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Calderone A, Jarry S, Couture EJ, Brassard P, Beaubien-Souligny W, Momeni M, Liszkowski M, Lamarche Y, Shaaban-Ali M, Matta B, Rochon A, Lebon JS, Ayoub C, Martins MR, Courbe A, Deschamps A, Denault AY. Early Detection and Correction of Cerebral Desaturation With Noninvasive Oxy-Hemoglobin, Deoxy-Hemoglobin, and Total Hemoglobin in Cardiac Surgery: A Case Series. Anesth Analg 2022; 135:1304-1314. [PMID: 36097147 DOI: 10.1213/ane.0000000000006155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Regional cerebral oxygen saturation (rS o2 ) obtained from near-infrared spectroscopy (NIRS) provides valuable information during cardiac surgery. The rS o2 is calculated from the proportion of oxygenated to total hemoglobin in the cerebral vasculature. Root O3 cerebral oximetry (Masimo) allows for individual identification of changes in total (ΔcHbi), oxygenated (Δ o2 Hbi), and deoxygenated (ΔHHbi) hemoglobin spectral absorptions. Variations in these parameters from baseline help identify the underlying mechanisms of cerebral desaturation. This case series represents the first preliminary description of Δ o2 Hbi, ΔHHbi, and ΔcHbi variations in 10 cardiac surgical settings. Hemoglobin spectral absorption changes can be classified according to 3 distinct variations of cerebral desaturation. Reduced cerebral oxygen content or increased cerebral metabolism without major blood flow changes is reflected by decreased Δ o2 Hbi, unchanged ΔcHbi, and increased ΔHHbi Reduced cerebral arterial blood flow is suggested by decreased Δ o2 Hbi and ΔcHbi, with variable ΔHHbi. Finally, acute cerebral congestion may be suspected with increased ΔHHbi and ΔcHbi with unchanged Δ o2 Hbi. Cerebral desaturation can also result from mixed mechanisms reflected by variable combination of those 3 patterns. Normal cerebral saturation can occur, where reduced cerebral oxygen content such as anemia is balanced by a reduction in cerebral oxygen consumption such as during hypothermia. A summative algorithm using rS o2 , Δ o2 Hbi, ΔHHbi, and ΔcHbi is proposed. Further explorations involving more patients should be performed to establish the potential role and limitations of monitoring hemoglobin spectral absorption signals.
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Affiliation(s)
- Alexander Calderone
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Stéphanie Jarry
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Etienne J Couture
- Departments of †Anesthesiology.,Medicine, Division of Intensive Care Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Quebec, Canada.,Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec, Quebec, Canada
| | - Patrice Brassard
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec, Quebec, Canada.,Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - William Beaubien-Souligny
- Department of Medicine, Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Mona Momeni
- Department of Acute Medicine, Cardiothoracic and Vascular Anesthesia Section, Cliniques Universitaires Saint-Luc, UC Louvain, Brussels, Belgium
| | - Mark Liszkowski
- Department of Medicine, Cardiology Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.,Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Yoan Lamarche
- Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.,Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mohamed Shaaban-Ali
- Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Basil Matta
- Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Antoine Rochon
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Sébastien Lebon
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Christian Ayoub
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Maria Rosal Martins
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Athanase Courbe
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alain Deschamps
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - André Y Denault
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.,Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Mokhtari M, Amirdosara M, Goharani R, Zangi M, Tafrishinejad A, Nashibi M, Dabbagh A, Sadeghi H, Nateghinia S, Hajiesmaeili M, Yousefi-Banaem H, Sayehmiri F. The Predictive Power of Near-Infrared Spectroscopy in Improving Cognitive Problems in Patients Undergoing Brain Surgeries: A Systematic Review. Anesth Pain Med 2022; 12:e116637. [PMID: 35433374 PMCID: PMC8995777 DOI: 10.5812/aapm.116637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 12/17/2021] [Accepted: 01/07/2022] [Indexed: 12/03/2022] Open
Abstract
One of the main objectives in neurosurgical procedures is the prevention of cerebral ischemia and hypoxia leading to secondary brain injury. Different methods for early detection of intraoperative cerebral ischemia and hypoxia have been used. Near-infrared spectroscopy (NIRS) is a simple, non-invasive method for monitoring cerebral oxygenation increasingly used today. The aim of this study was to systematically review the brain monitoring with NIRS in neurosurgery. The search process resulted in the detection of 324 articles using valid keywords on the electronic databases, including Embase, PubMed, Scopus, Web of Science, and Cochrane Library. Subsequently, the full texts of 34 studies were reviewed, and finally 11 articles (seven prospective studies, three retrospective studies, and one randomized controlled trial) published from 2005 to 2020 were identified as eligible for systematic review. Meta-analysis was not possible due to high heterogeneity in neurological and neurosurgical conditions of patients, expression of different clinical outcomes, and different standard reference tests in the studies reviewed. The results showed that NIRS is a non-invasive cerebral oximetry that provides continuous and measurable cerebral oxygenation information and can be used in a variety of clinical settings.
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Affiliation(s)
- Majid Mokhtari
- Department of Internal Medicine, Pulmonary and Critical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Amirdosara
- Anesthesiology Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Goharani
- Department of Anesthesiology, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Masood Zangi
- Anesthesiology Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Tafrishinejad
- Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Nashibi
- Fellowship of Neuroanesthesia, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Dabbagh
- Fellowship in Cardiac Anesthesiology, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Sadeghi
- Anesthesiology Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeedeh Nateghinia
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Hajiesmaeili
- Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hossein Yousefi-Banaem
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sayehmiri
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Shaaban-Ali M, Momeni M, Denault A. Clinical and Technical Limitations of Cerebral and Somatic Near-Infrared Spectroscopy as an Oxygenation Monitor. J Cardiothorac Vasc Anesth 2020; 35:763-779. [PMID: 32709385 DOI: 10.1053/j.jvca.2020.04.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/12/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022]
Abstract
Cerebral and somatic near-infrared spectroscopy monitors are commonly used to detect tissue oxygenation in various circumstances. This form of monitoring is based on tissue infrared absorption and can be influenced by several physiological and non-physiological factors that can induce error in the interpretation. This narrative review explores those clinical and technical limitations and proposes solutions and alternatives in order to avoid some of those pitfalls.
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Affiliation(s)
- Mohamed Shaaban-Ali
- Department of Anesthesia, College of Medicine, Assiut University, Assiut, Egypt
| | - Mona Momeni
- Department of Acute Medicine, Section Cardiothoracic and Vascular Anesthesia, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
| | - André Denault
- Department of Anesthesia and Critical Care Medicine, Montreal Heart Institute, Université de Montréal, and Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
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Kim W, Taw B, Yokosako S, Koyanagi M, Fukuda H, Sinclair D, Sirhan D, Teitelbaum J, Lui MW, Kasuya H, Angle M, Lo BW. The future of non-invasive cerebral oximetry in neurosurgical procedures: A systematic review. ACTA ACUST UNITED AC 2018. [DOI: 10.12688/mniopenres.12779.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background:Cerebral hypoxia is one of the most important causes of secondary brain injury during neurosurgical procedures and in neurointensive care. In patients with brain injury, cerebrovascular reactivity may be impaired and a decrease in mean arterial pressure or cerebral perfusion pressure may lead to inadequate cerebral blood flow and secondary ischemia. There are several techniques available to measure brain oxygenation. In particular, near infrared spectroscopy (NIRS) is a non-invasive neuromonitoring technique and there has been a rapid expansion of clinical evidence that NIRS reduces perioperative neurologic complications. Methods:This systematic review synthesizes prospective and retrospective cohort studies that investigate the benefit of using NIRS in prevention of perioperative neurologic complications. The methodological quality of these studies is appraised.Results:Seven studies were included in this systematic review. The methodological quality of each study was assessed. They had representative patient populations, clear selection criteria and clear descriptions of study designs. Reproducible study protocols with ethics board approval were present. Clinical results were described in sufficient detail and were applicable to patient undergoing neurosurgical procedures and in neurointensive care. Limitations included small sample sizes and lack of reference standard.Conclusions:This systematic review synthesizes the most current evidence of non-invasive, inexpensive, and continuous measurement of cerebral oxygenation by NIRS. Results gained from these studies are clinically useful and shed light on how this neuromonitoring technique is beneficial in preventing perioperative neurological complications.
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Abdullah A, Khan IH, Basuhail A, Hussain A. A Novel Near-Infrared Spectroscopy Based Spatiotemporal Cognition Study of the Human Brain Using Clustering. Cognit Comput 2015. [DOI: 10.1007/s12559-015-9358-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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6
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Calderon-Arnulphi M, Alaraj A, Slavin KV. Near infrared technology in neuroscience: past, present and future. Neurol Res 2013; 31:605-14. [DOI: 10.1179/174313209x383286] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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7
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Sung TY, Kang WS, Han SJ, Kim JS, Chee HK, Shin JK, Kim SH. Does Near-Infrared Spectroscopy Provide an Early Warning of Low Haematocrit following the Initiation of Hypothermic Cardiopulmonary Bypass in Cardiac Surgery? J Int Med Res 2011; 39:1497-503. [DOI: 10.1177/147323001103900439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated 151 patients undergoing cardiac surgery to determine whether measurement of regional cerebral oxygen saturation (rScO2) using near-infrared spectroscopy (NIRS) can indicate a low haematocrit after initiation of hypothermic cardiopulmonary bypass (CPB). Haematocrit, rScO2, haemoglobin level, arterial partial pressures of carbon dioxide and oxygen, systemic blood pressure, and nasopharyngeal and rectal temperatures were determined 5 min after the initial administration of heparin for CPB and 90 s after completion of the first cardioplegic solution injection. Immediately after initiation of hypothermic CPB, rScO2, haemoglobin and haematocrit values were significantly lower than those before CPB. No significant correlations were found between the change in haematocrit and changes in left, right and mean rScO2; thus, changes in rScO2 before and after initiation of hypothermic CPB did not reflect changes in haematocrit values. This indicates that NIRS cannot provide early warning of a low haematocrit immediately after initiation of hypothermic CPB in cardiac surgery.
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Affiliation(s)
- TY Sung
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - WS Kang
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - SJ Han
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - JS Kim
- Department of Cardiovascular and Thoracic Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - HK Chee
- Department of Cardiovascular and Thoracic Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - JK Shin
- Department of Cardiovascular and Thoracic Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - SH Kim
- Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Republic of Korea
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8
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Canova D, Roatta S, Bosone D, Micieli G. Inconsistent detection of changes in cerebral blood volume by near infrared spectroscopy in standard clinical tests. J Appl Physiol (1985) 2011; 110:1646-55. [PMID: 21474700 DOI: 10.1152/japplphysiol.00003.2011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The attractive possibility of near infrared spectroscopy (NIRS) to noninvasively assess cerebral blood volume and oxygenation is challenged by the possible interference from extracranial tissues. However, to what extent this may affect cerebral NIRS monitoring during standard clinical tests is ignored. To address this issue, 29 healthy subjects underwent a randomized sequence of three maneuvers that differently affect intra- and extracranial circulation: Valsalva maneuver (VM), hyperventilation (HV), and head-up tilt (HUT). Putative intracranial ("i") and extracranial ("e") NIRS signals were collected from the forehead and from the cheek, respectively, and acquired together with cutaneous plethysmography at the forehead (PPG), cerebral blood velocity from the middle cerebral artery, and arterial blood pressure. Extracranial contribution to cerebral NIRS monitoring was investigated by comparing Beer-Lambert (BL) and spatially resolved spectroscopy (SRS) blood volume indicators [the total hemoglobin concentration (tHb) and the total hemoglobin index, (THI)] and by correlating their changes with changes in extracranial circulation. While THIe and tHbe generally provided concordant indications, tHbi and THIi exhibited opposite-sign changes in a high percentage of cases (VM: 46%; HV: 31%; HUT: 40%). Moreover, tHbi was correlated with THIi only during HV (P < 0.05), not during VM and HUT, while it correlated with PPG in all three maneuvers (P < 0.01). These results evidence that extracranial circulation may markedly affect BL parameters in a high percentage of cases, even during standard clinical tests. Surface plethysmography at the forehead is suggested as complementary monitoring helpful in the interpretation of cerebral NIRS parameters.
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Affiliation(s)
- D Canova
- Neurovascular Laboratory, Istituto Di Ricovero e Cura a Carattere Scientifico, National Neurological Institute, C. Mondino Foundation, Pavia, [corrected] Italy.
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Diop M, Tichauer KM, Elliott JT, Migueis M, Lee TY, St Lawrence K. Comparison of time-resolved and continuous-wave near-infrared techniques for measuring cerebral blood flow in piglets. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:057004. [PMID: 21054120 DOI: 10.1117/1.3488626] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
A primary focus of neurointensive care is monitoring the injured brain to detect harmful events that can impair cerebral blood flow (CBF), resulting in further injury. Since current noninvasive methods used in the clinic can only assess blood flow indirectly, the goal of this research is to develop an optical technique for measuring absolute CBF. A time-resolved near-infrared (TR-NIR) apparatus is built and CBF is determined by a bolus-tracking method using indocyanine green as an intravascular flow tracer. As a first step in the validation of this technique, CBF is measured in newborn piglets to avoid signal contamination from extracerebral tissue. Measurements are acquired under three conditions: normocapnia, hypercapnia, and following carotid occlusion. For comparison, CBF is concurrently measured by a previously developed continuous-wave NIR method. A strong correlation between CBF measurements from the two techniques is revealed with a slope of 0.79±0.06, an intercept of -2.2±2.5 ml∕100 g∕min, and an R2 of 0.810±0.088. Results demonstrate that TR-NIR can measure CBF with reasonable accuracy and is sensitive to flow changes. The discrepancy between the two methods at higher CBF could be caused by differences in depth sensitivities between continuous-wave and time-resolved measurements.
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Affiliation(s)
- Mamadou Diop
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada N6A 4V2.
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10
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Durduran T, Choe R, Baker WB, Yodh AG. Diffuse Optics for Tissue Monitoring and Tomography. REPORTS ON PROGRESS IN PHYSICS. PHYSICAL SOCIETY (GREAT BRITAIN) 2010; 73:076701. [PMID: 26120204 PMCID: PMC4482362 DOI: 10.1088/0034-4885/73/7/076701] [Citation(s) in RCA: 561] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
This review describes the diffusion model for light transport in tissues and the medical applications of diffuse light. Diffuse optics is particularly useful for measurement of tissue hemodynamics, wherein quantitative assessment of oxy- and deoxy-hemoglobin concentrations and blood flow are desired. The theoretical basis for near-infrared or diffuse optical spectroscopy (NIRS or DOS, respectively) is developed, and the basic elements of diffuse optical tomography (DOT) are outlined. We also discuss diffuse correlation spectroscopy (DCS), a technique whereby temporal correlation functions of diffusing light are transported through tissue and are used to measure blood flow. Essential instrumentation is described, and representative brain and breast functional imaging and monitoring results illustrate the workings of these new tissue diagnostics.
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Affiliation(s)
- T Durduran
- ICFO- Institut de Ciències Fotòniques, Mediterranean Technology Park, 08860 Castelldefels (Barcelona), Spain
| | - R Choe
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - W B Baker
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - A G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
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11
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Maas AIR, Citerio G. Noninvasive monitoring of cerebral oxygenation in traumatic brain injury: a mix of doubts and hope. Intensive Care Med 2010; 36:1283-5. [PMID: 20502868 DOI: 10.1007/s00134-010-1921-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022]
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Schytz HW, Wienecke T, Jensen LT, Selb J, Boas DA, Ashina M. Changes in cerebral blood flow after acetazolamide: an experimental study comparing near-infrared spectroscopy and SPECT. Eur J Neurol 2009; 16:461-7. [PMID: 19236469 DOI: 10.1111/j.1468-1331.2008.02398.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE It is important to find a reliable and bedside method, which can estimate the cerebral blood flow (CBF) of patients in clinical settings. Estimation of CBF by calculating a blood flow index (BFI) using continuous wave near-infrared spectroscopy (CW-NIRS) and indocyanine green (ICG) as an i.v. tracer has been proposed to be a feasible and promising method. To validate if the BFI method can detect relative changes in CBF we compared data with the established method (133)Xenon single photon emission computer tomography ((133)Xe-SPECT). METHODS Ten healthy subjects were investigated before and after a bolus of acetazolamide. NIRS data were obtained using a multi source detector separation configuration in order to assess a corrected BFI (BFI(corr)) value, which attempts to eliminate contamination of skin blood flow. RESULTS Data obtained showed no significant correlation between CBF changes measured by (133)Xe-SPECT and BFI(corr) (0.133, P = 0.732). After acetazolamide, a 49% increase in CBF was detected using the (133)Xe-SPECT method, whereas no changes in any ICG variables were observed after acetazolamide. CONCLUSION The study shows that it is not possible to obtain reliable BFI data, which reflect changes in CBF after acetazolamide infusion, using the CW-NIRS and ICG method.
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Affiliation(s)
- H W Schytz
- Danish Headache Center and Department of Neurology Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark.
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Kakihana Y, Matsunaga A, Yasuda T, Imabayashi T, Kanmura Y, Tamura M. Brain oxymetry in the operating room: current status and future directions with particular regard to cytochrome oxidase. JOURNAL OF BIOMEDICAL OPTICS 2008; 13:033001. [PMID: 18601545 DOI: 10.1117/1.2940583] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Near-infrared spectroscopy (NIRS) is a cerebral monitoring method that noninvasively and continuously measures cerebral hemoglobin oxygenation and the redox state of cytochrome oxidase using highly tissue-permeable near-infrared light. This technique now has wide clinical application, and its usefulness in the measurement of cerebral hemoglobin oxygenation has been confirmed under global cerebral injury and/or hypoxemic hypoxia; however, regional cerebral infarction located far from the monitoring site may not be detected by NIRS. Furthermore, the specificity and accuracy of the measurement of the redox state of cytochrome oxidase remain controversial. We apply NIRS to both animal and clinical investigations. Based on these results, we discuss the significance of the measurement of cerebral hemoglobin oxygenation and cytochrome oxidase in vivo and in clinical medicine. Using our algorithm, cytochrome oxidase signals are unaffected by hemoglobin signals, even when hematocrit values change from 35 to 5% under cardiopulmonary bypass in a dog model. In the clinical study, cytochrome oxidase during surgery is likely to be a good (though not perfect) predictor of postoperative cerebral outcome. NIRS appears to be a promising technology, but additional investigations are required to establish its clinical efficacy and justify its routine use during operative and perioperative periods.
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Affiliation(s)
- Yasuyuki Kakihana
- Kagoshima University Hospital, Division of Intensive Care Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
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Wolf M, Ferrari M, Quaresima V. Progress of near-infrared spectroscopy and topography for brain and muscle clinical applications. JOURNAL OF BIOMEDICAL OPTICS 2007; 12:062104. [PMID: 18163807 DOI: 10.1117/1.2804899] [Citation(s) in RCA: 301] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This review celebrates the 30th anniversary of the first in vivo near-infrared (NIR) spectroscopy (NIRS) publication, which was authored by Professor Frans Jobsis. At first, NIRS was utilized to experimentally and clinically investigate cerebral oxygenation. Later it was applied to study muscle oxidative metabolism. Since 1993, the discovery that the functional activation of the human cerebral cortex can be explored by NIRS has added a new dimension to the research. To obtain simultaneous multiple and localized information, a further major step forward was achieved by introducing NIR imaging (NIRI) and tomography. This review reports on the progress of the NIRS and NIRI instrumentation for brain and muscle clinical applications 30 years after the discovery of in vivo NIRS. The review summarizes the measurable parameters in relation to the different techniques, the main characteristics of the prototypes under development, and the present commercially available NIRS and NIRI instrumentation. Moreover, it discusses strengths and limitations and gives an outlook into the "bright" future.
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Affiliation(s)
- Martin Wolf
- University Hospital Zurich, Clinic of Neonatology, Biomedical Optics Research Laboratory, 8091 Zurich, Switzerland.
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15
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Hashimoto K, Uruma G, Abo M. Activation of the prefrontal cortex during the wisconsin card sorting test (Keio Version) as measured by two-channel near-infrared spectroscopy in patients with traumatic brain injury. Eur Neurol 2007; 59:24-30. [PMID: 17917454 DOI: 10.1159/000109257] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 03/28/2007] [Indexed: 11/19/2022]
Abstract
To investigate brain activation in the prefrontal cortex (PFC) during the Wisconsin Card Sorting Test (Keio Version) (KWCST), we examined changes in total hemoglobin volume (THV) in 8 patients with traumatic brain injury (TBI) and 20 healthy control subjects using two-channel near-infrared spectroscopy. As a result, average THV in the right PFC during KWCST in TBI patients (-0.131 +/- 0.127) was significantly lower than in control subjects (0.016 +/- 0.135) (2 x 3 ANOVA; p < 0.05). These results demonstrated that the TBI patients had lower circulation of hemoglobin in the right PFC during the KWCST than the control subjects.
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Affiliation(s)
- Keiji Hashimoto
- Department of Rehabilitation Medicine, Jikei University School of Medicine, Tokyo, Japan.
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16
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Springett R, Swartz HM. Measurements of oxygen in vivo: overview and perspectives on methods to measure oxygen within cells and tissues. Antioxid Redox Signal 2007; 9:1295-301. [PMID: 17576162 DOI: 10.1089/ars.2007.1620] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Spahn G, Plettenberg H, Nagel H, Kahl E, Klinger HM, Mückley T, Günther M, Hofmann GO, Mollenhauer JA. Evaluation of cartilage defects with near-infrared spectroscopy (NIR): an ex vivo study. Med Eng Phys 2007; 30:285-92. [PMID: 17553725 DOI: 10.1016/j.medengphy.2007.04.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Revised: 04/16/2007] [Accepted: 04/24/2007] [Indexed: 10/23/2022]
Abstract
Damaged cartilage undergoes complex changes in composition, histological structure, and mechanical properties. Near-infrared-spectroscopy (NIR spectroscopy) is an important method to measure changes in composition of complex composites. The present study was aimed at evaluating NIR spectroscopy as a means to quantitate tissue alterations in low grade cartilage defects. Fresh medial femoral condyles from female sheep were collected. Cartilage defects were graded according to the International Cartilage Repair Society (ICRS). Specimens were examined by a NIR spectroscopy device (spectral range of 1100-1700 nm). Absorption spectra were calculated from the reference and measurement spectra. As indicator for cartilage composition the ratio (absorption ratio, AR) of the two main absorption bands in this region was calculated. Mechanical stiffness was measured as Shore A. Water-, glycosaminoglycan-, and collagen content and histological grade (Mankin score) were determined. The NIR absorption in ICRS grade 1 defects (AR=2.1+/-0.1) was significantly higher than in intact cartilage (AR=1.5+/-0.1). ICRS grade 2 specimens tended to a higher NIR absorption. NIR absorption correlated significantly with Mankin score (R=0.896), water content (R=0.845), and mechanical stiffness (R=0.877). Initial cartilage degeneration correlates with changes in NIR absorption, indicating NIR spectroscopy to reflect complex structural changes in degenerated cartilage. The data suggest that NIR spectroscopy could be useful for in situ detection of early cartilage defects.
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Affiliation(s)
- Gunter Spahn
- Center of Traumatology and Orthopaedic Surgery, Eisenach Sophienstrasse 16, Eisenach, Germany.
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Haitsma IK, Maas AIR. Monitoring cerebral oxygenation in traumatic brain injury. PROGRESS IN BRAIN RESEARCH 2007; 161:207-16. [PMID: 17618979 DOI: 10.1016/s0079-6123(06)61014-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Ischemia is a common problem after traumatic brain injury (TBI) that eludes detection with standard monitoring. In this review we will discuss four available techniques (SjVO2, PET, NIRS and PbrO2) to monitor cerebral oxygenation. We present technical data including strengths and weaknesses of these systems, information from clinical studies and formulate a vision for the future.
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Affiliation(s)
- Iain K Haitsma
- Department of Neurosurgery, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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