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Lian C, Li P, Wang N, Lu Y, Shangguan W. Comparison of basic regional cerebral oxygen saturation values in patients of different ages: a pilot study. J Int Med Res 2021; 48:300060520936868. [PMID: 32833525 PMCID: PMC7448148 DOI: 10.1177/0300060520936868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To explore the basic values of regional cerebral oxygen saturation (rSO2) among different age groups. Methods One hundred twenty patients who were scheduled for elective surgery aged 0 to 80 years (American Society of Anesthesiologists [ASA] physical status I or II) or neonates just after birth via cesarean section were enrolled and divided into the following six groups: infant (0 month and ≤12 months), toddler (>1 and ≤3 years old), preschool (>3 and ≤6 years old), school age (>6 and ≤18 years old), adult (>18 and ≤65 years old), and elderly (>65 and ≤80 years old) groups. There were 20 patients in each group. Results The basic values of rSO2 in infant, toddler, preschool, school age, adults, and elderly groups were 70.41% ± 4.66%, 72.43% ± 3.81%, 70.77% ± 3.27%, 70.62% ± 2.20%, 69.76% ± 6.02%, and 62.69% ± 3.14%, respectively. The basic value in the elderly group was lower compared with other five groups. There was no significant difference among infant, toddler, preschool age, school age, and adult groups. Conclusions The basic value of rSO2 in elderly patients is lower. Age is an important factor that affects the underlying value of rSO2.
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Affiliation(s)
- Chaohui Lian
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peng Li
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ning Wang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Lu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wangning Shangguan
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Gerdessen L, Meybohm P, Choorapoikayil S, Herrmann E, Taeuber I, Neef V, Raimann FJ, Zacharowski K, Piekarski F. Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis. J Clin Monit Comput 2020; 35:245-258. [PMID: 32815042 PMCID: PMC7943515 DOI: 10.1007/s10877-020-00579-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
Estimating intraoperative blood loss is one of the daily challenges for clinicians. Despite the knowledge of the inaccuracy of visual estimation by anaesthetists and surgeons, this is still the mainstay to estimate surgical blood loss. This review aims at highlighting the strengths and weaknesses of currently used measurement methods. A systematic review of studies on estimation of blood loss was carried out. Studies were included investigating the accuracy of techniques for quantifying blood loss in vivo and in vitro. We excluded nonhuman trials and studies using only monitoring parameters to estimate blood loss. A meta-analysis was performed to evaluate systematic measurement errors of the different methods. Only studies that were compared with a validated reference e.g. Haemoglobin extraction assay were included. 90 studies met the inclusion criteria for systematic review and were analyzed. Six studies were included in the meta-analysis, as only these were conducted with a validated reference. The mixed effect meta-analysis showed the highest correlation to the reference for colorimetric methods (0.93 95% CI 0.91–0.96), followed by gravimetric (0.77 95% CI 0.61–0.93) and finally visual methods (0.61 95% CI 0.40–0.82). The bias for estimated blood loss (ml) was lowest for colorimetric methods (57.59 95% CI 23.88–91.3) compared to the reference, followed by gravimetric (326.36 95% CI 201.65–450.86) and visual methods (456.51 95% CI 395.19–517.83). Of the many studies included, only a few were compared with a validated reference. The majority of the studies chose known imprecise procedures as the method of comparison. Colorimetric methods offer the highest degree of accuracy in blood loss estimation. Systems that use colorimetric techniques have a significant advantage in the real-time assessment of blood loss.
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Affiliation(s)
- Lara Gerdessen
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.,Department of Anaesthesia and Critical Care, University Hospital Würzburg, Würzburg, Germany
| | - Suma Choorapoikayil
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, Department of Medicine, Goethe University, Frankfurt, Germany
| | - Isabel Taeuber
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Vanessa Neef
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Florian J Raimann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Florian Piekarski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Abstract
Transfusion decision making (TDM) in the critically ill requires consideration of: (1) anemia tolerance, which is linked to active pathology and to physiologic reserve, (2) differences in donor RBC physiology from that of native RBCs, and (3) relative risk from anemia-attributable oxygen delivery failure vs hazards of transfusion, itself. Current approaches to TDM (e.g. hemoglobin thresholds) do not: (1) differentiate between patients with similar anemia, but dissimilar pathology/physiology, and (2) guide transfusion timing and amount to efficacy-based goals (other than resolution of hemoglobin thresholds). Here, we explore approaches to TDM that address the above gaps.
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Affiliation(s)
- Chris Markham
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, McDonnell Pediatric Research Building, Campus Box 8208, 660 South Euclid Avenue, St Louis, MO 63110-1093, USA
| | - Sara Small
- Social Systems Design Laboratory, Brown School of Social Work, Washington University, Campus Box 1196, 1 Brookings Drive, St Louis, MO 63130, USA
| | - Peter Hovmand
- Social Systems Design Laboratory, Brown School of Social Work, Washington University, Campus Box 1196, 1 Brookings Drive, St Louis, MO 63130, USA
| | - Allan Doctor
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, McDonnell Pediatric Research Building, Campus Box 8208, 660 South Euclid Avenue, St Louis, MO 63110-1093, USA.
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Edmonds HL, Ganzel BL, Austin EH. Cerebral Oximetry for Cardiac and Vascular Surgery. Semin Cardiothorac Vasc Anesth 2017; 8:147-66. [PMID: 15248000 DOI: 10.1177/108925320400800208] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The technology of transcranial near-infrared spectroscopy (NIRS) for the measurement of cerebral oxygen balance was introduced 25 years ago. Until very recently, there has been only occasional interest in its use during surgical monitoring. Now, however, substantial technologic advances and numerous clinical studies have, at least partly, succeeded in overcoming long-standing and widespread misunderstanding and skepticism regarding its value. Our goals are to clarify common misconceptions about near-infrared spectroscopy and acquaint the reader with the substantial literature that now supports cerebral oximetric monitoring in cardiac and major vascular surgery.
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Affiliation(s)
- Harvey L Edmonds
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, Kentucky 40202-3619, USA.
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5
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Duret J, Pottecher J, Bouzat P, Brun J, Harrois A, Payen JF, Duranteau J. Skeletal muscle oxygenation in severe trauma patients during haemorrhagic shock resuscitation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:141. [PMID: 25882441 PMCID: PMC4391580 DOI: 10.1186/s13054-015-0854-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 03/03/2015] [Indexed: 02/07/2023]
Abstract
Introduction Early alterations in tissue oxygenation may worsen patient outcome following traumatic haemorrhagic shock. We hypothesized that muscle oxygenation measured using near-infrared spectroscopy (NIRS) on admission could be associated with subsequent change in the SOFA score after resuscitation. Methods The study was conducted in two Level I trauma centres and included 54 consecutive trauma patients with haemorrhagic shock, presenting within 6 hours of injury. Baseline tissue haemoglobin oxygen saturation (StO2) in the thenar eminence muscle and StO2 changes during a vascular occlusion test (VOT) were determined at 6 hours (H6) and 72 hours (H72) after the admission to the emergency room. Patients showing an improved SOFA score at H72 (SOFA improvers) were compared to those for whom it was unchanged or worse (SOFA non-improvers). Results Of the 54 patients, 34 patients were SOFA improvers and 20 SOFA non-improvers. They had comparable injury severity scores on admission. SOFA improvers had higher baseline StO2 values and a steeper StO2 desaturation slope at H6 compared to the SOFA non-improvers. These StO2 variables similarly correlated with the intra-hospital mortality. The StO2 reperfusion slope at H6 was similar between the two groups of patients. Conclusions Differences in StO2 parameters on admission of traumatic haemorrhagic shock were found between patients who had an improvement in organ failure in the first 72 hours and those who had unchanged or worse conditions. The use of NIRS to guide the initial management of trauma patients with haemorrhagic shock warrants further investigations.
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Affiliation(s)
- Jerome Duret
- Pole Anesthésie-Réanimation, Hôpital Michallon, Boulevard de la Chantourne, Grenoble, F-38043, France.
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Pôle Anesthésie Réanimation Chirurgicale SAMU, Hôpital de Hautepierre, Service d'Anesthésie-Réanimation Chirurgicale, 1 avenue Molière, F-67098, Strasbourg, France. .,Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Institut de Physiologie, Equipe d'Accueil EA3072 "Mitochondrie, stress oxydant et protection musculaire", 11 rue Humann, F-67000, Strasbourg, France.
| | - Pierre Bouzat
- Pole Anesthésie-Réanimation, Hôpital Michallon, Boulevard de la Chantourne, Grenoble, F-38043, France. .,Université Joseph Fourier, Grenoble Institut des Neurosciences, 6 rue Jules Horowitz, Grenoble, F-38043, France. .,INSERM, U836, Chemin Fortuné Ferrini, Grenoble, F-38042, France.
| | - Julien Brun
- Pole Anesthésie-Réanimation, Hôpital Michallon, Boulevard de la Chantourne, Grenoble, F-38043, France.
| | - Anatole Harrois
- AP-HP, Service d' Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre, 78, rue du Général Leclerc, F-94275, Le Kremlin-Bicêtre, France. .,Laboratoire d'Etude de la Microcirculation, "Bio-CANVAS: Biomarqueurs in CardiaNeuroVascular Diseases" UMRS 942, 2 Rue Ambroise-Paré, 75010, Paris, France.
| | - Jean-Francois Payen
- Pole Anesthésie-Réanimation, Hôpital Michallon, Boulevard de la Chantourne, Grenoble, F-38043, France. .,Université Joseph Fourier, Grenoble Institut des Neurosciences, 6 rue Jules Horowitz, Grenoble, F-38043, France. .,INSERM, U836, Chemin Fortuné Ferrini, Grenoble, F-38042, France.
| | - Jacques Duranteau
- AP-HP, Service d' Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre, 78, rue du Général Leclerc, F-94275, Le Kremlin-Bicêtre, France. .,Laboratoire d'Etude de la Microcirculation, "Bio-CANVAS: Biomarqueurs in CardiaNeuroVascular Diseases" UMRS 942, 2 Rue Ambroise-Paré, 75010, Paris, France.
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Desebbe O, Faulcon C, Henaine R, Tran L, Koffel C, Delannoy B, Lehot JJ, Bastien O, Maucort-Boulch D. Tissue Hemoglobin Monitoring Is Unable to Follow Variations of Arterial Hemoglobin During Transitions From Pulsatile to Constant Flow in Cardiac Surgery. J Cardiothorac Vasc Anesth 2014; 28:668-73. [DOI: 10.1053/j.jvca.2013.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Indexed: 11/11/2022]
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Changes in regional tissue oxygenation saturation and desaturations after red blood cell transfusion in preterm infants. J Perinatol 2013; 33:282-7. [PMID: 22935773 DOI: 10.1038/jp.2012.108] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study investigated the ability of near-infrared spectroscopy (NIRS) to detect subgroups of preterm infants who benefit most from red blood cell (RBC) transfusion in regard to cerebral/renal tissue oxygenation (i) and the number of general oxygen desaturation below 80% (SaO(2) <80%) (ii). STUDY DESIGN Cerebral regional (crSO(2)) and peripheral regional (prSO(2)) NIRS parameters were recorded before, during, immediately after and 24 h after transfusion in 76 infants. Simultaneously, SaO(2) <80% were recorded by pulse oximetry. To answer the basic question of the study, all preterm infants were divided into two subgroups according to their pretransfusion crSO(2) values (<55% and ≥55%). This cutoff was determined by a k-means clustering analysis. RESULT crSO(2) and prSO(2) increased significantly in the whole study population. A stronger increase (P<0.0005) of both was found in the subgroup with pretransfusion crSO(2) values <55%. Regarding the whole population, a significant decrease (P<0.05) of episodes with SaO(2) <80% was observed. The subgroup with crSO(2) baselines <55% had significant (P<0.05) more episodes with SaO(2) <80% before transfusion. During and after transfusion, the frequency of episodes with SaO(2) <80% decreased more in this group compared with the group with crSO(2) baselines ≥55%. CONCLUSION NIRS measurement is a simple, non-invasive method to monitor regional tissue oxygenation and the efficacy of RBC transfusion. Infants with low initial NIRS values benefited most from blood transfusions regarding SaO(2) <80%, which may be important for their general outcome.
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8
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Kowalsky JM, France JL, Wissel ME, France CR. Effect of applied muscle tension on cerebral oxygenation in female blood donors. Transfusion 2011; 51:1802-8. [DOI: 10.1111/j.1537-2995.2011.03075.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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9
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Kim SH, Yoon TG, Kim TY, Kim HK, Sung WS. Cerebral oximetry monitoring during aortic arch aneurysm replacement surgery in Jehovah's Witness patient -A case report-. Korean J Anesthesiol 2010; 58:191-6. [PMID: 20498799 PMCID: PMC2872849 DOI: 10.4097/kjae.2010.58.2.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 09/25/2009] [Accepted: 10/06/2009] [Indexed: 11/30/2022] Open
Abstract
Anesthetic management for aortic arch aneurysm (AAA) surgery employing deep hypothermic circulatory arrest in a Jehovah's Witness (JW) patient is a challenge to anesthesiologist due to its complexity of procedures and their refusal of allogeneic transfusion. Even in the strict application of intraoperative acute normovolemic hemodilution (ANH) and intraopertive cell salvage (ICS) technique, prompt timing of re-administration of salvaged blood is essential for successful operation without allogeneic transfusion or ischemic complication of major organs. Cerebral oximetery (rSO(2)) monitoring using near infrared spectroscopy is a useful modality for detecting cerebral ischemia during the AAA surgery requiring direct interruption of cerebral flow. The present case showed that rSO(2) can be used as a trigger facilitating to find a better timing for the re-administration of salvaged blood acquired during the AAA surgery for JW patient.
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Affiliation(s)
- Seong-Hyop Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Tae-Gyoon Yoon
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Tae-Yop Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hae-Kyoung Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Woo-Sung Sung
- Department of Anesthesiology and Pain Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
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Tissue hemoglobin index: a non-invasive optical measure of total tissue hemoglobin. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13 Suppl 5:S2. [PMID: 19951386 PMCID: PMC2786104 DOI: 10.1186/cc8000] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The tissue hemoglobin index (THI) is a hemoglobin signal strength metric provided on the InSpectra StO2 Tissue Oxygenation Monitor, Model 650. There is growing interest regarding the physiologic meaning of THI and whether a clinically useful correlation between THI and blood hemoglobin concentration exists. A series of in vitro and in vivo experiments was performed to evaluate whether THI has potential utility beyond its primary purpose of helping InSpectra device users optimally position a StO2 sensor over muscle tissue. METHODS The THI and tissue hemoglobin oxygen saturation (StO2) were measured using the InSpectra StO2 Tissue Oxygenation Monitor, Model 650, with a 15 mm optical sensor. A THI normal reference range was established in the thenar eminence (hand) for 434 nonhospitalized human volunteers. In 30 subjects, the thenar THI was also evaluated during 5-minute arterial and venous blood flow occlusions, and with blood volume exsanguination in the hand induced with an Esmarch bandage. In addition, correlation of the THI to blood total hemoglobin concentration (Hbt) was studied in five pigs whose Hbt was isovolumetrically diluted from 13 to 4 g/dl systemically and 0.5 g/dl locally in the hind limb. The sensitivity and specificity of the THI to measure tissue hemoglobin concentration (THC) were characterized in vitro using isolated blood tissue phantoms. RESULTS In human thenar tissue, the average THI was 14.1 +/- 1.6 (mean +/- standard deviation). The THI extrapolated to 100% blood volume exsanguination was 3.7 +/- 2.0 units presumably from myoglobin. On average, the THI increased 1.5 +/- 1.0 units with venous occlusion and decreased 4.0 +/- 2.0 units with arterial occlusion. In porcine hind limbs, the THI weakly correlated with Hbt (r2 = 0.26) while DeltaTHI during venous occlusion had a stronger correlation (r2 = 0.62). In vitro tests indicated that THI strongly correlated (r2 > 0.99) to phantom THC and was insensitive to StO2 changes. CONCLUSIONS Steady-state THI values do not reliably indicate Hbt. The THI is a reproducible quantitative index for THC, and THI trends can discriminate between arterial or venous blood flow occlusions. The THI magnitude permits the estimation of myoglobin's contribution to StO2.
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Biggins PDE, Kusterbeck A, Hiltz JA. Bio-inspired approaches to sensing for defence and security applications. Analyst 2008; 133:563-70. [DOI: 10.1039/b717935a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Green DW. A retrospective study of changes in cerebral oxygenation using a cerebral oximeter in older patients undergoing prolonged major abdominal surgery. Eur J Anaesthesiol 2007; 24:230-4. [PMID: 17054814 DOI: 10.1017/s0265021506001645] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2006] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective was to carry out a retrospective study of changes in regional cerebral oxygen saturation (rSO2) using the Somanetics Invos Cerebral Oximeter (SICO) in older patients undergoing prolonged major abdominal surgery. Since evidence is accumulating that detection and correction of falls in rSO2 may be associated with a reduced incidence of postoperative cognitive dysfunction, the study assessed the incidence and possible predisposing factors for significant falls in rSO2 and strategies for correction. METHODS Data from 46 consecutive patients aged 55 yr or above undergoing major abdominal surgery were collected and studied. A SICO electrode was placed over the right forehead prior to commencement of anaesthesia and values of rSO2 were recorded automatically on a floppy disk at 20 s intervals throughout the procedure and until transfer of the patient to the postanaesthesia care unit. Anaesthesia and physiological data were routinely collected by the author on an anaesthetic record computer and transferred to an Excel spreadsheet for analysis. RESULTS Average duration of the surgery exceeded 7 h. Average blood loss was 1363 mL (interquartile range 500-2000). In 11 of the 46 patients the rSO2 drop exceeded 20%, and in six, there was a significant temporal association of rSO2 drop with ongoing major haemorrhage. In 23 of the 46 patients, a maximum drop in rSO2 occurred, which was about 15% or more. Fall in rSO2 in the 46 patients significantly correlated with blood loss (P < 0.05) and percentage fall in haemoglobin (Hb) (P = 0.01) but not with lowest Hb. Despite maintenance of conventional haemodynamic parameters such as systolic blood pressure (BP) in most patients, the fall in rSO2 seemed only reversible by blood transfusion. In five of the six patients who experienced the greatest decline in rSO2 during haemorrhage, there was no correlation between fall in rSO2 and systolic BP. CONCLUSIONS This retrospective study confirms that a significant reduction in rSO2 is a common accompaniment to prolonged major abdominal surgery in elderly patients, especially if associated with blood loss, and is correctable by blood transfusion. In most cases, these changes would have gone unnoticed with conventional monitoring.
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Affiliation(s)
- D W Green
- King's College Hospital NHS Trust, Intensive Care and Pain Relief, Department of Anaesthetics, Denmark Hill, London, UK.
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Lee J, Saltzman DJ, Cerussi AE, Gelfand DV, Milliken J, Waddington T, Tromberg BJ, Brenner M. Broadband diffuse optical spectroscopy measurement of hemoglobin concentration during hypovolemia in rabbits. Physiol Meas 2006; 27:757-67. [PMID: 16772673 DOI: 10.1088/0967-3334/27/8/009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Serial blood draws for the assessment of trauma patients' hemoglobin (sHgb) and hematocrit (sHct) is standard practice. A device that would allow for continuous real-time, non-invasive monitoring of hemoglobin and tissue perfusion would potentially improve recognition, monitoring and resuscitation of blood loss. We developed a device utilizing diffuse optical spectroscopy (DOS) technology that simultaneously measures tissue scattering and near-infrared (NIR) absorption to obtain non-invasive measurements of oxy- (Hb-O(2)), deoxyhemoglobin (Hb-R) concentrations and tissue hemoglobin concentration (THC) in an animal model of hypovolemic shock induced by successive blood withdrawals. Intubated New Zealand White rabbits (N = 16) were hemorrhaged via a femoral arterial line every 20 min until a 20% blood loss (10-15 cc kg(-1)) was achieved to attain hypovolemia. A broadband DOS probe placed on the inner thigh was used to measure muscle concentrations of Hb-O(2) and Hb-R, during blood withdrawal. THC and tissue hemoglobin saturation (S(T)O(2)) were calculated from DOS [Hb-O(2)] and [Hb-R]. Broadband DOS-measured values were compared against traditional invasive measurements: systemic sHgb, arterial oxygen saturation (S(a)O(2)) and venous oxygen saturation (S(v)O(2)) drawn from arterial and central venous blood. DOS and traditional invasive measurements versus blood loss were closely correlated (r(2) = 0.96) showing a decline with removal of blood. S(T)O(2) and [Hb-O(2)] followed similar trends with hemorrhage, while [Hb-R] remained relatively constant. These measurements may be limited to some extent by the inability to distinguish between hemoglobin and myoglobin contributions to DOS signals in tissue at this time. Broadband DOS provides a potential platform for reliable non-invasive measurements of tissue oxygenated and deoxygenated hemoglobin and may accurately reflect the degree of systemic hypovolemia and compromised tissue perfusion.
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Affiliation(s)
- Jangwoen Lee
- Beckman Laser Institute, University of California, Irvine, CA 92612, USA.
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France CR, France JL, Patterson SM. Blood pressure and cerebral oxygenation responses to skeletal muscle tension: a comparison of two physical maneuvers to prevent vasovagal reactions. Clin Physiol Funct Imaging 2006; 26:21-5. [PMID: 16398666 DOI: 10.1111/j.1475-097x.2005.00642.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The present study compared blood pressure, heart rate, and cerebral oxygenation responses to two manipulations used to prevent vasovagal reaction -- skeletal muscle tensing alone and skeletal muscle tensing with leg crossing. METHODS AND RESULTS Using a repeated measures within-subjects design, healthy young adults engaged in a brief laboratory protocol that included an initial 3 min resting baseline, 3 min of muscle tensing (or no-tensing control), and a 1 min orthostatic challenge. This sequence was repeated three times for each participant to allow for a direct comparison of physiological responses to two different muscle-tensing manipulations as compared to the no-tensing control condition. Results indicated that, relative to the no-tensing, both muscle tensing manipulations elicited significant increases in systolic blood pressure (8.7 +/- 1.1 mmHg), diastolic blood pressure (4.9 +/- 0.6 mmHg), and heart rate (10.9 +/- 0.9 bpm), while a significant increase in cerebral oxygenation was only observed in response to muscle tensing with legs crossed (0.8 +/- 0.2%). Blood pressure and heart rate responses to orthostatic challenge did not differ between the two tensing manipulations, although muscle tensing with legs crossed was followed by a more rapid recovery of cerebral oxygenation levels. CONCLUSION These findings suggest that muscle tensing elicits physiological adaptations that may help reduce the risk of vasovagal reactions; however, the combination of lower body tension with the legs crossed is likely to be most effective as it was uniquely associated with significant increases in the flow of oxygenated blood to the brain.
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Affiliation(s)
- C R France
- Department of Psychology, Porter Hall, Ohio University, Athens, 45701, USA.
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Pattinson KTS, Imray CHE, Wright AD. What does cerebral oximetry measure? Br J Anaesth 2005; 94:863; author reply 863-4. [PMID: 15878895 DOI: 10.1093/bja/aei558] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gagnon RE, Macnab AJ, Gagnon FA, Blackstock D, LeBlanc JG. Comparison of two spatially resolved NIRS oxygenation indices. J Clin Monit Comput 2004; 17:385-91. [PMID: 14650633 DOI: 10.1023/a:1026274124837] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
UNLABELLED We compared the percentage haemoglobin oxygenation indices from two near infrared spectrophotometers (NIRS) to determine whether the devices reported similar changes in response to induced changes in oxygenation. METHODS 24 healthy juvenile swine undergoing cardiac bypass surgery had INVOS 5100 and NIRO-300 sensors applied to the brow. Induced events included circulatory arrest, altered blood flow rate, core cooling, and re-warming. RESULTS The average data collection was 4 hours 36 minutes and had an r = 0.82 mean correlation between the INVOS and NIRO. The total resting baseline collection from all trials (8,590 pairs) had a correlation of r = 0.62. The average relationship between the INVOS and NIRO was non-linear: an INVOS regional oxygen saturation index (rSO2) of 0% was equivalent to a NIRO tissue oxygenation index (TOI) of 36.2%; values were equal at 56.8%; and an (rSO2) of 100% was equivalent to a TOI 85.9%. There was good or excellent agreement (r > 0.5) between the (rSO2) and TOI patterns of change during induced events in 96% of trials. The INVOS and NIRO were most closely correlated when an attenuation filter was used to obtain identical emitter/detector separations. CONCLUSIONS There was close agreement between the INVOS 5100 and NIRO-300 in response to major physiological change, although absolute values of (rSO2) and TOI were not identical. There was less agreement during baseline measurements or minimal physiologic change.
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Affiliation(s)
- Roy E Gagnon
- Department of Pediatrics, Children's & Women's Health Centre, University of British Columbia, Vancouver, Canada.
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Menke J, Stöcker H, Sibrowski W. Cerebral oxygenation and hemodynamics during blood donation studied by near-infrared spectroscopy. Transfusion 2004; 44:414-21. [PMID: 14996201 DOI: 10.1111/j.1537-2995.2003.00663.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Blood donation is a safe human model for acute blood loss. This study investigated associated changes in regional cerebral oxygenation and cerebral blood volume (CBV) by near-infrared spectroscopy (NIRS). STUDY DESIGN AND METHODS Fifty healthy blood donors donated 450 mL of whole blood within 4 to 9 minutes. Changes in regional cerebral oxygen saturation (rSO2) and cerebral tissue Hb concentration (HbT) were semiquantitatively measured by NIRS. Venous Hb concentration was measured before and after blood donation. The predonation and postdonation CBV was estimated from HbT and venous Hb concentration. Differences between pre- and postdonation study parameters were analyzed by paired t tests (p < 0.05). RESULTS Within the study group, rSO2 decreased by 0.44 sat percent (p < 0.01) on average during blood donation, which is still within the range of individual physiologic baseline variation. The average venous Hb concentration decreased significantly by 4.6 percent, whereas HbT increased significantly by 2.5 percent and CBV increased even by 7.5 percent on average. CONCLUSION The increase in CBV indicates cerebral vasodilation, which seems to be the major compensation mechanism during acute blood loss. The decrease in rSO2 was relatively small, indicating that cerebral oxygenation was maintained within the physiologic range.
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Affiliation(s)
- J Menke
- Department of Transfusion Medicine, University Hospital, 48149 Münster, Germany.
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Kishi K, Kawaguchi M, Yoshitani K, Nagahata T, Furuya H. Influence of Patient Variables and Sensor Location on Regional Cerebral Oxygen Saturation Measured by INVOS 4100 Near-Infrared Spectrophotometers. J Neurosurg Anesthesiol 2003; 15:302-6. [PMID: 14508170 DOI: 10.1097/00008506-200310000-00002] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cerebral oximeter based on near-infrared spectroscopy has been used as a continuous, noninvasive monitoring of regional cerebral oxygen saturation (rSO2). Although the absolute rSO2 values have a wide range of variability, the factors affecting a variability of rSO2 values have not been extensively investigated. The authors investigated the influence of patient variables and sensor location on rSO2 measured by the cerebral oximeter INVOS 4100 in 111 patients anesthetized with sevoflurane, fentanyl, and nitrous oxide in oxygen. The sensors for rSO2 measurements were applied on the right forehead (R), 1 cm lateral to R (R1), on the left forehead (L), 1 cm lateral to L (L1), and on the center of the forehead (C). The relationship between the rSO2 values and patient variables were also analyzed. Values of rSO2 at R1 and L1 were significantly lower than those at R and L, respectively. Values of rSO2 at C were significantly higher compared with those at other sites. There were no significant correlations between the rSO2 values and values of weight, height, and head size. Values of rSO2 were similar between males and females. A significant negative correlation between the rSO2 values and age and a positive correlation between the rSO2 values and hemoglobin concentration were observed. These data indicate that patient age, hemoglobin concentration at the measurement, and sensor location can affect rSO2 values.
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Affiliation(s)
- Katsuyoshi Kishi
- Departments of Anesthesiology, Bell Land General Hospital, Osaka, Japan
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