard to ensure patient safety. The data was compared against the data from the commercial system and analysis was performed in the time and frequency domain. The performance of the design suggests that, in some respects, the design was comparable to the commer- cial system, however, a number of performance characteristics fell short of the commercial system. Suggestions have been made to address these problems in further research.

[pt] Esta dissertação tem por objetivo o desenvolvimento de um transdutor de pressão de alta sensibilidade, baseado nas características de fase da impedância de sensores de Magnetoimpedância Gigante. A configuração do dispositivo visa a aplicações biomédicas, tais como medições da onda de pulso arterial e de sua velocidade de propagação. Projetou-se um sistema de transdução de pressão em tensão, que contém um módulo intermediário baseado em um magnetômetro GMI. O protótipo implementado inclui uma estrutura mecânica, responsável pela transdução de pressão em campo magnético, e um circuito eletrônico, responsável pela conversão deste em uma tensão elétrica de saída. A conversão de pressão em campo magnético é feita por meio de uma fonte de campo magnético aderida a uma membrana elástica. Foram realizados estudos comparativos empregando agulhas magnetizadas e ímãs permanentes como fontes móveis de campo. Por sua vez, o elemento sensor GMI utilizado foi experimentalmente caracterizado, a fim de se obter suas curvas características de módulo e fase, em função do campo magnético. O circuito eletrônico de transdução foi projetado e avaliado de forma computacional e experimental. As principais características do mesmo são detalhadas ao longo do texto e as previsões teórico-computacionais são comparadas com os resultados experimentais obtidos. Por sua vez, parâmetros chave do protótipo desenvolvido são minuciosamente analisados, tais como: sensibilidade, linearidade e resposta em frequência. Também, avalia-se a densidade espectral de ruído do transdutor desenvolvido e estima-se sua resolução na banda de passagem. Os resultados obtidos indicam que o protótipo de baixo custo desenvolvido apresenta alta resolução e alta sensibilidade, além de uma banda de passagem compatível com a requerida pelas aplicações biomédicas nas quais deseja-se empregá-lo. Dessa forma, espera-se que o dispositivo desenvolvido contribua para o avanço tecnológico do ferramental utilizado no setor da saúde. / [en] This dissertation aims at the development of a high sensitivity pressure transducer, based on the phase impedance characteristics of Giant Magnetoimpedance sensors. The configuration is intended to employ the developed device in biomedical applications, such as in measurements of arterial pulse wave and pulse wave velocity. A transduction system of pressure into voltage was designed, which contains an intermediate module based on a GMI magnetometer. The idealized prototype contains a mechanical structure, responsible for converting pressure into magnetic field, and an electronic circuit, responsible for converting the latter into a voltage output. The conversion of pressure into magnetic field is performed by means of a magnetic field source adhered to an elastic membrane. Comparative studies were carried out using magnetized needles and permanent magnets as field sources. In turn, the GMI sensor element was experimentally characterized in order to evaluate how its impedance magnitude and phase are affected by the magnetic field. The influence of the cable length used to interconnect the GMI sensor to the electronic circuit is also discussed. The electronic transduction circuit was designed and analyzed by computational and experimental evaluations. The main features of the circuit are detailed throughout the text and the theoretical and computational predictions are compared with the obtained experimental results. Furthermore, the key parameters of the developed prototype are meticulously analyzed, such as: sensitivity, linearity and frequency response. Also, the spectral noise density of the developed transducer is evaluated and its resolution in the passband is estimated. The obtained results indicate that the developed prototype presents low cost of manufacture and operation, high resolution, high sensitivity and a passband compatible with the requirements imposed by the biomedical applications of interest. In this way, it is intended that the device developed in the present Dissertation contributes to the technological enhancement of measurement equipment used in health sector.

[pt] A velocidade da onda de pulso (VOP) tem sido identificada como o padrão-ouro para avaliação da rigidez arterial e, recentemente, vem sendo reconhecida como um importante indicador no diagnóstico e tratamento de doenças cardiovasculares. Atualmente, já existem dispositivos comerciais capazes de efetuar a medição da VOP, entretanto, ainda exigem um investimento financeiro significativo e alguns requerem um treinamento especializado para seu correto uso. Os, transdutores de pressão atuais são majoritariamente baseados em sensores piezoresistivos, piezoelétricos e capacitivos. Entretanto, pesquisas recentes demostraram que transdutores de pressão que utilizam sensores magnéticos baseados na magnetoimpedância gigante (GMI) apresentam elevada sensibilidade. Tendo em vista que a VOP é um importante indicador do risco de distúrbios cardiovasculares, e considerando os potenciais beneficios dos sensores GMI em relação às demais alternativas, esta tese de doutorado buscou utilizar-se destes elementos sensores a fim de desenvolver um sistema de medição portátil, não-invasivo, de baixo custo, acessível e simples de usar, capaz de efetuar a medição da VOP. Neste intuito, foram desenvolvidos transdutores de alta sensibilidade, baseados nas características de fase da impedância de sensores de Magnetoimpedância Gigante, destinados à medição da velocidade da onda de pulso arterial. A fim de se otimizar as características de desempenho dos transdutores, foram realizadas avaliações teórico-computacionais dos transdutores na configuração em malha aberta e fechada, bem como ensaios experimentais dos protótipos projetados. As caracterizações e ensaios experimentais realizados com o transdutor de pressão em malha aberta resultaram em uma sensibilidade de 59,6 mV/kPa, e resolução de 192,8 Pa para uma média de 30 amostras, na banda de passagem de 1000 Hz. Por outro lado, a configuração em malha fechada apresentou uma sensibilidade de 54,2 mV/kPa, e resolução de 206,0 Pa para uma média de 30 amostras, na banda de passagem de 32 Hz. Tendo em vista os valores de sensibilidade e resolução obtidos, propõe-se empregar o sistema de transdução de pressão que incorpora uma câmara incompressível para amplificação mecânica, na medição de ondas de pulso arterial. Neste protótipo, uma pequena membrana semirrígida localizada na superfície da câmara incompressível é posicionada sobre a superfície da pele, próxima à artéria de interesse. Deste modo, pequenas mudanças de pressão na superfície da pele, causadas pela onda de pulso arterial, provocam uma variação do campo magnético sobre o elemento sensor. Por outra parte, devido à alta sensibilidade apresentada pelo transdutor magnetico (magnetômetro GMI) na configuração de malha aberta (0,2 mV/nT) e de malha fechada (0,19 mV/nT), estes foram usados para medir diretamente a forma de onda do pulso arterial, sem utilizar uma câmara incompressível para transdução mecânica. Nesta medição, considerando a adequada resolução espacial para as demandas anatômicas, utiliza-se um pequeno marcador magnético, envolto por uma fita adesiva hipoalergênica e flexível, aderida á região da pele sobre a artéria de interesse, e aproxima-se o sensor magnético GMI da superfície da pele onde o marcador foi colocado. Finalmente, as configurações propostas foram analisadas e comparadas, a fim de se identificar aquela com melhor desempenho, a qual foi utilizada para medição da VOP. Como o estudo envolve o registro da onda de pulso em participantes da pesquisa, o projeto foi submetido à apreciação e aprovado pela Comissão da Câmara de Ética em Pesquisa da Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio) 045/2020 – Protocolo 83/2020. Espera-se que o dispositivo desenvolvido contribua para o avanço tecnológico do ferramental utilizado no setor da saúde. / [en] Pulse wave velocity (PWV) is considered the gold standard for assessing arterial stiffness and recently, it has been recognized as an important indicator in the diagnosis and treatment of cardiovascular disease. Currently, there are commercial devices capable of measuring PWV, however, significant investments are required and some devices requires specialized training for their correct use. Conventional pressure-sensing devices are mainly based on piezoresistive, piezoelectric and capacitive sensors. Recent investigations, however, show that pressure transducer using magnetic sensors based on the giant Magnetoimpedance (GMI) present high-sensitivity. Considering that, PWV is a significant risk factor for future cardiovascular disease and in view of some of the advantages of GMI sensors in relation to another sensing technologies, this doctoral thesis aims to develop a portable measurement system, non-invasive, low-cost, accessible and simple to use, capable of measuring PWV. For this purpose, we have developed a high-sensitivity transducers based on the impedance phase characteristics of GMI sensors, for measuring the arterial pulse wave velocity. In order to improve the performance characteristics of the transducers, computational and theoretical analysis in open and closed loop configuration were performed. The characterizations and experimental tests performed with the open-loop pressure transducer resulted in a sensitivity of 59.6 mV/kPa, and resolution of 192.8 Pa for an average of 30 samples, in the 1000 Hz passband. On the other hand, the closed-loop configuration presented a sensitivity of 54.2 mV/kPa, and a resolution of 206.0 Pa for an average of 30 samples, in the 32 Hz passband. In view of the considerable sensitivity and resolution obtained, it is proposed to employ a pressure transduction system that incorporates an incompressible chamber for mechanical amplification, in the measurement of arterial pulse waves. In this prototype, a small semi-rigid membrane located on the surface of the incompressible chamber is positioned over the surface of the skin, close to the artery of interest. In this way, small pressure changes on the skin surface, caused by the arterial pulse wave, cause a variation of the magnetic field on the sensing element. On the other hand, due to the high sensitivity presented by the magnetic transducer (GMI magnetometer) in the open-loop (0.2 mV/nT) and closed-loop (0.19 mV/nT) configurations, they were used to measure the shape pulse waveform without using an incompressible chamber for mechanical transduction. In this test, considering the adequate spatial resolution for the anatomical demands, a small magnetic marker is used, the magnetic marker is attached to the skin region over the artery of interest, and the GMI magnetic sensor is approached near the marker placed of the skin surface. Finally, the proposed configurations were analyzed and compared in order to identify the one with the best performance, which was used to measure PWV. As the study involves recording the pulse wave in research participants, the project was submitted for consideration and approved by the Research Ethics Committee of the Pontifical Catholic University of Rio de Janeiro (PUC-Rio) 045/2020 – Protocol 83/2020. It is expected that the device developed will contribute to the technological advancement of the tools used in the health sector.