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  • Author: Steffen Leonhardt x
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Abstract

The feasibility of bioimpedance spectroscopy (BIS) techniques for monitoring intradialytic changes in body fluids is advancing. The aim of this study was to compare the knee-to-knee (kkBIS) with the traditional whole-body (whBIS) with respect to continuous assessment of fluid volume status in hemodialysis patients. Twenty patients divided into two groups, hemodynamically stable and unstable, were recruited. Bioimpedance data from two different electrodes configurations (hand-to-foot and knee-to-knee) were collected and retrospectively analysed. A good correlation between the two methods with respect to changes in extracellular resistance (Re) and Re normalized for ultrafiltration volume (ΔRe/UFV) with p < 0.001 was observed. The relationship between relative change (%) in ΔRe and that in patient weight was most notable with kkBIS (4.82 ± 3.31 %/kg) in comparison to whBIS (3.69 ± 2.90 %/kg) in unstable patients. Furthermore, results based on kkBIS showed a reduced ability of the thigh compartments to keep up with the volume changes in the trunk for unstable patients. kkBIS provided a comparable sensitivity to whBIS even in patients at risk of intradialytic hypotension while avoiding the need for the complex implementation imposed by whBIS or other configurations.

Abstract

Chronic venous insufficiency of the lower limbs is a disease which is caused by an increased blood pressure inside the veins of the leg and the resulting increase of the contained blood volume. This work focuses on developing a device which uses impedance plethysmography, also known as impedance phlebography, to obtain information about the blood volume in the lower leg and provides the possibility to measure the impedance semi contact-less, e.g. through compression stockings. Furthermore a real-time beat-to-beat interval detection algorithm was implemented. Finally, the function of the developed impedance measuring system and the whole system was verified by comparing it with a gold standard. In comparison to the conductive coupling, the system performed similarly. The analysis showed that the developed system is suitable for semi-capacitive IPG. The algorithm was implemented conservatively since it provided a good false-positive rate of 0 %, but only a moderate sensitivity of about 68 %. Reliable and continuous measurement of the pulse signal was only possible in periods of immobility.

Abstract

Lung pathologies such as edema, atelectasis or pneumonia are potentially life threatening conditions. Especially in critically ill and mechanically ventilated patients, an early diagnosis and treatment is crucial to prevent an Acute Respiratory Distress Syndrome []. Thus, continuous monitoring tool for the lung condition available at the bedside would be highly appreciated. One concept for this is Electrical Impedance Tomography (EIT). In EIT, an electrode belt of typically 16 or 32 electrodes is attached at the body surface and multiple impedance measurements are performed. From this, the conductivity change inside the body is reconstructed in a two-dimensional image. In various studies, EIT proved to be a useful tool for quantifying recruitment maneuvers, the assessment of the ventilation homogeneity, the detection of lung edema or perfusion monitoring [, , , ]. Nevertheless, the main problem of EIT is the low spatial resolution (compared to CT) and the limitation to two dimensional images. In this paper, we try to address the latter issue: Instead of projecting conductivity changes onto a two-dimensional image, we adjust electrode positions to focus single tetrapolar measurements to specific, three-dimensional regions of interest. In earlier work, we defined guidelines to achieve this focusing [, ]. In this paper, we demonstrate in simulations and in a water tank experiment that applying these guidelines can help to detect pathologies in specific lung regions.

Abstract

Athletes need a balanced body composition in order to achieve maximum performance. Especially dehydration reduces power and endurance during physical exercise. Monitoring the body composition, with a focus on body fluid, may help to avoid reduction in performance and other health problems. For this, a potential measurement method is bioimpedance spectroscopy (BIS). BIS is a simple, non-invasive measurement method that allows to determine different body compartments (body fluid, fat, fat-free mass). However, because many physiological changes occur during physical exercise that can influence impedance measurements and distort results, it cannot be assumed that the BIS data are related to body fluid loss alone. To confirm that BIS can detect body fluid loss due to physical exercise, finite element (FE) simulations were done. Besides impedance, also the current density contribution during a BIS measurement was modeled to evaluate the influence of certain tissues on BIS measurements. Simulations were done using CST EM Studio (Computer Simulation Technology, Germany) and the Visible Human Data Set (National Library of Medicine, USA). In addition to the simulations, BIS measurements were also made on athletes. Comparison between the measured bioimpedance data and simulation data, as well as body weight loss during sport, indicates that BIS measurements are sensitive enough to monitor body fluid loss during physical exercise.

Abstract

Ventricular Assist Devices (VADs) are used to treat patients with cardiogenic shock. As the heart is unable to supply the organs with sufficient oxygenated blood and nutrients, a VAD maintains the circulation to keep the patient alive. The observation of the patient's hemodynamics is crucial for an individual treatment; therefore, sensors to measure quantifiable hemodynmaic parameters are desirable.

In addition to pressure measurement, the volume of the left ventricle and the progress of muscle recovery seem to be promising parameters. Ongoing research aims to estimate ventricular volume and changes in electrical properties of cardiac muscle tissue by applying bioimpedance measurement. In the case where ventricular insufficiency is treated by a catheter-based VAD, this very catheter could be used to conduct bioimpedance measurement inside the assisted heart. However, the simultaneous measurement of bioimpedance and VAD support has not yet been realized, although this would allow the determination of various loading conditions of the ventricle. For this purpose, it is necessary to develop models to validate and quantify bioimpedance measurement during VAD support.

In this study, we present an in silico and an in vitro conductivity model of a left ventricle to study the application of bioimpedance measurement in the context of VAD therapy. The in vitro model is developed from casting two anatomical silicone phantoms: One phantom of pure silicone, and one phantom enriched with carbon, to obtain a conductive behavior close to the properties of heart muscle tissue. Additionally, a measurement device to record the impedance inside the ventricle is presented. Equivalent to the in vitro model, the in silico model was designed. This finite element model offers changes in material properties for myocardium and the blood cavity.

The measurements in the in vitro models show a strong correlation with the results of the simulation of the in silico model. The measurements and the simulation demonstrate a decrease in impedance, when conductive muscle properties are applied and higher impedances correspond to smaller ventricle cross sections.

The in silico and in vitro models are used to further investigate the application of bioimpedance measurement inside the left heart ventricle during VAD support. We are confident that the models presented will allow for future evaluation of hemodynamic monitoring during VAD therapy at an early stage of research and development.