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although the device has been in development for nearly a decade, it has just recently been commercialized and is now available. a number of other wearable devices are currently being developed that allow continuous, noninvasive blood pressure measurement. unfortunately, ppg-based measurement of blood flow has not been widely used because of the need for continuous, noninvasive measurement of the arterial blood flow to a particular region of the tissue. this has been made possible by the development of a number of techniques, including radionuclide flow studies, magnetic resonance imaging, positron emission tomography, and others.

in this study, the noninvasive measurement of arterial blood pressure with the ppg technique was performed on 21 male sprague-dawley rats (350-400 gm). the ppg sensor was placed on the tail with the light-emitting diode pointing toward the heart. the ppg signal was calibrated by measuring the resistance of the sensor to a known pressure level before the implantation. the pressure was measured using a digital pressure manometer placed on the tail and a transducer. a catheter was inserted into the tail vein via the femoral vein to obtain a blood sample for blood gas analysis. the blood gas was analyzed using an i-stat analyzer (abbott laboratories, princeton, nj). all measurements were performed at room temperature (20-22 degree c).

the body temperature of the animals was not controlled during the experiment. the animal body temperature was measured via a temperature probe in the tail vein and was kept between 36.5 degree c and 37.5 degree c. after the baseline measurement, the rats were anesthetized with chloral hydrate (50 mg/kg) and the ppg sensor was sutured to the rat tail skin. the rats were allowed to recover from the anesthesia and were placed in a cage on a heating pad. the ppg measurement was repeated for three hours and the data were recorded.

there are many ways to estimate the total blood flow through a region of tissue. the simplest is to estimate the amount of blood that has passed through, either in a calculated manner or by direct measurement of the blood volume ( 4 ). however, this approach does not allow for the assessment of the distribution of blood flow among the different tissues, the presence of abnormalities, or the potential for autoregulation. a much more accurate measure can be obtained by measuring the amount of blood in a region in the body over time. this is the approach of the total tissue blood flow meter and is based on the principle of co 2 and o 2 washout from the tissue, as described by fick’s principle ( 2 ). the method involves a gas and metabolite analyzer that measures changes in concentration of gases and metabolites in the tissue over time, and the results are then processed to provide a measure of the total tissue blood flow in the region of the tissue under investigation. the gas analyzer is normally a mass spectrometer, although there are other techniques such as photoacoustic spectrometry, tissue oximetry, and so on. another method that has been used to measure tissue blood flow is to measure the rate at which the tissue takes up and releases oxygen and carbon dioxide by tissue spectrophotometry ( 19 ).
we have developed a miniature, wearable, wireless system that allows for the continuous, noninvasive measurement of blood oxygenation in the finger tip using ppg. the device uses a small, red light-emitting diode (led) as a light source, which is driven by a small, low-power microcontroller, and a reflectance photodiode (pd) that is placed on the fingertip. from the relative power of the reflected light, the microcontroller calculates the ratio of oxyhemoglobin (hbo 2 ) and deoxyhemoglobin (hb) in the fingertip using the following equation: hbo 2 hb hbo 2 hb 1.5 + 1 hb o 2 + 0.5 hb o 2 + 2 hb = 1.5 hb + 0.5 hbo 2 + 0.5 hb + 2.5 hbo 2 = hbo 2 + hb. light energy is converted to electrical energy by the pd, allowing continuous monitoring of fingertip hbo 2 and hb. the system is intended to be used for continuous, noninvasive fingertip monitoring of arterial blood oxygenation (abo 2 ) in individuals at risk for hypoxia during sleep (e.g., patients with sleep apnea or heart failure). the device has been evaluated in a number of studies involving healthy volunteers in awake and sleep states ( 21, 26, 27 ). a small pilot study that involves continuous, noninvasive monitoring of abo 2 in patients with sleep apnea is also described.
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