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Wu Y, Xu Z, Ge W, Zhang X, Zheng L, Ning X, Ni X. Study on cerebral oxygen saturation in children with sleep-disordered breathing. J Sleep Res 2024:e14366. [PMID: 39394853 DOI: 10.1111/jsr.14366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/28/2024] [Accepted: 09/16/2024] [Indexed: 10/14/2024]
Abstract
To explore the association between the severity of sleep-disordered breathing, different types of respiratory events, peripheral oxygen saturation (SpO2), age and sleep stage on cerebral oxygen saturation (rSO2) in children. We enrolled children aged 4-14 years who were treated for snoring or mouth breathing at the Sleep Center of Beijing Children's Hospital, from February 2022 to July 2022. All children completed polysomnography, and SpO2, rSO2, and heart rate (HR) were recorded synchronously. A total of 70 children were included, including 16 (22.9%) with primary snoring, 38 (54.3%) with mild obstructive sleep apnea (OSA), and 16 (22.9%) with moderate-to-severe OSA. There were no significant differences in the mean rSO2 or minimum rSO2 among the primary snoring, mild OSA, and moderate-to-severe OSA groups (all p > 0.05). A total of 1119 respiratory events were included in the analysis. Regardless of the type of respiratory event, rSO2 and HR changes occur prior to fluctuations in SpO2. A mixed-effects model showed that ΔrSO2 was positively correlated with ΔSpO2, duration of respiratory event, mixed and obstructive apnea, central apnea, while negatively correlated with age and rapid eye movement (REM) sleep stage (all p < 0.05). Larger rSO2 fluctuations were impacted by a greater ΔSpO2, longer duration of respiratory events, younger age, apnea-related respiratory events and non-REM sleep stage. Thus, sleep disordered breathing in younger children warrants more attention. More research is needed to determine whether REM sleep has special protective effects on rSO2.
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Affiliation(s)
- Yunxiao Wu
- School of Instrumentation Science and Optoelectronic Engineering, Beihang University, Beijing, China
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhifei Xu
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, China National Clinical Research Center of Respiratory Diseases, National Center for Children's Health, Beijing, China
| | - Wentong Ge
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Zhang
- Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Li Zheng
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaolin Ning
- School of Instrumentation Science and Optoelectronic Engineering, Beihang University, Beijing, China
- Key Laboratory of Ultra-Weak Magnetic Field Measurement Technology, Ministry of Education, School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
- Institute of Large-Scale Scientific Facility and Centre for Zero Magnetic Field Science, Beihang University, Hangzhou, China
- National Institute of Extremely-Weak Magnetic Field Infrastructure, Hangzhou, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Zavriyev AI, Kaya K, Wu KC, Pierce ET, Franceschini MA, Robinson MB. Measuring pulsatile cortical blood flow and volume during carotid endarterectomy. BIOMEDICAL OPTICS EXPRESS 2024; 15:1355-1369. [PMID: 38495722 PMCID: PMC10942688 DOI: 10.1364/boe.507730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 03/19/2024]
Abstract
Carotid endarterectomy (CEA) involves removal of plaque in the carotid artery to reduce the risk of stroke and improve cerebral perfusion. This study aimed to investigate the utility of assessing pulsatile blood volume and flow during CEA. Using a combined near-infrared spectroscopy/diffuse correlation spectroscopy instrument, pulsatile hemodynamics were assessed in 12 patients undergoing CEA. Alterations to pulsatile amplitude, pulse transit time, and beat morphology were observed in measurements ipsilateral to the surgical side. The additional information provided through analysis of pulsatile hemodynamic signals has the potential to enable the discovery of non-invasive biomarkers related to cortical perfusion.
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Affiliation(s)
- Alexander I. Zavriyev
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kutlu Kaya
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kuan Cheng Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric T. Pierce
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Angela Franceschini
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell B. Robinson
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Agrawal S, Abecasis F, Jalloh I. Neuromonitoring in Children with Traumatic Brain Injury. Neurocrit Care 2024; 40:147-158. [PMID: 37386341 PMCID: PMC10861621 DOI: 10.1007/s12028-023-01779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
Traumatic brain injury remains a major cause of mortality and morbidity in children across the world. Current management based on international guidelines focuses on a fixed therapeutic target of less than 20 mm Hg for managing intracranial pressure and 40-50 mm Hg for cerebral perfusion pressure across the pediatric age group. To improve outcome from this complex disease, it is essential to understand the pathophysiological mechanisms responsible for disease evolution by using different monitoring tools. In this narrative review, we discuss the neuromonitoring tools available for use to help guide management of severe traumatic brain injury in children and some of the techniques that can in future help with individualizing treatment targets based on advanced cerebral physiology monitoring.
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Affiliation(s)
- Shruti Agrawal
- Department of Paediatric Intensive Care, Cambridge University Hospitals National Health Service Foundation Trust, Level 3, Box 7, Addenbrookes Hospital Hills Road, Cambridge, UK.
- University of Cambridge, Cambridge, UK.
| | - Francisco Abecasis
- Paediatric Intensive Care Unit, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ibrahim Jalloh
- University of Cambridge, Cambridge, UK
- Department of Neurosurgery, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
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Contreras-Briceño F, Espinosa-Ramírez M, Rivera-Greene A, Guerra-Venegas C, Lungenstrass-Poulsen A, Villagra-Reyes V, Caulier-Cisterna R, Araneda OF, Viscor G. Monitoring Changes in Oxygen Muscle during Exercise with High-Flow Nasal Cannula Using Wearable NIRS Biosensors. BIOSENSORS 2023; 13:985. [PMID: 37998160 PMCID: PMC10669262 DOI: 10.3390/bios13110985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
Exercise increases the cost of breathing (COB) due to increased lung ventilation (V˙E), inducing respiratory muscles deoxygenation (∇SmO2), while the increase in workload implies ∇SmO2 in locomotor muscles. This phenomenon has been proposed as a leading cause of exercise intolerance, especially in clinical contexts. The use of high-flow nasal cannula (HFNC) during exercise routines in rehabilitation programs has gained significant interest because it is proposed as a therapeutic intervention for reducing symptoms associated with exercise intolerance, such as fatigue and dyspnea, assuming that HFNC could reduce exercise-induced ∇SmO2. SmO2 can be detected using optical wearable devices provided by near-infrared spectroscopy (NIRS) technology, which measures the changes in the amount of oxygen bound to chromophores (e.g., hemoglobin, myoglobin, cytochrome oxidase) at the target tissue level. We tested in a study with a cross-over design whether the muscular desaturation of m.vastus lateralis and m.intercostales during a high-intensity constant-load exercise can be reduced when it was supported with HFNC in non-physically active adults. Eighteen participants (nine women; age: 22 ± 2 years, weight: 65.1 ± 11.2 kg, height: 173.0 ± 5.8 cm, BMI: 21.6 ± 2.8 kg·m-2) were evaluated in a cycle ergometer (15 min, 70% maximum watts achieved in ergospirometry (V˙O2-peak)) breathing spontaneously (control, CTRL) or with HFNC support (HFNC; 50 L·min-1, fiO2: 21%, 30 °C), separated by seven days in randomized order. Two-way ANOVA tests analyzed the ∇SmO2 (m.intercostales and m.vastus lateralis), and changes in V˙E and ∇SmO2·V˙E-1. Dyspnea, leg fatigue, and effort level (RPE) were compared between trials by the Wilcoxon matched-paired signed rank test. We found that the interaction of factors (trial × exercise-time) was significant in ∇SmO2-m.intercostales, V˙E, and (∇SmO2-m.intercostales)/V˙E (p < 0.05, all) but not in ∇SmO2-m.vastus lateralis. ∇SmO2-m.intercostales was more pronounced in CTRL during exercise since 5' (p < 0.05). Hyperventilation was higher in CTRL since 10' (p < 0.05). The ∇SmO2·V˙E-1 decreased during exercise, being lowest in CTRL since 5'. Lower dyspnea was reported in HFNC, with no differences in leg fatigue and RPE. We concluded that wearable optical biosensors documented the beneficial effect of HFNC in COB due to lower respiratory ∇SmO2 induced by exercise. We suggest incorporating NIRS devices in rehabilitation programs to monitor physiological changes that can support the clinical impact of the therapeutic intervention implemented.
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Affiliation(s)
- Felipe Contreras-Briceño
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
- Millennium Institute for Intelligent Healthcare Engineering (iHEALTH), Av. Vicuña Mackenna #4860, Santiago 7820436, Chile
| | - Maximiliano Espinosa-Ramírez
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Augusta Rivera-Greene
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Camila Guerra-Venegas
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Antonia Lungenstrass-Poulsen
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Victoria Villagra-Reyes
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile; (M.E.-R.); (A.R.-G.); (C.G.-V.); (A.L.-P.); (V.V.-R.)
| | - Raúl Caulier-Cisterna
- Department of Informatics and Computing, Faculty of Engineering, Universidad Tecnológica Metropolitana, Av. José Pedro Alessandri #1242, Santiago 7800002, Chile;
| | - Oscar F. Araneda
- Laboratory of Integrative Physiology of Biomechanics and Physiology of Effort, Kinesiology School, Faculty of Medicine, Universidad de los Andes, Av. Monseñor Álvaro del Portillo 12455, Santiago 7620001, Chile;
| | - Ginés Viscor
- Secció de Fisiologia, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, Av. Diagonal #643, 08028 Barcelona, Spain;
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Guo F, Jia S, Wang Q, Liu Q, Hu M, Wang W, Liu S, Li Q, Lu B, Zheng Y. Which Predictor, SctO2 or SstO2, Is more Sensitive for Postoperative Cognitive Dysfunction in Spine Surgery: A Prospective Observational Study? Orthop Surg 2022; 15:276-285. [PMID: 36394155 PMCID: PMC9837245 DOI: 10.1111/os.13580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Patients undergoing spinal surgery in the prone position may experience venous stasis, often resulting in edema in dependent areas of the body, including the head, and increased postoperative cognitive dysfunction (POCD). Not only does POCD present challenges for post-operative care and recovery, it can also cause permanent damage to the patient's brain and increase mortality and social costs. We aimed to clarify the incidence of POCD in patients with hypertension after prone spine surgery and to further determine the association between intraoperative somatic tissue oxygen saturation (SstO2)/cerebral tissue oxygen saturation (SctO2) and POCD. METHODS Patients with hypertension scheduled for open prone spine surgery from January 2020 to April 2021 were included in this single-center, prospective, observational study. SctO2 and SstO2 were monitored by near-infrared spectroscopy continuously throughout the surgery. The primary outcome was POCD assessed using the Mini-Mental Status Examination (MMSE). The association of SstO2 and SctO2 with POCD was evaluated with unadjusted analyses and multivariable logistic regression. RESULTS One hundred and one of 112 identified patients were included, 28 (27.8%) of whom developed POCD. None of the investigated SctO2 indices were predictive of POCD. However, the patients with POCD had greater decreases in intraoperative absolute SstO2 and relative SstO2 than the patients without POCD (P = 0.037, P = 0.036). Moreover, three SstO2 indices were associated with POCD, including a greater absolute SstO2 decrease (P = 0.021), a greater relative SstO2 decrease (P = 0.032), and a drop below 90% of the baseline SstO2 (P = 0.002), independent of ASA III status, preoperative platelets and postoperative sepsis. In addition, there was no correlation between intraoperative SctO2 and intraoperative SstO2 or between their respective absolute declines. CONCLUSION Twenty-eight (27.7%) of 101 patients developed POCD in patients with hypertension undergoing prone spine surgery, and intraoperative SstO2 is associated with POCD, whereas SctO2 shows no association with POCD. This study may initially provide a valuable new approach to the prevention of POCD in this population.
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Affiliation(s)
- Fei Guo
- Department of AnesthesiologyZigong Fourth People's Hospital Affiliated to Southwest Medical UniversityZigongChina
| | - Shuaiying Jia
- Department of AnesthesiologyZigong Fourth People's Hospital Affiliated to Southwest Medical UniversityZigongChina,Department of AnesthesiologyThe Affiliated Hospital of North Sichuan Medical CollegeNanchongChina
| | - Qiyan Wang
- Department of AnesthesiologyZigong Fourth People's Hospital Affiliated to Southwest Medical UniversityZigongChina
| | - Qinyu Liu
- Translational Medicine Center, the Second Affiliated HospitalGuangzhou Medical UniversityGuangzhouChina
| | - Mingquan Hu
- Department of AnesthesiologyZigong Fourth People's Hospital Affiliated to Southwest Medical UniversityZigongChina
| | - Wenzhang Wang
- Department of AnesthesiologyZigong Fourth People's Hospital Affiliated to Southwest Medical UniversityZigongChina
| | - Shijian Liu
- Department of AnesthesiologyZigong Fourth People's Hospital Affiliated to Southwest Medical UniversityZigongChina
| | - Qiang Li
- Department of AnesthesiologyZigong Fourth People's Hospital Affiliated to Southwest Medical UniversityZigongChina
| | - Bin Lu
- Department of AnesthesiologyZigong Fourth People's Hospital Affiliated to Southwest Medical UniversityZigongChina
| | - Yeying Zheng
- Department of AnesthesiologyZigong Fourth People's Hospital Affiliated to Southwest Medical UniversityZigongChina
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6
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Onur T, Karaca Ü, Ata F, Sayan HE, Onur A, Yilmaz C, Balkaya AN, Eriş C. Intraoperative hyperoxygenation may negatively affect postoperative cognitive functions in coronary artery bypass graft operations: A randomized controlled study. J Card Surg 2022; 37:2552-2563. [PMID: 35678327 DOI: 10.1111/jocs.16661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 03/09/2022] [Accepted: 05/09/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In this study, it was aimed to compare various parameters during surgery and postoperative cognitive functions in patients undergoing coronary artery bypass graft (CABG) surgery using different levels of perioperative oxygen. METHODS One hundred patients scheduled for elective CABG surgery were included in the study. The patients were divided into two groups according to arterial oxygen levels during surgery. In the normoxia group (NG) (n = 50), partial arterial oxygen pressure (PaO2 ) was between ≥100 and <180 mmHg with at least 40% fraction of inspired oxygen (FiO2 ) mechanical ventilation (MV), and in the hyperoxia group (HG) (n = 50), PaO2 was ≥180 mmHg with 100% FiO2 MV. Hemodynamic parameters, peripheral oxygen saturation (SpO2 ), regional cerebral oxygen saturation (rSO2 ) measured from bilateral sensors, and blood gas values were recorded at the planned measurement times. Postoperative features (mortality and infection rates, length of stay in the hospital, and intensive care unit) and complications of the patients have been recorded (low cardiac output syndrome, renal failure, delirium). Mini-Mental State Examination (MMSE) test was applied to the patients before and at the 12th, 24th hours; on the first, third, sixth months after surgery. RESULTS Extubation time was found to be shorter in NG (p < .05). Between the groups, rSO2 and mean arterial pressure were found to be significantly lower in HG at the time of T4 measurement (p = .042, p = .038, respectively). MMSE values of the groups at the first, third, and sixth months were found to be significantly higher in NG (p = .017, p = .014, p = .002, respectively). CONCLUSION Hyperoxemia application during CABG may be associated with worse postoperative late-term cognitive functions.
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Affiliation(s)
- Tuğba Onur
- Departmant of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Ümran Karaca
- Departmant of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Filiz Ata
- Departmant of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Halil E Sayan
- Departmant of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Anıl Onur
- Departmant of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Canan Yilmaz
- Departmant of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Ayşe N Balkaya
- Departmant of Anesthesiology and Reanimation, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Cüneyt Eriş
- Departmant of Cardiovascular Surgery, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
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Guo H, Bai W, Ouyang W, Liu Y, Wu C, Xu Y, Weng Y, Zang H, Liu Y, Jacobson L, Hu Z, Wang Y, Arafa HM, Yang Q, Lu D, Li S, Zhang L, Xiao X, Vázquez-Guardado A, Ciatti J, Dempsey E, Ghoreishi-Haack N, Waters EA, Haney CR, Westman AM, MacEwan MR, Pet MA, Rogers JA. Wireless implantable optical probe for continuous monitoring of oxygen saturation in flaps and organ grafts. Nat Commun 2022; 13:3009. [PMID: 35637230 PMCID: PMC9151749 DOI: 10.1038/s41467-022-30594-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 05/04/2022] [Indexed: 12/24/2022] Open
Abstract
Continuous, real-time monitoring of perfusion after microsurgical free tissue transfer or solid organ allotransplantation procedures can facilitate early diagnosis of and intervention for anastomotic thrombosis. Current technologies including Doppler systems, cutaneous O2-sensing probes, and fluorine magnetic resonance imaging methods are limited by their intermittent measurements, requirements for skilled personnel, indirect interfaces, and/or their tethered connections. This paper reports a wireless, miniaturized, minimally invasive near-infrared spectroscopic system designed for uninterrupted monitoring of local-tissue oxygenation. A bioresorbable barbed structure anchors the probe stably at implantation sites for a time period matched to the clinical need, with the ability for facile removal afterward. The probe connects to a skin-interfaced electronic module for wireless access to essential physiological parameters, including local tissue oxygenation, pulse oxygenation, and heart rate. In vitro tests and in vivo studies in porcine flap and kidney models demonstrate the ability of the system to continuously measure oxygenation with high accuracy and sensitivity.
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Affiliation(s)
- Hexia Guo
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Wubin Bai
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60208, USA.
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA.
- Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA.
| | - Wei Ouyang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Yihan Liu
- Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Changsheng Wu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Yameng Xu
- The Institute of Materials Science and Engineering, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Yang Weng
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Hao Zang
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Yiming Liu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Lauren Jacobson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Ziying Hu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Yihang Wang
- Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Hany M Arafa
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Quansan Yang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Di Lu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Shuo Li
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Lin Zhang
- Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Xun Xiao
- Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
| | | | - Joanna Ciatti
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA
| | - Elizabeth Dempsey
- Developmental Therapeutics Core, Northwestern University, Evanston, IL, 60208, USA
| | | | - Emily A Waters
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, IL, 60208, USA
| | - Chad R Haney
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, IL, 60208, USA
| | - Amanda M Westman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Matthew R MacEwan
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Mitchell A Pet
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | - John A Rogers
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60208, USA.
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, 60208, USA.
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, 60208, USA.
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA.
- Department of Chemistry, Northwestern University, Evanston, IL, 60208, USA.
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Evanston, IL, 60208, USA.
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8
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Sainbhi AS, Gomez A, Froese L, Slack T, Batson C, Stein KY, Cordingley DM, Alizadeh A, Zeiler FA. Non-Invasive and Minimally-Invasive Cerebral Autoregulation Assessment: A Narrative Review of Techniques and Implications for Clinical Research. Front Neurol 2022; 13:872731. [PMID: 35557627 PMCID: PMC9087842 DOI: 10.3389/fneur.2022.872731] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/30/2022] [Indexed: 12/13/2022] Open
Abstract
The process of cerebral vessels regulating constant cerebral blood flow over a wide range of systemic arterial pressures is termed cerebral autoregulation (CA). Static and dynamic autoregulation are two types of CA measurement techniques, with the main difference between these measures relating to the time scale used. Static autoregulation looks at the long-term change in blood pressures, while dynamic autoregulation looks at the immediate change. Techniques that provide regularly updating measures are referred to as continuous, whereas intermittent techniques take a single at point in time. However, a technique being continuous or intermittent is not implied by if the technique measures autoregulation statically or dynamically. This narrative review outlines technical aspects of non-invasive and minimally-invasive modalities along with providing details on the non-invasive and minimally-invasive measurement techniques used for CA assessment. These non-invasive techniques include neuroimaging methods, transcranial Doppler, and near-infrared spectroscopy while the minimally-invasive techniques include positron emission tomography along with magnetic resonance imaging and radiography methods. Further, the advantages and limitations are discussed along with how these methods are used to assess CA. At the end, the clinical considerations regarding these various techniques are highlighted.
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Affiliation(s)
- Amanjyot Singh Sainbhi
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
- *Correspondence: Amanjyot Singh Sainbhi
| | - Alwyn Gomez
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Logan Froese
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Trevor Slack
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Carleen Batson
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kevin Y. Stein
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dean M. Cordingley
- Applied Health Sciences Program, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada
| | - Arsalan Alizadeh
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Frederick A. Zeiler
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Centre on Aging, University of Manitoba, Winnipeg, MB, Canada
- Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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9
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Howarth CN, Leung TS, Banerjee J, Eaton S, Morris JK, Aladangady N. Regional cerebral and splanchnic tissue oxygen saturation in preterm infants - Longitudinal normative measurements. Early Hum Dev 2022; 165:105540. [PMID: 35065416 DOI: 10.1016/j.earlhumdev.2022.105540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To investigate regional splanchnic and cerebral tissue oxygen saturation in preterm infants <30 weeks gestation. METHODS Cerebral (cTOI) and splanchnic (sTOI) Tissue Oxygenation Index were measured weekly in 5 min epochs for a total period of 60 min using NIRS (NIRO-300) for the first 8 weeks of life, in 48 appropriately grown preterm infants born at <30 weeks gestation. Infants who developed HPI and/or NEC (n = 12) and those that died (n = 1) were excluded from our main outcome measure of regional gut and cerebral tissue oxygenation in healthy preterm infants <30 weeks gestation. RESULTS Median birthweight 789 g (460-1486), gestational age 25+6 weeks (23+0-29+1) and 51.4% female. 217 NIRS measurements were completed across the first 8 weeks of life. Mean weekly cTOI ranged from 56.8-65.4% and sTOI ranged from 36.7-46.0%. Mean cTOI was significantly higher than mean sTOI (p < 0.001) throughout the first 8 weeks of life. Mean cTOI decreased significantly with increasing postnatal age [-0.59% each week (-1.26% to -0.07%) p = 0.04]. None of the examined confounding factors had a significant effect. CONCLUSIONS This is the first report of regional cerebral and splanchnic tissue oxygen saturation ranges during the first 8 weeks of life for preterm infants born at <30 weeks gestation.
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Affiliation(s)
- Claire N Howarth
- Homerton University Hospital NHS Foundation Trust, London, UK; Queen Mary University of London, London, UK.
| | - Terence S Leung
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Jayanta Banerjee
- Imperial College Healthcare NHS Trust, London, UK; Imperial College London, UK
| | - Simon Eaton
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Narendra Aladangady
- Homerton University Hospital NHS Foundation Trust, London, UK; Queen Mary University of London, London, UK
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10
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Takegawa R, Hayashida K, Yin T, Choudhary RC, Miyara SJ, Khalili H, Shoaib M, Endo Y, Molmenti EP, Becker LB. Real-Time Brain Monitoring by Near-Infrared Spectroscopy Predicts Neurological Outcome after Cardiac Arrest and Resuscitation in Rats: A Proof of Concept Study of a Novel Prognostic Measure after Cardiac Arrest. J Clin Med 2021; 11:jcm11010131. [PMID: 35011872 PMCID: PMC8745661 DOI: 10.3390/jcm11010131] [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: 11/25/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 12/03/2022] Open
Abstract
Clinical studies have demonstrated that dynamic changes in regional cerebral oxygen saturation (rSO2) after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) have a role in predicting neurological outcomes after the return of spontaneous circulation (ROSC). Our study evaluated whether the timing of rSO2 decline shortly after CPR reflects the severity of brain injury in a rat model of CA. Rats were subjected to different durations of asphyxia to produce variable severities of brain injury, due to CA. Time from ROSC to achieving the initial minimum rSO2 was defined as Tnadir. A Tnadir cut-off of 24 min had optimal sensitivity and specificity for predicting good neurological outcomes at 72 h after ROSC (AUC, 0.88; sensitivity, 89%; specificity, 86%; p < 0.01). Immunohistochemistry at 72 h post-CA revealed that the number of Fluoro-Jade B positive degenerating neurons in the hippocampus CA1 sector were markedly higher in animals with Tnadir > 24 min than that in animals with Tnadir ≤ 24 min. There was no difference in the gene expressions of cytokines and mitochondrial fission proteins in the brain at 2 h after ROSC between rats with Tnadir > 24 min and with Tnadir ≤ 24 min. In conclusion, Tnadir can be a novel predictor of good neurological outcomes after CA/CPR.
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Affiliation(s)
- Ryosuke Takegawa
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA; (R.T.); (T.Y.); (R.C.C.); (S.J.M.); (H.K.); (M.S.); (Y.E.); (L.B.B.)
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY 11030, USA
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Kei Hayashida
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA; (R.T.); (T.Y.); (R.C.C.); (S.J.M.); (H.K.); (M.S.); (Y.E.); (L.B.B.)
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY 11030, USA
- Correspondence:
| | - Tai Yin
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA; (R.T.); (T.Y.); (R.C.C.); (S.J.M.); (H.K.); (M.S.); (Y.E.); (L.B.B.)
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY 11030, USA
| | - Rishabh C. Choudhary
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA; (R.T.); (T.Y.); (R.C.C.); (S.J.M.); (H.K.); (M.S.); (Y.E.); (L.B.B.)
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY 11030, USA
| | - Santiago J. Miyara
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA; (R.T.); (T.Y.); (R.C.C.); (S.J.M.); (H.K.); (M.S.); (Y.E.); (L.B.B.)
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY 11030, USA
| | - Houman Khalili
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA; (R.T.); (T.Y.); (R.C.C.); (S.J.M.); (H.K.); (M.S.); (Y.E.); (L.B.B.)
| | - Muhammad Shoaib
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA; (R.T.); (T.Y.); (R.C.C.); (S.J.M.); (H.K.); (M.S.); (Y.E.); (L.B.B.)
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA;
| | - Yusuke Endo
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA; (R.T.); (T.Y.); (R.C.C.); (S.J.M.); (H.K.); (M.S.); (Y.E.); (L.B.B.)
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY 11030, USA
| | - Emesto P. Molmenti
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA;
- Department of Surgery, North Shore University Hospital, Northwell Health, Manhasset, NY 11030, USA
| | - Lance B. Becker
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA; (R.T.); (T.Y.); (R.C.C.); (S.J.M.); (H.K.); (M.S.); (Y.E.); (L.B.B.)
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY 11030, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA;
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11
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Gomez A, Sainbhi AS, Froese L, Batson C, Alizadeh A, Mendelson AA, Zeiler FA. Near Infrared Spectroscopy for High-Temporal Resolution Cerebral Physiome Characterization in TBI: A Narrative Review of Techniques, Applications, and Future Directions. Front Pharmacol 2021; 12:719501. [PMID: 34803673 PMCID: PMC8602694 DOI: 10.3389/fphar.2021.719501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/22/2021] [Indexed: 12/31/2022] Open
Abstract
Multimodal monitoring has been gaining traction in the critical care of patients following traumatic brain injury (TBI). Through providing a deeper understanding of the individual patient's comprehensive physiologic state, or "physiome," following injury, these methods hold the promise of improving personalized care and advancing precision medicine. One of the modalities being explored in TBI care is near-infrared spectroscopy (NIRS), given it's non-invasive nature and ability to interrogate microvascular and tissue oxygen metabolism. In this narrative review, we begin by discussing the principles of NIRS technology, including spatially, frequency, and time-resolved variants. Subsequently, the applications of NIRS in various phases of clinical care following TBI are explored. These applications include the pre-hospital, intraoperative, neurocritical care, and outpatient/rehabilitation setting. The utility of NIRS to predict functional outcomes and evaluate dysfunctional cerebrovascular reactivity is also discussed. Finally, future applications and potential advancements in NIRS-based physiologic monitoring of TBI patients are presented, with a description of the potential integration with other omics biomarkers.
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Affiliation(s)
- Alwyn Gomez
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Amanjyot Singh Sainbhi
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Logan Froese
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Carleen Batson
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Arsalan Alizadeh
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Asher A Mendelson
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada.,Section of Critical Care, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Frederick A Zeiler
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada.,Centre on Aging, University of Manitoba, Winnipeg, MB, Canada.,Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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12
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Cowling N, Woldeyohannes S, Sole Guitart A, Goodwin W. Measurement of Tissue Oximetry in Standing Unsedated and Sedated Horses. Vet Sci 2021; 8:vetsci8100202. [PMID: 34679032 PMCID: PMC8537620 DOI: 10.3390/vetsci8100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
Near infrared spectroscopy (NIRS) noninvasively measures peripheral tissue oxygen saturation (StO2) and may be useful to detect early changes in StO2 in anaesthetized and critically ill horses. This study aimed to identify the muscle belly that provided the highest percentage of successful StO2 readings and the highest mean StO2 value. Fifty adult horses were enrolled in a prospective controlled study. StO2 was measured at six different muscles in each horse, for each intervention: hair overlying the muscle was clipped (post clipping: PC), clipped skin was cleaned with chlorhexidine (post-surgical prepping: PP) and medetomidine was administered intravenously (post medetomidine: PM). Mean StO2 values were calculated for each muscle, and a linear effects model was used to assess the effect of muscle group and intervention on StO2. The sartorius muscle gave the highest percentage of successful StO2 values (p < 0.001) and the highest mean (90% CI) StO2 values for the PC, PP and PM interventions. Surgical prepping of the skin increased the success for measurement of StO2 values. For all muscles, administration of medetomidine was associated with lower StO2 values (p < 0.001). In conclusion, of the muscles examined, the sartorius muscle may be the preferred muscle to measure StO2 in horses, and clipping and cleaning of the probe placement site is recommended.
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13
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Coşarcan SK, Gurkan Y, Doğan AT, Koyuncu Ö, Erçelen Ö. Could Interscalene Block Possibly be Protective Against Cerebral Ischemia During Shoulder Surgery in a Beach Chair Position? Cureus 2021; 13:e16773. [PMID: 34476141 PMCID: PMC8404480 DOI: 10.7759/cureus.16773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Arthroscopic shoulder surgeries are usually performed in a sitting position. The sitting position is known to cause physiological changes related to cardiovascular adaptation. Interscalene nerve blocks (ISB) are the most commonly used techniques and are considered gold standard regional anesthesia methods for shoulder surgeries. Cerebral vessels located around sympathetic ganglia provide sympathetic system integrity. This local anesthetic spreading during ISB could be a side effect or provide a protective effect on cerebral ischemia. Our study aimed to investigate the cerebral protective effect of the ISB in arthroscopic shoulder surgeries in a sitting position. Material and methods After the approval of Koç University Clinical Research Ethics Committee (2020.020.IRB1.011), records of patients between January and December 2019 with shoulder arthroscopy at the Vehbi Koç Foundation (VKV) American hospital were retrospectively reviewed. Records of the hemodynamic response, INVOSTM (Medtronic, Minneapolis, USA) (rSO2) parameters, pain scores, and additional analgesic needs of all cases were examined in the intraoperative and postoperative period. Results Data of 40 patients who met the criteria to be included in the study was analyzed. Our study showed that the sitting position leading to hypotension coincided with a decrease in INVOS values. Nevertheless, we did not record any significant hypotension after ISB, and this may be due to the use of a minimal dose of local anesthetic. There was a certain increase in near-infrared spectroscopy (NIRS) values after ISB. We saw that the value of regional oxygen saturation (rSO2) increased on both the ISB side and the non-ISB side. This shows that the ISB can have a global impact on the brain. Specificially, the increase in rSO2 values in the ISB side compared to the other side suggests that ISB has possible positive effects on cerebral blood flow. Conclusion Our study has shown that ISB may transiently increase the rSO2 levels in the sitting position during shoulder surgery.
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Affiliation(s)
| | | | | | - Özgür Koyuncu
- Orthopaedics and Traumatology, VKV American Hospital, Istanbul, TUR
| | - Ömür Erçelen
- Anesthesiology, VKV American Hospital, Istanbul, TUR
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14
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Barud M, Dabrowski W, Siwicka-Gieroba D, Robba C, Bielacz M, Badenes R. Usefulness of Cerebral Oximetry in TBI by NIRS. J Clin Med 2021; 10:2938. [PMID: 34209017 PMCID: PMC8268432 DOI: 10.3390/jcm10132938] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 12/14/2022] Open
Abstract
Measurement of cerebral oximetry by near-infrared spectroscopy provides continuous and non-invasive information about the oxygen saturation of haemoglobin in the central nervous system. This is especially important in the case of patients with traumatic brain injuries. Monitoring of cerebral oximetry in these patients could allow for the diagnosis of inadequate cerebral oxygenation caused by disturbances in cerebral blood flow. It could enable identification of episodes of hypoxia and cerebral ischemia. Continuous bedside measurement could facilitate the rapid diagnosis of intracranial bleeding or cerebrovascular autoregulation disorders and accelerate the implementation of treatment. However, it should be remembered that the method of monitoring cerebral oximetry by means of near-infrared spectroscopy also has its numerous limitations, resulting mainly from its physical properties. This paper summarizes the usefulness of monitoring cerebral oximetry by near-infrared spectroscopy in patients with traumatic brain injury, taking into account the advantages and the disadvantages of this technique.
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Affiliation(s)
- Małgorzata Barud
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-954 Lublin, Poland; (W.D.); (D.S.-G.)
| | - Wojciech Dabrowski
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-954 Lublin, Poland; (W.D.); (D.S.-G.)
| | - Dorota Siwicka-Gieroba
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-954 Lublin, Poland; (W.D.); (D.S.-G.)
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, Policlinico San Martino, 16100 Genova, Italy;
| | - Magdalena Bielacz
- Institute of Tourism and Recreation, State Vocational College of Szymon Szymonowicz, 22-400 Zamosc, Poland;
| | - Rafael Badenes
- Department of Anaesthesiology and Intensive Care, Hospital Clìnico Universitario de Valencia, University of Valencia, 46010 Valencia, Spain;
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15
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Kovacsova Z, Bale G, Mitra S, Lange F, Tachtsidis I. Absolute quantification of cerebral tissue oxygen saturation with multidistance broadband NIRS in newborn brain. BIOMEDICAL OPTICS EXPRESS 2021; 12:907-925. [PMID: 33680549 PMCID: PMC7901317 DOI: 10.1364/boe.412088] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 05/23/2023]
Abstract
Tissue oximetry with near-infrared spectroscopy (NIRS) is a technique for the measurement of absolute tissue oxygen saturation (StO2). Offering a real-time and non-invasive assessment of brain oxygenation and haemodynamics, StO2 has potential to be used for the assessment of newborn brain injury. Multiple algorithms have been developed to measure StO2, however, issues with low measurement accuracy or extracranial tissue signal contamination remain. In this work, we present a novel algorithm to recover StO2 in the neonate, broadband multidistance oximetry (BRUNO), based on a measurement of the gradient of attenuation against distance measured with broadband NIRS. The performance of the algorithm was compared to two other published algorithms, broadband fitting (BF) and spatially resolved spectroscopy (SRS). The median error when recovering StO2 in light transport simulations on a neonatal head mesh was 0.4% with BRUNO, 4.2% with BF and 9.5% with SRS. BRUNO was more sensitive to brain tissue oxygenation changes, shown in layered head model simulations. Comparison of algorithm performance during full oxygenation-deoxygenation cycles in a homogeneous dynamic blood phantom showed significant differences in the dynamic range of the algorithms; BRUNO recovered StO2 over 0-100%, BF over 0-90% and SRS over 39-80%. Recovering StO2 from data collected in a neonate treated at the neonatal intensive care showed different baseline values; mean StO2 was 64.9% with BRUNO, 67.2% with BF and 73.2% with SRS. These findings highlight the effect of StO2 algorithm selection on oxygenation recovery; applying BRUNO in the clinical care setting could reveal further insight into complex haemodynamic processes occurring during neonatal brain injury.
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Affiliation(s)
- Zuzana Kovacsova
- Department of Medical Physics & Biomedical Engineering, University College London, London, WC1E 6BT, UK
| | - Gemma Bale
- Department of Medical Physics & Biomedical Engineering, University College London, London, WC1E 6BT, UK
- Department of Engineering, University of Cambridge, Cambridge, CB2 1PZ, UK
- Department of Physics, University of Cambridge, Cambridge, CB3 0HE, UK
| | - Subhabrata Mitra
- Institute for Women’s Health, University College London and Neonatal Unit, University College London Hospitals Trust, London, NW1 2BU, UK
| | - Frédéric Lange
- Department of Medical Physics & Biomedical Engineering, University College London, London, WC1E 6BT, UK
| | - Ilias Tachtsidis
- Department of Medical Physics & Biomedical Engineering, University College London, London, WC1E 6BT, UK
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16
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Verhaeghe C, Lapage K, Moerman A. Quantitative assessment of cytochrome C oxidase patterns in muscle tissue by the use of near-infrared spectroscopy (NIRS) in healthy volunteers. J Clin Monit Comput 2021; 36:271-278. [PMID: 33459945 DOI: 10.1007/s10877-021-00648-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
Cytochrome C oxidase (CCO) acts as final electron acceptor in the respiratory chain, possibly providing information concerning cellular oxygenation. CCO is a chromophore with a broad absorption peak in the near-infrared spectrum in its reduced state (835 nm). However, this peak overlaps with deoxygenated haemoglobin (HHb; 755 nm) which is present in much higher concentrations. NIRO-300 measures CCO signals, but did not receive FDA approval for this use due to presumed lack of independency of the measured CCO changes. However, there is no proven evidence for this assumption. We hypothesized that the NIRO-300 provides a HHb independent measurement of CCO concentration changes. In this single-center crossover randomized controlled trial in healthy volunteers, subjects were randomized to receive arterial occlusion to the left arm and venous stasis on the right arm (n = 5) or vice versa (n = 5) during 5 min. After a resting period, the second part of the cross over study was performed. We placed the NIRO-300 optodes bilateral at the level of the brachioradial muscle in order to collect NIRS data continuously. Data was analysed using a generalized additive mixed model. HHb and CCO follow a significant different trend over time during the intervention period for both arterial occlusion (F = 20.645, edf = 3.419, p < 0.001) and venous stasis (F = 9.309, edf = 4.931, p < 0.001). Our data indicate that CCO concentration changes were not affected by HHb changes, thereby proving independency.Clinical trial registration: B670201732023 on June 28, 2017.
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Affiliation(s)
- Carl Verhaeghe
- Department of Anaesthesia, UZ Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Koen Lapage
- Department of Anaesthesia, ASZ Aalst, Aalst, Belgium
| | - Anneliese Moerman
- Department of Anaesthesia, UZ Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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17
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A wireless, skin-interfaced biosensor for cerebral hemodynamic monitoring in pediatric care. Proc Natl Acad Sci U S A 2020; 117:31674-31684. [PMID: 33257558 PMCID: PMC7749320 DOI: 10.1073/pnas.2019786117] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The standard of clinical care in many pediatric and neonatal neurocritical care units involves continuous monitoring of cerebral hemodynamics using hard-wired devices that physically adhere to the skin and connect to base stations that commonly mount on an adjacent wall or stand. Risks of iatrogenic skin injuries associated with adhesives that bond such systems to the skin and entanglements of the patients and/or the healthcare professionals with the wires can impede clinical procedures and natural movements that are critical to the care, development, and recovery of pediatric patients. This paper presents a wireless, miniaturized, and mechanically soft, flexible device that supports measurements quantitatively comparable to existing clinical standards. The system features a multiphotodiode array and pair of light-emitting diodes for simultaneous monitoring of systemic and cerebral hemodynamics, with ability to measure cerebral oxygenation, heart rate, peripheral oxygenation, and potentially cerebral pulse pressure and vascular tone, through the utilization of multiwavelength reflectance-mode photoplethysmography and functional near-infrared spectroscopy. Monte Carlo optical simulations define the tissue-probing depths for source-detector distances and operating wavelengths of these systems using magnetic resonance images of the head of a representative pediatric patient to define the relevant geometries. Clinical studies on pediatric subjects with and without congenital central hypoventilation syndrome validate the feasibility for using this system in operating hospitals and define its advantages relative to established technologies. This platform has the potential to substantially enhance the quality of pediatric care across a wide range of conditions and use scenarios, not only in advanced hospital settings but also in clinics of lower- and middle-income countries.
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18
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Takegawa R, Hayashida K, Rolston DM, Li T, Miyara SJ, Ohnishi M, Shiozaki T, Becker LB. Near-Infrared Spectroscopy Assessments of Regional Cerebral Oxygen Saturation for the Prediction of Clinical Outcomes in Patients With Cardiac Arrest: A Review of Clinical Impact, Evolution, and Future Directions. Front Med (Lausanne) 2020; 7:587930. [PMID: 33251235 PMCID: PMC7673454 DOI: 10.3389/fmed.2020.587930] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/02/2020] [Indexed: 12/24/2022] Open
Abstract
Despite three decades of advancements in cardiopulmonary resuscitation (CPR) methods and post-resuscitation care, neurological prognosis remains poor among survivors of out-of-hospital cardiac arrest, and there are no reliable methods for predicting neurological outcomes in patients with cardiac arrest (CA). Adopting more effective methods of neurological monitoring may aid in improving neurological outcomes and optimizing therapeutic interventions for each patient. In the present review, we summarize the development, evolution, and potential application of near-infrared spectroscopy (NIRS) in adults with CA, highlighting the clinical relevance of NIRS brain monitoring as a predictive tool in both pre-hospital and in-hospital settings. Several clinical studies have reported an association between various NIRS oximetry measurements and CA outcomes, suggesting that NIRS monitoring can be integrated into standardized CPR protocols, which may improve outcomes among patients with CA. However, no studies have established acceptable regional cerebral oxygen saturation cut-off values for differentiating patient groups based on return of spontaneous circulation status and neurological outcomes. Furthermore, the point at which resuscitation efforts can be considered futile remains to be determined. Further large-scale randomized controlled trials are required to evaluate the impact of NIRS monitoring on survival and neurological recovery following CA.
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Affiliation(s)
- Ryosuke Takegawa
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health System, Manhasset, NY, United States.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, United States.,Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kei Hayashida
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health System, Manhasset, NY, United States.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, United States
| | - Daniel M Rolston
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, United States.,Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States.,Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | - Timmy Li
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, United States.,Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | - Santiago J Miyara
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health System, Manhasset, NY, United States.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, United States.,Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States.,Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States
| | - Mitsuo Ohnishi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Tadahiko Shiozaki
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Lance B Becker
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health System, Manhasset, NY, United States.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, United States.,Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
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19
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Peng A, Chua MJ, Chan B, Jaeger M, Aneman A, Chuan A. Tissue oxygenation indices of cerebrovascular autoregulation in healthy volunteers: a comparison of two NIRS devices. Neurol Res 2020; 42:897-903. [PMID: 32643591 DOI: 10.1080/01616412.2020.1790869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Correlation coefficients between blood pressure and cerebral oxygen saturation measured using near-infrared spectrometry may be used to derive the tissue oximetry index of cerebral autoregulation. Cerebral oxygen saturations demonstrate poor agreement between near-infrared spectrometers however it is unclear if measurements of autoregulation are similarly specific to the equipment used. METHODS Cerebral oxygen saturation was monitored bilaterally in 74 healthy volunteers using both the FORE-SIGHT and EQUANOX monitors in random order. The tissue oximetry index was calculated during changes in blood pressure induced by isometric handgrip manoeuvres and the mean bias and limits of agreement were calculated. RESULTS Tissue oximetry index measured by FORE-SIGHT was higher than EQUANOX (0.21 ± 0.16 versus 0.15 ± 0.17, P < 0.001) and limits of agreement were -0.24 to 0.36. Baseline cerebral oxygen saturation by FORE-SIGHT was lower than EQUANOX by 1.48% (CI95% 0.63-2.33) and limits of agreement ranged from -11.8% to 8.8%. CONCLUSIONS The substantial bias and wide limits of agreement for the tissue oximetry index as a measure of cerebral autoregulation indicate that values must be treated as specific to models of near-infrared spectrometers.
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Affiliation(s)
- Alexander Peng
- Department of Intensive Care, Blacktown Hospital , Sydney, Australia
| | - Matthew J Chua
- Department of Intensive Care, Nepean Hospital , Sydney, Australia
| | - Bernard Chan
- Junior Medical Staff Unit, Royal North Shore Hospital , Sydney, Australia
| | - Matthias Jaeger
- South Western Sydney Clinical School, University of New South Wales , Sydney, Australia.,Department of Neurosurgery, Wollongong Hospital , Wollongong, Australia
| | - Anders Aneman
- South Western Sydney Clinical School, University of New South Wales , Sydney, Australia.,Department of Intensive Care Medicine, Liverpool Hospital , Sydney, Australia
| | - Alwin Chuan
- South Western Sydney Clinical School, University of New South Wales , Sydney, Australia.,Department of Anaesthesia, Liverpool Hospital , Sydney, Australia
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20
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Mitra S, Bale G, Meek J, Tachtsidis I, Robertson NJ. Cerebral Near Infrared Spectroscopy Monitoring in Term Infants With Hypoxic Ischemic Encephalopathy-A Systematic Review. Front Neurol 2020; 11:393. [PMID: 32536901 PMCID: PMC7267214 DOI: 10.3389/fneur.2020.00393] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Neonatal hypoxic ischemic encephalopathy (HIE) remains a significant cause of mortality and morbidity worldwide. Cerebral near infrared spectroscopy (NIRS) can provide cot side continuous information about changes in brain hemodynamics, oxygenation and metabolism in real time. Objective: To perform a systematic review of cerebral NIRS monitoring in term and near-term infants with HIE. Search Methods: A systematic search was performed in Ovid EMBASE and Medline database from inception to November 2019. The search combined three broad categories: measurement (NIRS monitoring), disease condition [hypoxic ischemic encephalopathy (HIE)] and subject category (newborn infants) using a stepwise approach as per PRISMA guidance. Selection Criteria: Only human studies published in English were included. Data Collection and Analysis: Two authors independently selected, assessed the quality, and extracted data from the studies for this review. Results: Forty-seven studies on term and near-term infants following HIE were identified. Most studies measured multi-distance NIRS based cerebral tissue saturation using monitors that are referred to as cerebral oximeters. Thirty-nine studies were published since 2010; eight studies were published before this. Fifteen studies reviewed the neurodevelopmental outcome in relation to NIRS findings. No randomized study was identified. Conclusion: Commercial NIRS cerebral oximeters can provide important information regarding changes in cerebral oxygenation and hemodynamics following HIE and can be particularly helpful when used in combination with other neuromonitoring tools. Optical measurements of brain metabolism using broadband NIRS and cerebral blood flow using diffuse correlation spectroscopy add additional pathophysiological information. Further randomized clinical trials and large observational studies are necessary with proper study design to assess the utility of NIRS in predicting neurodevelopmental outcome and guiding therapeutic interventions.
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Affiliation(s)
- Subhabrata Mitra
- Neonatology, Institute for Women's Health, University College London, London, United Kingdom
| | - Gemma Bale
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Judith Meek
- Neonatology, Institute for Women's Health, University College London, London, United Kingdom
| | - Ilias Tachtsidis
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Nicola J. Robertson
- Neonatology, Institute for Women's Health, University College London, London, United Kingdom
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21
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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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22
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Öztürk NY, Aygün B, Uyar E, Girgin Fİ. Comparison of Bilateral Cerebro-Renal Tissue Oxygenations in Healthy Children. Indian J Pediatr 2020; 87:99-104. [PMID: 31879839 DOI: 10.1007/s12098-019-03093-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/30/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate right and left cerebral tissue (ctSO2) and renal tissue oxygenations (rtSO2) in otherwise healthy children. METHODS In this observational cross-sectional study, one hundred children seen as outpatients for well child care or common non-critical complaints, were included. Bilateral ctSO2 and rtSO2 were recorded simultaneously with INVOS™ 5100 device. RESULTS The median age was 6.7 y (IQR 3-10.4) and median weight was 21 kg (IQR 13-33). Right and left sided ctSO2 and rtSO2 values were 78.7% ± 6.0% and 79.1% ± 5.7%; 81.5% ± 9.4% and 81.4% ± 9.5% respectively. There were no differences in right and left cerebral and renal near infrared spectroscopy (NIRS) values, and no age centered lateralization effect. Renal measurements were higher than cerebral counterparts in 63% of the children. Interaction between age and regional oxygenation was significant. For both sides, renal oxygenation was higher than that of cerebrum in older children, whereas the opposite held true with younger age. CONCLUSIONS There are no right and left side differences in ctSO2 and rtSO2 values in otherwise healthy children. On the other hand, there seem to be differences between cerebral and renal regions with a significant age effect. Acknowledging its limitations, this study sheds light on laterality and cranial and renal NIRS measurements in otherwise healthy children, and may contribute to the interpretation of NIRS data in critically ill patients.
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Affiliation(s)
- Nilüfer Yalındağ Öztürk
- Division of Pediatric Critical Care, Department of Pediatrics, Marmara University School of Medicine, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mah, Mimar Sinan Cad, No 41 Ust Kaynarca Pendik, 34889, Pendik, İstanbul, Turkey.
| | - Burcu Aygün
- Division of Pediatric Critical Care, Department of Pediatrics, Marmara University School of Medicine, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mah, Mimar Sinan Cad, No 41 Ust Kaynarca Pendik, 34889, Pendik, İstanbul, Turkey
| | - Emel Uyar
- Division of Pediatric Critical Care, Department of Pediatrics, Marmara University School of Medicine, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mah, Mimar Sinan Cad, No 41 Ust Kaynarca Pendik, 34889, Pendik, İstanbul, Turkey
| | - Feyza İnceköy Girgin
- Division of Pediatric Critical Care, Department of Pediatrics, Marmara University School of Medicine, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mah, Mimar Sinan Cad, No 41 Ust Kaynarca Pendik, 34889, Pendik, İstanbul, Turkey
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23
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Cournoyer A, Cossette S, Paquet J, Daoust R, Marquis M, Notebaert É, Iseppon M, Chauny JM, Denault A. Association Between the Quantity of Subcutaneous Fat and the Inter-Device Agreement of 2 Tissue Oximeters. J Cardiothorac Vasc Anesth 2019; 33:2989-2994. [DOI: 10.1053/j.jvca.2019.01.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Indexed: 11/11/2022]
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24
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Hansen RK, Nielsen PS, Schelske MW, Secher NH, Volianitis S. CO 2 supplementation dissociates cerebral oxygenation and middle cerebral artery blood velocity during maximal cycling. Scand J Med Sci Sports 2019; 30:399-407. [PMID: 31650627 DOI: 10.1111/sms.13582] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/28/2019] [Accepted: 10/21/2019] [Indexed: 12/15/2022]
Abstract
This study evaluated whether the reduction of prefrontal cortex oxygenation (ScO2 ) during maximal exercise depends on the hyperventilation-induced hypocapnic attenuation of middle cerebral artery blood velocity (MCA Vmean ). Twelve endurance-trained males (age: 25 ± 3 years, height: 183 ± 8 cm, weight: 75 ± 9 kg; mean ± SD) performed in three separate laboratory visits, a maximal oxygen uptake (VO2 max) test, an isocapnic (end-tidal CO2 tension (PetCO2 ) clamped at 40 ± 1 mmHg), and an ambient air controlled-pace constant load high-intensity ergometer cycling to exhaustion, while MCA Vmean (transcranial Doppler ultrasound) and ScO2 (near-infrared spectroscopy) were determined. Duration of exercise (12 min 25 s ± 1 min 18 s) was matched by performing the isocapnic trial first. Pulmonary VO2 was 90 ± 6% versus 93 ± 5% of the maximal value (P = .012) and PetCO2 40 ± 1 versus 34 ± 4 mmHg (P < .05) during the isocapnic and control trials, respectively. During the isocapnic trial MCA Vmean increased by 16 ± 13% until clamping was applied and continued to increase (by 14 ± 28%; P = .017) until the end of exercise, while there was no significant change during the control trial (P = .071). In contrast, ScO2 decreased similarly in both trials (-3.2 ± 5.1% and -4.1 ± 9.6%; P < .001, isocapnic and control, respectively) at exhaustion. The reduction in prefrontal cortex oxygenation during maximal exercise does not depend solely on lowered cerebral blood flow as indicated by middle cerebral blood velocity.
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Affiliation(s)
- Rasmus K Hansen
- Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Peter S Nielsen
- Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Markus W Schelske
- Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Niels H Secher
- Department of Anaesthesia, The Copenhagen Muscle Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stefanos Volianitis
- Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Department of Anaesthesia, The Copenhagen Muscle Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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25
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Wagenaar N, van den Berk DJ, Lemmers PM, van der Aa NE, Dudink J, van Bel F, Groenendaal F, de Vries LS, Benders MJ, Alderliesten T. Brain Activity and Cerebral Oxygenation After Perinatal Arterial Ischemic Stroke Are Associated With Neurodevelopment. Stroke 2019; 50:2668-2676. [PMID: 31390967 PMCID: PMC6756254 DOI: 10.1161/strokeaha.119.025346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/15/2019] [Accepted: 06/18/2019] [Indexed: 11/17/2022]
Abstract
Background and Purpose- In infants with perinatal arterial ischemic stroke (PAIS), early prognosis of neurodevelopmental outcome is important to adequately inform parents and caretakers. Early continuous neuromonitoring after PAIS may improve early prognosis. Our aim was to study early cerebral electrical activity and oxygenation measured by amplitude-integrated electroencephalography (aEEG) and near-infrared spectroscopy in term neonates with PAIS and relate these to the development of cerebral palsy and cognitive deficit. Methods- aEEG patterns and regional cerebral oxygen saturation (rScO2) levels of both hemispheres were studied for 120 hours from the first clinical symptoms of PAIS (ie, seizures) onward. Multivariable analyses were used to investigate the association between aEEG, near-infrared spectroscopy, clinical variables, and neurodevelopmental outcome. Results- In 52 patients with PAIS (gestational age, 40.4±1.4 weeks; birth weight, 3282±479 g), median time to a continuous background pattern was longer in the ipsilesional compared with the contralesional hemisphere (13.5 versus 10.0 hours; P<0.05). rScO2 decreased over time in both hemispheres but less in the ipsilesional one, resulting in a rScO2 asymmetry ratio of 4.5% (interquartile range, -4.3% to 5.9%; P<0.05) between hemispheres from day 3 after symptoms onward. Both time to normal background pattern and asymmetry in rScO2 were negatively affected by gestational age, size of the PAIS, use of antiepileptic drugs, and mechanical ventilation. After correction for size of the PAIS on magnetic resonance imaging, a slower recovery of background pattern on ipsilesional aEEG and increased rScO2 asymmetry between hemispheres was related with an increased risk for cognitive deficit (<-1 SD) at a median of 24.0 (interquartile range, 18.4-24.4) months of age. Conclusions- Recovery of background pattern on aEEG and cerebral oxygenation are both affected by PAIS and related to neurocognitive development. Both measurements may provide valuable early prognostic information. Additionally, monitoring cerebral activity and oxygenation may be useful in identifying infants eligible for early neuroprotective interventions and to detect early effects of these interventions.
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Affiliation(s)
- Nienke Wagenaar
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
- University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Daphne J.M. van den Berk
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Petra M.A. Lemmers
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
- University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Niek E. van der Aa
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
- University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Jeroen Dudink
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
- University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Frank van Bel
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
- University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Floris Groenendaal
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
- University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Linda S. de Vries
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
- University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Manon J.N.L. Benders
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
- University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
| | - Thomas Alderliesten
- From the Department of Neonatology, University Medical Center Utrecht (N.W., D.J.M.v.d.B., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
- University Medical Center Utrecht Brain Center (N.W., P.M.A.L., N.E.v.d.A., J.D., F.v.B., F.G., L.S.d.V., M.J.N.L.B., T.A.), Utrecht University, the Netherlands
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26
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Credeur DP, Jones R, Stanford D, Stoner L, McCoy S, Jessee M. Central cardiovascular hemodynamic response to unilateral handgrip exercise with blood flow restriction. Eur J Appl Physiol 2019; 119:2255-2263. [PMID: 31420736 DOI: 10.1007/s00421-019-04209-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/08/2019] [Indexed: 12/21/2022]
Abstract
AIM Exercise training with blood flow restriction (BFR) increases muscle size and strength. However, there is limited investigation into the effects of BFR on cardiovascular health, particularly central hemodynamic load. PURPOSE To determine the effects of BFR exercise on central hemodynamic load (heart rate-HR, central pressures, arterial wave reflection, and aortic stiffness). METHODS Fifteen males (age = 25 ± 2 years; BMI = 27 ± 2 kg/m2, handgrip max voluntary contraction-MVC = 50 ± 2 kg) underwent 5-min bouts (counter-balanced, 10 min rest between) of rhythmic unilateral handgrip (1 s squeeze, 2 s relax) performed with a moderate-load (60% MVC) with and without BFR (i.e., 71 ± 5% arterial inflow flow reduction, assessed via Doppler ultrasound), and also with a low-load (40% MVC) with BFR. Outcomes included HR, central mean arterial pressure (cMAP), arterial wave reflection (augmentation index, AIx; wave reflection magnitude, RM%), aortic arterial stiffness (pulse wave velocity, aPWV), and peripheral (vastus lateralis) microcirculatory response (tissue saturation index, TSI%). RESULTS HR increased above baseline and time control for all handgrip bouts, but was similar between the moderate load with and without BFR conditions (moderate-load with BFR = + 9 ± 2; moderate-load without BFR = + 8 ± 2 bpm, p < 0.001). A similar finding was noted for central pressure (e.g., moderate load with BFR, cMAP = + 14 ± 1 mmHg, p < 0.001). No change occurred for RM% or AIx (p > 0.05) for any testing stage. TSI% increased during the moderate-load conditions (p = 0.01), and aPWV increased above baseline following moderate-load handgrip with BFR only (p = 0.012). CONCLUSIONS Combined with BFR, moderate load handgrip training with BFR does not significantly augment central hemodynamic load during handgrip exercise in young healthy men.
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Affiliation(s)
- Daniel P Credeur
- School of Kinesiology and Nutrition, University of Southern Mississippi, Hattiesburg, MS, USA.
| | - Raymond Jones
- School of Kinesiology and Nutrition, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Daphney Stanford
- School of Kinesiology and Nutrition, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Lee Stoner
- Department of Exercise and Sports Science, University of North Carolina, Chapel Hill, NC, USA
| | - Stephanie McCoy
- School of Kinesiology and Nutrition, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Matthew Jessee
- School of Kinesiology and Nutrition, University of Southern Mississippi, Hattiesburg, MS, USA
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Consequence of insertion trauma - effect on early measurements when using intracerebral devices. Sci Rep 2019; 9:10652. [PMID: 31337819 PMCID: PMC6650456 DOI: 10.1038/s41598-019-47052-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/10/2019] [Indexed: 12/27/2022] Open
Abstract
There are a variety of devices that quantify biological properties of cerebral tissue. Installing such device will cause a local insertion trauma, which will affect early measurements. Current literature proposes minimum one hour of observation before acquiring first measurements when using microdialysis. It is unknown whether this applies to other intracerebral devices. We therefore aimed to investigate time needed to reach steady state when using microdialysis and two intracerebral probes in a piglet model. Ten newborn piglets less than 24 hours of age were anaesthetized. Two probes (Codman and OxyLite/OxyFlo) and a microdialysis catheter (CMA Microdialysis) were installed 10 mm into the left hemisphere. Probes measured intracranial pressure, cerebral blood flow, and oxygen tension. The microdialysis catheter measured lactate, glucose, glycerol, and pyruvate. Measurements were acquired hourly for 20 hours. Lactate and glycerol peaked immediately after insertion and reached steady state after approximately four hours. Glucose, pyruvate, cerebral blood flow, and intracranial pressure reached steady state immediately. Oxygen tension reached steady state after 12 hours. With time, interindividual variability decreased for the majority of measurements. Consequently, time to stabilization after insertion depends on the choice of device and is crucial to obtain valid baseline values with high degree of precision.
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28
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Aydın G, Sayan CD. Is body mass index a risk factor for low cerebral oxygenation during spinal anesthesia in women undergoing cesarean section? A preliminary study. Turk J Med Sci 2019; 49:854-861. [PMID: 31190520 PMCID: PMC7018328 DOI: 10.3906/sag-1810-208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background/aim In this study, it was aimed to investigate the relationship between body mass index (BMI) and cerebral oxygenation during spinal anesthesia in women undergoing cesarean section. This study also aimed to demonstrate whether fetal cord blood oxygenation was affected by maternal BMI and/or delivery time. Materials and methods The study included parturients with ASA I score undergoing cesarean section under spinal anesthesia in 2015 and 2016. They were divided into two groups according to BMI: Group 1 comprised parturients with BMI of <30 (n = 11) and Group 2 comprised parturients with BMI of ≥30 (n = 17). Right cerebral oxygenation (RSO2) and left cerebral oxygenation (LSO2) monitoring was performed using near-infrared spectroscopy (NIRS). The participants were divided into two groups according to the duration of fetal delivery. Group A included parturients with delivery time of <2 min (n = 7) and Group B those with delivery time of >2 min (n = 18), and fetal cord blood oxygenation was measured using a blood gas analyzer. Results Evaluation was made of a total of 25 patients. The RSO2 values were measured at the 20th, 30th, and 35th minutes of the cesarean section procedure and the median values of all the time intervals in Group 1 were significantly lower than those of Group 2 (P < 0.05). The LSO2 value was significantly lower in Group 1 at the 35th minute compared to Group 2 (P < 0.05). The PO2 values of fetal cord blood were significantly lower in Group B (P < 0.05). Conclusion The results of this study showed that parturients with BMI of <30 who are undergoing cesarean section under spinal anesthesia might have an increased risk of complications due to decreased cerebral oxygenation related with hypotension. Therefore, it can be suggested that before and during cesarean section these patients should be closely monitored for cerebral oxygenation using NIRS.
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Affiliation(s)
- Gülçin Aydın
- Department of Anesthesiology and Reanimation, School of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Cemile Dayangan Sayan
- Department of Obstetrics and Gynecology, School of Medicine, Kırıkkale University, Kırıkkale, Turkey
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Konishi T, Kurazumi T, Kato T, Takko C, Ogawa Y, Iwasaki KI. Changes in cerebral oxygen saturation and cerebral blood flow velocity under mild +Gz hypergravity. J Appl Physiol (1985) 2019; 127:190-197. [PMID: 31169473 PMCID: PMC6692742 DOI: 10.1152/japplphysiol.00119.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We previously reported that cerebral blood flow (CBF) was reduced by even mild +Gz hypergravity. Regional cerebral oxygen saturation as measured by near-infrared spectroscopy (C-rSO2) has been widely used to detect cerebral ischemia in clinical practice. For example, decreases in C-rSO2 reflect reduced CBF or arterial oxygen saturation. Thus it was hypothesized that C-rSO2 would decrease in association with reduced CBF during mild hypergravity. To test this hypothesis, we measured CBF velocity by transcranial Doppler ultrasonography and C-rSO2 during mild +Gz hypergravity while participants were in a sitting position. Among 17 male participants, 15 completed 21 min of exposure to +1.5 Gz generated by short-arm centrifuge. C-rSO2 and mean CBF velocity in the middle cerebral artery (MCBFVMCA) during centrifugation were averaged every 5 min and compared with pre-hypergravity (+1.0 Gz). C-rSO2 did not change significantly throughout centrifugation, although MCBFVMCA gradually decreased from the beginning (−1.2% at 0–5 min), and significantly decreased at 5–10 min (−4.8%), 10–15 min (−6.7%), and 15–20 min (−7.4%). Contrary to our hypothesis, decreases in C-rSO2 were not detected, despite reductions in CBF velocity during hypergravity. Since some assumptions, such as unaltered arteriovenous volume ratio, hemoglobin concentration, extracranial blood flow, and brain activity, need to be satisfied to monitor cerebral ischemia by C-rSO2, the present results suggest that these necessary assumptions for near-infrared spectroscopy are not always applicable, and that cerebral oxygenation may not precisely reflect decreases in CBF under mild +Gz hypergravity. NEW & NOTEWORTHY To our knowledge, this is the first study to evaluate simultaneously cerebral oxygenation monitored by near-infrared spectroscopy and cerebral blood flow (CBF) monitored by transcranial Doppler under +1.5 Gz hypergravity. Contrary to our hypothesis, there was no significant correlation between CBF velocity and regional cerebral oxygen saturation (C-rSO2). However, an incomplete case nearly involving syncope suggests the possibility that C-rSO2 can detect a remarkable decrease in CBF with development of presyncope during +Gz hypergravity.
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Affiliation(s)
- Toru Konishi
- Department of Social Medicine, Division of Hygiene, Nihon University School of Medicine , Tokyo , Japan.,Aeromedical Laboratory, Japan Air Self-Defense Force, Ministry of Defense , Saitama , Japan
| | - Takuya Kurazumi
- Department of Social Medicine, Division of Hygiene, Nihon University School of Medicine , Tokyo , Japan
| | - Tomokazu Kato
- Department of Social Medicine, Division of Hygiene, Nihon University School of Medicine , Tokyo , Japan
| | - Chiharu Takko
- Department of Social Medicine, Division of Hygiene, Nihon University School of Medicine , Tokyo , Japan
| | - Yojiro Ogawa
- Department of Social Medicine, Division of Hygiene, Nihon University School of Medicine , Tokyo , Japan
| | - Ken-Ichi Iwasaki
- Department of Social Medicine, Division of Hygiene, Nihon University School of Medicine , Tokyo , Japan
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Aubrun F, Baillard C, Beuscart JB, Billard V, Boddaert J, Boulanger É, Dufeu N, Friggeri A, Khiami F, Salmon PK, Merloz P, Minville V, Molliex S, Mouchoux C, Pain L, Piriou V, Raux M, Servin F. Recommandation sur l’anesthésie du sujet âgé : l’exemple de fracture de l’extrémité supérieure du fémur. ANESTHÉSIE & RÉANIMATION 2019. [DOI: 10.1016/j.anrea.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Al-Subu AM, Hornik CP, Cheifetz IM, Lodge AJ, Ofori-Amanfo G. Correlation between Regional Cerebral Saturation and Invasive Cardiac Index Monitoring after Heart Transplantation Surgery. J Pediatr Intensive Care 2018; 7:196-200. [PMID: 31073494 PMCID: PMC6506669 DOI: 10.1055/s-0038-1660788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/30/2018] [Indexed: 10/14/2022] Open
Abstract
The present study assessed the correlations between cerebral regional saturation detected by near infrared spectroscopy (NIRS) and cardiac index (CI) measured by pulmonary artery catheter. This was a retrospective cohort study conducted in the cardiac intensive care unit in a tertiary care children's hospital. Patients younger than 18 years of age who underwent heart transplantation and had a pulmonary artery catheter on admission to the pediatric cardiac intensive care unit between January, 2010, and August, 2013, were included. There were no interventions. A total of 10 patients were included with median age of 14 years (range, 7-17). Indications for transplantation were dilated cardiomyopathy ( n = 9) and restrictive cardiomyopathy ( n = 1). Mixed venous oxygen saturation (SvO 2 ), cerebral regional tissue saturation (rSO 2 ), and CI were recorded hourly for 8 to 92 hours post-transplantation. Spearman's rank correlation coefficient was used to assess correlations between SvO 2 and cerebral rSO 2 and between CI and cerebral rSO 2 . A total of 410 data points were collected. Median, 25th and 75th percentiles of cerebral rSO 2 , CI, and SvO 2 were 65% (54-69), 2.9 L/min/m 2 (2.2-4.0), and 75% (69-79), respectively. The correlation coefficient between cerebral rSO 2 and CI was 0.104 ( p = 0.034) and that for cerebral rSO 2 and SvO 2 was 0.11 ( p = 0.029). The correlations between cerebral rSO 2 and CI and between cerebral rSO 2 and SvO 2 were weak. Cerebral rSO 2 as detected by NIRS may not be an accurate indicator of CI in critically ill patients.
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Affiliation(s)
- Awni M. Al-Subu
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, American Family Children's Hospital, The University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, United States
| | - Christoph P. Hornik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina, United States
| | - Ira M. Cheifetz
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina, United States
| | - Andrew J. Lodge
- Division of Pediatric Cardiac Surgery, Duke Children's Hospital, Durham, North Carolina, United States
| | - George Ofori-Amanfo
- Division of Pediatric Critical Care, Department of Pediatrics, Kravis Children's Hospital at Mount Sinai, New York, United States
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Cardim D, Griesdale DE. Near-infrared spectroscopy: unfulfilled promises. Br J Anaesth 2018; 121:523-526. [PMID: 30115246 DOI: 10.1016/j.bja.2018.05.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/28/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- D Cardim
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver BC, Canada
| | - D E Griesdale
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver BC, Canada; Department of Medicine, Divisions of Critical Care Medicine and Neurology, University of British Columbia, Vancouver BC, Canada.
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Maharjan A, Wang E, Peng M, Cakmak YO. Improvement of Olfactory Function With High Frequency Non-invasive Auricular Electrostimulation in Healthy Humans. Front Neurosci 2018; 12:225. [PMID: 29740266 PMCID: PMC5928377 DOI: 10.3389/fnins.2018.00225] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/22/2018] [Indexed: 11/13/2022] Open
Abstract
In past literature on animal models, invasive vagal nerve stimulation using high frequencies has shown to be effective at modulating the activity of the olfactory bulb (OB). Recent advances in invasive vagal nerve stimulation in humans, despite previous findings in animal models, used low frequency stimulation and found no effect on the olfactory functioning. The present article aimed to test potential effects of non-invasive, high and low frequency vagal nerve stimulation in humans, with supplementary exploration of the orbitofrontal cortex using near-infrared spectroscopy (NIRS). Healthy, male adult participants (n = 18) performed two olfactory tests [odor threshold test (OTT) and supra-threshold test (STT)] before and after receiving high-, low frequency vagal nerve stimulation and placebo (no stimulation). Participant's olfactory functioning was monitored using NIRS, and assessed with two behavioral olfactory tests. NIRS data of separate stimulation parameters were statistically analyzed using repeated-measures ANOVA across different stages. Data from olfactory tests were analyzed using paired parametric and non-parametric statistical tests. Only high frequency, non-invasive vagal nerve stimulation was able to positively modulate the performance of the healthy participants in the STT (p = 0.021, Wilcoxon sign-ranked test), with significant differences in NIRS (p = 0.014, post-hoc with Bonferroni correction) recordings of the right hemispheric, orbitofrontal cortex. The results from the current article implore further exploration of the neurocircuitry involved under vagal nerve stimulation and the effects of non-invasive, high frequency, vagal nerve stimulation toward olfactory dysfunction which showcase in Parkinson's and Alzheimer's Diseases. Despite the sufficient effect size (moderate effect, correlation coefficient (r): 0.39 for the STT) of the current study, future research should replicate the current findings with a larger cohort.
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Affiliation(s)
- Ashim Maharjan
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Eunice Wang
- Department of Food Science, University of Otago, Dunedin, New Zealand
| | - Mei Peng
- Department of Food Science, University of Otago, Dunedin, New Zealand
| | - Yusuf O Cakmak
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.,Brain Health Research Centre, Dunedin, New Zealand.,Medical Technologies Centre of Research Excellence, Auckland, New Zealand
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McManus CJ, Collison J, Cooper CE. Performance comparison of the MOXY and PortaMon near-infrared spectroscopy muscle oximeters at rest and during exercise. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-14. [PMID: 29368457 DOI: 10.1117/1.jbo.23.1.015007] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 01/04/2018] [Indexed: 05/23/2023]
Abstract
The purpose of the study was to compare muscle oxygenation as measured by two portable, wireless near-infrared spectroscopy (NIRS) devices under resting and dynamic conditions. A recently developed low-cost NIRS device (MOXY) was compared against an established PortaMon system that makes use of the spatially resolved spectroscopy algorithm. The influence of increasing external pressure on tissue oxygen saturation index (TSI) indicated that both devices are stable between 2 and 20 mmHg. However, above this pressure, MOXY reports declining TSI values. Analysis of adipose tissue thickness (ATT) and TSI shows a significant, nonlinear difference between devices at rest. The devices report similar TSI (%) values at a low ATT (<7 mm) (PortaMon minus MOXY difference is +1.1±2.8%) with the major subsequent change between the devices occurring between 7 and 10 mm; at ATT values >10 mm the difference remains constant (-14.7±2.8%). The most likely explanation for this difference is the small source-detector separation (2.5 cm) in the MOXY resulting in lower tissue penetration into muscle in subjects with higher ATT. Interday test-retest reliability of resting TSI was evaluated on five separate occasions, with the PortaMon reporting a lower coefficient of variation (1.8% to 2.5% versus 5.7% to 6.2%). In studies on male subjects with low ATT, decreases in the TSI were strongly correlated during isometric exercise, arterial occlusion, and incremental arm crank exercise. However, the MOXY reports a greater dynamic range, particularly during ischemia induced by isometric contraction or occlusion (Δ74.3% versus Δ43.7%; hyperemia MAX-occlusion MIN). This study shows that in this subject group both MOXY and PortaMon produce physiologically credible TSI measures during rest and exercise. However, the absolute values obtained during exercise are generally not comparable between devices unless corrected by physiological calibration following an arterial occlusion.
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Affiliation(s)
- Chris J McManus
- University of Essex, School of Sport, Rehabilitation and Exercise Sciences, Colchester, United Kingdom
| | - Jay Collison
- University of Essex, School of Sport, Rehabilitation and Exercise Sciences, Colchester, United Kingdom
| | - Chris E Cooper
- University of Essex, School of Sport, Rehabilitation and Exercise Sciences, Colchester, United Kingdom
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Knols RH, Swanenburg J, De Bon D, Gennaro F, Wolf M, Krüger B, Bettex D, de Bruin ED. Investigating the Usability and Acute Effects of a Bedside Video Console to Prefrontal Cortical Activity Alterations: A Preclinical Study in Healthy Elderly. Front Syst Neurosci 2017; 11:85. [PMID: 29234277 PMCID: PMC5712300 DOI: 10.3389/fnsys.2017.00085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/07/2017] [Indexed: 12/16/2022] Open
Abstract
Elderly people at risk of developing cognitive decline; e.g., following surgery, may benefit from structured, challenging, and repetitive cognitive video training. This study assessed usability and acute effects of a newly developed bedside console (COPHYCON). Fifteen healthy elderly individuals performed a one-time 80-min intervention, including cognitive video games aimed at improving awareness and selective attention. Perceived usefulness and perceived ease of use (Technology Acceptance Model) were assessed together with measures of the achieved game level, reaction times, (in-) correct responses during ALERT and SELECT game play. Further, prefrontal cortical involvement of the regional cerebral hemoglobin saturation (rS02%) assessed with functional near infrared spectroscopy (fNIRS) (n = 5) and EEG power (n = 10) was analyzed. All participants completed the study without any adverse events. Perceived usefulness and perceived ease of use (TAM scores range 1-7) of the system varied between 3.9 and 6.3. The game levels reached for awareness varied between 9 and 11 (initial score 8-10), for reaction speed between 439 and 469 ms, and for correct responses between 74.1 and 78.8%. The highest level for the selective attention games was 2 (initial score 1), where reaction speed varied between 439 and 469 ms, correct responses between 96.2 and 98.5%, respectively. The decrease of rS02% in the right prefrontal cortex during gameplay was significantly (p < 0.001) lower, compared to the left prefrontal cortex. Four participants yielded significant lower rS02% measures after exergaming with the ALERT games (p < 0.000), but not with the SELECT games. EEG recordings of theta power significantly decreased in the averaged ~0.25-0.75 time interval for the left prefrontal cortex sensor across the cognitive game levels between the ALERT 1 and SELECT 1, as well as between SELECT 1 and 2 games. Participants rated the usability of the COPHYCON training positively. Further results indicate that video gaming may be an effective measure to affect prefrontal cortical functioning in elderly. The results warrant a clinical explorative study investigating the feasibility of the COPHYCON in a clinical setting.
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Affiliation(s)
- Ruud H. Knols
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
| | - Jaap Swanenburg
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
- Department of Chiropractic Medicine, Faculty of Medicine, Balgrist University Hospital, University of Zürich, Zurich, Switzerland
| | - Dino De Bon
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Federico Gennaro
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Martin Wolf
- Biomedical Optics Research Laboratory, Division of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Bernard Krüger
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Dominique Bettex
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
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Kassab A, Le Lan J, Tremblay J, Vannasing P, Dehbozorgi M, Pouliot P, Gallagher A, Lesage F, Sawan M, Nguyen DK. Multichannel wearable fNIRS-EEG system for long-term clinical monitoring. Hum Brain Mapp 2017; 39:7-23. [PMID: 29058341 DOI: 10.1002/hbm.23849] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/02/2017] [Accepted: 10/08/2017] [Indexed: 01/27/2023] Open
Abstract
Continuous brain imaging techniques can be beneficial for the monitoring of neurological pathologies (such as epilepsy or stroke) and neuroimaging protocols involving movement. Among existing ones, functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) have the advantage of being noninvasive, nonobstructive, inexpensive, yield portable solutions, and offer complementary monitoring of electrical and local hemodynamic activities. This article presents a novel system with 128 fNIRS channels and 32 EEG channels with the potential to cover a larger fraction of the adult superficial cortex than earlier works, is integrated with 32 EEG channels, is light and battery-powered to improve portability, and can transmit data wirelessly to an interface for real-time display of electrical and hemodynamic activities. A novel fNIRS-EEG stretchable cap, two analog channels for auxiliary data (e.g., electrocardiogram), eight digital triggers for event-related protocols and an internal accelerometer for movement artifacts removal contribute to improve data acquisition quality. The system can run continuously for 24 h. Following instrumentation validation and reliability on a solid phantom, performance was evaluated on (1) 12 healthy participants during either a visual (checkerboard) task at rest or while pedalling on a stationary bicycle or a cognitive (language) task and (2) 4 patients admitted either to the epilepsy (n = 3) or stroke (n = 1) units. Data analysis confirmed expected hemodynamic variations during validation recordings and useful clinical information during in-hospital testing. To the best of our knowledge, this is the first demonstration of a wearable wireless multichannel fNIRS-EEG monitoring system in patients with neurological conditions. Hum Brain Mapp 39:7-23, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Ali Kassab
- Research Center, Centre Hospitalier Universitaire de Montréal, Université de Montréal, Montréal, Québec, H2X 0A9, Canada
| | - Jérôme Le Lan
- Department of Electrical Engineering, École Polytechnique de Montréal, Montréal, Québec, H3T 1J4, Canada
| | - Julie Tremblay
- Research Center, Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, H3T 1C4, Canada
| | - Phetsamone Vannasing
- Research Center, Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, H3T 1C4, Canada
| | - Mahya Dehbozorgi
- Department of Electrical Engineering, École Polytechnique de Montréal, Montréal, Québec, H3T 1J4, Canada
| | - Philippe Pouliot
- Department of Electrical Engineering, École Polytechnique de Montréal, Montréal, Québec, H3T 1J4, Canada.,Research Center, Montreal Heart Institute, Montréal, Québec, H1T 1C8, Canada
| | - Anne Gallagher
- Research Center, Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, H3T 1C4, Canada
| | - Frédéric Lesage
- Department of Electrical Engineering, École Polytechnique de Montréal, Montréal, Québec, H3T 1J4, Canada
| | - Mohamad Sawan
- Department of Electrical Engineering, École Polytechnique de Montréal, Montréal, Québec, H3T 1J4, Canada
| | - Dang Khoa Nguyen
- Research Center, Centre Hospitalier Universitaire de Montréal, Université de Montréal, Montréal, Québec, H2X 0A9, Canada.,Department of Neurology, Hôpital Notre-Dame (Centre Hospitalier de l'Université de Montréal), Montréal, Québec, H2L 4M1, Canada
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Mukaida H, Hayashida M, Matsushita S, Yamamoto M, Nakamura A, Amano A. Brain natriuretic peptide (BNP) may play a major role in risk stratification based on cerebral oxygen saturation by near-infrared spectroscopy in patients undergoing major cardiovascular surgery. PLoS One 2017; 12:e0181154. [PMID: 28704502 PMCID: PMC5507540 DOI: 10.1371/journal.pone.0181154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/27/2017] [Indexed: 01/08/2023] Open
Abstract
Purpose A previous study reported that low baseline cerebral oxygen saturation (ScO2) (≤50%) measured with near-infrared spectroscopy was predictive of poor clinical outcomes after cardiac surgery. However, such findings have not been reconfirmed by others. We conducted the current study to evaluate whether the previous findings would be reproducible, and to explore mechanisms underlying the ScO2-based outcome prediction. Methods We retrospectively investigated 573 consecutive patients, aged 20 to 91 (mean ± standard deviation, 67.1 ± 12.8) years, who underwent major cardiovascular surgery. Preanesthetic baseline ScO2, lowest intraoperative ScO2, various clinical variables, and hospital mortality were examined. Results Bivariate regression analyses revealed that baseline ScO2 correlated significantly with plasma brain natriuretic peptide concentration (BNP), hemoglobin concentration (Hgb), estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction (LVEF) (p < 0.0001 for each). Baseline ScO2 correlated with BNP in an exponential manner, and BNP was the most significant factor influencing ScO2. Logistic regression analyses revealed that baseline and lowest intraoperative ScO2 values, but not relative ScO2 decrements, were significantly associated with hospital mortality (p < 0.05), independent of the EuroSCORE (p < 0.01). Receiver operating curve analysis of ScO2 values and hospital mortality revealed an area under the curve (AUC) of 0.715 (p < 0.01) and a cutoff value of ≤50.5% for the baseline and ScO2, and an AUC of 0.718 (p < 0.05) and a cutoff value of ≤35% for the lowest intraoperative ScO2. Low baseline ScO2 (≤50%) was associated with increases in intubation time, intensive care unit stay, hospital stay, and hospital mortality. Conclusion Baseline ScO2 was reflective of severity of systemic comorbidities and was predictive of clinical outcomes after major cardiovascular surgery. ScO2 correlated most significantly with BNP in an exponential manner, suggesting that BNP plays a major role in the ScO2-based outcome prediction.
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Affiliation(s)
- Hiroshi Mukaida
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Clinical Engineering, Juntendo University Hospital, Tokyo, Japan
- * E-mail:
| | - Masakazu Hayashida
- Department of Anesthesiology & Pain Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoshi Matsushita
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Makiko Yamamoto
- Department of Anesthesiology & Pain Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsushi Nakamura
- Department of Clinical Engineering, Kyorin University Faculty of Health Sciences, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
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Nordström CH, Koskinen LO, Olivecrona M. Aspects on the Physiological and Biochemical Foundations of Neurocritical Care. Front Neurol 2017; 8:274. [PMID: 28674514 PMCID: PMC5474476 DOI: 10.3389/fneur.2017.00274] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/29/2017] [Indexed: 12/25/2022] Open
Abstract
Neurocritical care (NCC) is a branch of intensive care medicine characterized by specific physiological and biochemical monitoring techniques necessary for identifying cerebral adverse events and for evaluating specific therapies. Information is primarily obtained from physiological variables related to intracranial pressure (ICP) and cerebral blood flow (CBF) and from physiological and biochemical variables related to cerebral energy metabolism. Non-surgical therapies developed for treating increased ICP are based on knowledge regarding transport of water across the intact and injured blood-brain barrier (BBB) and the regulation of CBF. Brain volume is strictly controlled as the BBB permeability to crystalloids is very low restricting net transport of water across the capillary wall. Cerebral pressure autoregulation prevents changes in intracranial blood volume and intracapillary hydrostatic pressure at variations in arterial blood pressure. Information regarding cerebral oxidative metabolism is obtained from measurements of brain tissue oxygen tension (PbtO2) and biochemical data obtained from intracerebral microdialysis. As interstitial lactate/pyruvate (LP) ratio instantaneously reflects shifts in intracellular cytoplasmatic redox state, it is an important indicator of compromised cerebral oxidative metabolism. The combined information obtained from PbtO2, LP ratio, and the pattern of biochemical variables reveals whether impaired oxidative metabolism is due to insufficient perfusion (ischemia) or mitochondrial dysfunction. Intracerebral microdialysis and PbtO2 give information from a very small volume of tissue. Accordingly, clinical interpretation of the data must be based on information of the probe location in relation to focal brain damage. Attempts to evaluate global cerebral energy state from microdialysis of intraventricular fluid and from the LP ratio of the draining venous blood have recently been presented. To be of clinical relevance, the information from all monitoring techniques should be presented bedside online. Accordingly, in the future, the chemical variables obtained from microdialysis will probably be analyzed by biochemical sensors.
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Affiliation(s)
| | - Lars-Owe Koskinen
- Department of Clinical Neuroscience, Division of Neurosurgery, Umeå University, Umeå, Sweden
| | - Magnus Olivecrona
- Faculty of Health and Medicine, Department of Anesthesia and Intensive Care, Section for Neurosurgery Örebro University Hospital, Örebro University, Örebro, Sweden
- Department for Medical Sciences, Örebro University, Örebro, Sweden
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Olmo Arroyo J, Khirani S, Amaddeo A, Griffon L, De Sanctis L, Pouard P, Fauroux B. A comparison of pulse oximetry and cerebral oxygenation in children with severe sleep apnea-hypopnea syndrome: a pilot study. J Sleep Res 2017; 26:799-808. [DOI: 10.1111/jsr.12561] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jorge Olmo Arroyo
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
- ASV Santé; Gennevilliers France
| | - Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
- Paris Descartes University; Paris France
- Research Unit INSERM U 955; Team 13; Créteil France
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
| | - Livio De Sanctis
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
| | - Philippe Pouard
- Pediatric Cardiac Intensive Care and Anaesthesia Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
- Paris Descartes University; Paris France
- Research Unit INSERM U 955; Team 13; Créteil France
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41
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Chirinos JA, Londono-Hoyos F, Zamani P, Beraun M, Haines P, Vasim I, Varakantam S, Phan TS, Cappola TP, Margulies KB, Townsend RR, Segers P. Effects of organic and inorganic nitrate on aortic and carotid haemodynamics in heart failure with preserved ejection fraction. Eur J Heart Fail 2017; 19:1507-1515. [PMID: 28547861 DOI: 10.1002/ejhf.885] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 04/04/2017] [Accepted: 04/10/2017] [Indexed: 01/23/2023] Open
Abstract
AIMS To assess the haemodynamic effects of organic vs. inorganic nitrate administration among patients with heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS We assessed carotid and aortic pressure-flow relations non-invasively before and after the administration of 0.4 mg of sublingual nitroglycerin (n = 26), and in a separate sub-study, in response to 12.9 mmoL of inorganic nitrate (n = 16). Nitroglycerin did not consistently reduce wave reflections arriving at the proximal aorta (change in real part of reflection coefficient, 1st harmonic: -0.09; P = 0.01; 2nd harmonic: -0.045, P = 0.16; 3rd harmonic: +0.087; P = 0.05), but produced profound vasodilatation in the carotid territory, with a significant reduction in systolic blood pressure (133.6 vs. 120.5 mmHg; P = 0.011) and a marked reduction in carotid bed vascular resistance (19 580 vs. 13 078 dynes · s/cm5 ; P = 0.001) and carotid characteristic impedance (3440 vs. 1923 dynes · s/cm5 ; P = 0.002). Inorganic nitrate, in contrast, consistently reduced wave reflections across the first three harmonics (change in real part of reflection coefficient, 1st harmonic: -0.12; P = 0.03; 2nd harmonic: -0.11, P = 0.01; 3rd harmonic: -0.087; P = 0.09) and did not reduce blood pressure, carotid bed vascular resistance, or carotid characteristic impedance (P = NS). CONCLUSIONS Nitroglycerin produces marked vasodilatation in the carotid circulation, with a pronounced reduction in blood pressure and inconsistent effects on central wave reflections. Inorganic nitrate, in contrast, produces consistent reductions in wave reflections, and unlike nitroglycerin, it does so without significant hypotension or cerebrovascular dilatation. These haemodynamic differences may underlie the different effects on exercise capacity and side effect profile of inorganic vs. organic nitrate in HFpEF.
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Affiliation(s)
- Julio A Chirinos
- University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Francisco Londono-Hoyos
- University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Institute of Biomedical Technology, Ghent University, Ghent, Belgium
| | - Payman Zamani
- University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Melissa Beraun
- University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Philip Haines
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Izzah Vasim
- University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Swapna Varakantam
- University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Timothy S Phan
- University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas P Cappola
- University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth B Margulies
- University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Raymond R Townsend
- University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick Segers
- Institute of Biomedical Technology, Ghent University, Ghent, Belgium
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42
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Wen SYB, Peng AZY, Boyle S, Cai S, Pope L, Tran MT, Short TG, Aneman A, Jaeger M, Chuan A. A Pilot Study Using Preoperative Cerebral Tissue Oxygen Saturation to Stratify Cardiovascular Risk in Major Non-Cardiac Surgery. Anaesth Intensive Care 2017; 45:202-209. [PMID: 28267942 DOI: 10.1177/0310057x1704500210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This prospective pilot study evaluated whether low preoperative cerebral tissue oxygen saturation is associated with unfavourable outcomes after major elective non-cardiac surgery. Eighty-one patients over 60 years of age, American Society of Anesthesiologists physical status 3 or 4, were recruited. Resting cerebral tissue oxygen saturation was recorded on room air, and after oxygen supplementation, using cerebral oximetry. The primary outcome was 30-day major adverse event of combined mortality or severe morbidity, and the secondary outcome was 30-day new disability. Eleven patients (13.6%) suffered a major adverse event, and 28 patients (34.6%) experienced new disability. Room air cerebral tissue oxygen saturation was significantly different between patients who had a major adverse event, 67% (95% confidence interval [CI] 65–70) versus unaffected, 71% (95% CI 70–72; P=0.04). No statistical difference was found between patients for new disability (range 70%– 74%; P=0.73). Room air cerebral tissue oxygen saturation was significantly associated with major adverse events (odds ratio 1.36 (95% CI 1.03–1.79), P=0.03). Saturation levels ≤68% carried a positive likelihood ratio of 2.2 for death or severe morbidity, P=0.04. A definitive trial is required to confirm if cerebral oximetry can be used to stratify the cardiovascular risk of patients presenting for non-cardiac surgery.
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Affiliation(s)
- S. Y. B. Wen
- South West Sydney Clinical School, University of NSW, Sydney, New South Wales
| | - A. Z. Y. Peng
- South West Sydney Clinical School, University of NSW, Sydney, New South Wales
| | - S. Boyle
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
| | - S. Cai
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
| | - L. Pope
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
| | - M. T. Tran
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
| | - T. G. Short
- Department of Anaesthesia, Auckland City Hospital, New Zealand
| | - A. Aneman
- Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales
| | - M. Jaeger
- South Western Sydney Clinical School, University of NSW, Sydney, New South Wales
| | - A. Chuan
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
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43
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Lopez MG, Pandharipande P, Morse J, Shotwell MS, Milne GL, Pretorius M, Shaw AD, Roberts LJ, Billings FT. Intraoperative cerebral oxygenation, oxidative injury, and delirium following cardiac surgery. Free Radic Biol Med 2017; 103:192-198. [PMID: 28039082 PMCID: PMC5258679 DOI: 10.1016/j.freeradbiomed.2016.12.039] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/16/2016] [Accepted: 12/26/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Delirium affects 20-30% of patients after cardiac surgery and is associated with increased mortality and persistent cognitive decline. Hyperoxic reperfusion of ischemic tissues increases oxidative injury, but oxygen administration remains high during cardiac surgery. We tested the hypothesis that intraoperative hyperoxic cerebral reperfusion is associated with increased postoperative delirium and that oxidative injury mediates this association. METHODS We prospectively measured cerebral oxygenation with bilateral oximetry monitors in 310 cardiac surgery patients, quantified intraoperative hyperoxic cerebral reperfusion by measuring the magnitude of cerebral oxygenation above baseline after any ischemic event, and assessed patients for delirium twice daily in the ICU following surgery using the confusion assessment method for ICU (CAM-ICU). We examined the association between hyperoxic cerebral reperfusion and postoperative delirium, adjusted for the extent of cerebral hypoxia, the extent of cerebral hyperoxia prior to any ischemia, and additional potential confounders and risk factors for delirium. To assess oxidative injury mediation, we examined the association between hyperoxic cerebral reperfusion and delirium after further adjusting for plasma levels of F2-isoprostanes and isofurans at baseline and ICU admission, the association between hyperoxic cerebral reperfusion and these markers of oxidative injury, and the association between these markers and delirium. RESULTS Ninety of the 310 patients developed delirium following surgery. Every 10%·hour of intraoperative hyperoxic cerebral reperfusion was independently associated with a 65% increase in the odds of delirium (OR, 1.65 [95% CI, 1.12-2.44]; P=0.01). Hyperoxia prior to ischemia was also independently associated with delirium (1.10 [1.01-1.19]; P=0.02), but hypoxia was not (1.12 [0.97-1.29]; P=0.11). Increased hyperoxic cerebral reperfusion was associated with increased concentrations of F2-isoprostanes and isofurans at ICU admission, increased concentrations of these markers were associated with increased delirium, and the association between hyperoxic cerebral reperfusion and delirium was weaker after adjusting for these markers of oxidative injury. CONCLUSIONS Intraoperative hyperoxic cerebral reperfusion was associated with increased postoperative delirium, and increased oxidative injury following hyperoxic cerebral reperfusion may partially mediate this association. Further research is needed to assess the potential deleterious role of cerebral hyper-oxygenation during surgery.
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Affiliation(s)
- Marcos G Lopez
- Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Pratik Pandharipande
- Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jennifer Morse
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Matthew S Shotwell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Ginger L Milne
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Mias Pretorius
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA; Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Andrew D Shaw
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - L Jackson Roberts
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Frederic T Billings
- Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA; Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA; Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
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44
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Nissen M, Cernaianu G, Thränhardt R, Vahdad MR, Barenberg K, Tröbs RB. Does metabolic alkalosis influence cerebral oxygenation in infantile hypertrophic pyloric stenosis? J Surg Res 2017; 212:229-237. [PMID: 28550912 DOI: 10.1016/j.jss.2017.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 12/30/2016] [Accepted: 01/19/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND This pilot study focuses on regional tissue oxygenation (rSO2) in patients with infantile hypertrophic pyloric stenosis in a perioperative setting. To investigate the influence of enhanced metabolic alkalosis (MA) on cerebral (c-rSO2) and renal (r-rSO2) tissue oxygenation, two-site near-infrared spectroscopy (NIRS) technology was applied. MATERIALS AND METHODS Perioperative c-rSO2, r-rSO2, capillary blood gases, and electrolytes from 12 infants were retrospectively compared before and after correction of MA at admission (T1), before surgery (T2), and after surgery (T3). RESULTS Correction of MA was associated with an alteration of cerebral oxygenation without affecting renal oxygenation. When compared to T1, 5-min mean (± standard deviation) c-rSO2 increased after correction of MA at T2 (72.74 ± 4.60% versus 77.89 ± 5.84%; P = 0.058), reaching significance at T3 (80.79 ± 5.29%; P = 0.003). Furthermore, relative 30-min c-rSO2 values at first 3 h of metabolic compensation were significantly lowered compared with postsurgical states at 16 and 24 h. Cerebral oxygenation was positively correlated with levels of sodium (r = 0.37; P = 0.03) and inversely correlated with levels of bicarbonate (r = -0.34; P = 0.05) and base excess (r = -0.36; P = 0.04). Analysis of preoperative and postoperative cerebral and renal hypoxic burden yielded no differences. However, a negative correlation (r = -0.40; P = 0.03) regarding hematocrite and mean r-rSO2, indirectly indicative of an increased renal blood flow under hemodilution, was obtained. CONCLUSIONS NIRS seems suitable for the detection of a transiently impaired cerebral oxygenation under state of pronounced MA in infants with infantile hypertrophic pyloric stenosis. Correction of MA led to normalization of c-rSO2. NIRS technology constitutes a promising tool for optimizing perioperative management, especially in the context of a possible diminished neurodevelopmental outcome after pyloromyotomy.
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Affiliation(s)
- Matthias Nissen
- Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, Herne, Germany.
| | - Grigore Cernaianu
- Department of Pediatrics and Adolescent Medicine, Pediatric Surgery, University of Cologne, Cologne, Germany
| | - Rene Thränhardt
- Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, Herne, Germany
| | - Mohammad R Vahdad
- Department of Pediatric Surgery, University Hospital Giessen/Marburg, Marburg, Germany
| | - Karin Barenberg
- Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, Herne, Germany
| | - Ralf-Bodo Tröbs
- Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, Herne, Germany
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45
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Dix LML, van Bel F, Lemmers PMA. Monitoring Cerebral Oxygenation in Neonates: An Update. Front Pediatr 2017; 5:46. [PMID: 28352624 PMCID: PMC5348638 DOI: 10.3389/fped.2017.00046] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/24/2017] [Indexed: 11/13/2022] Open
Abstract
Cerebral oxygenation is not always reflected by systemic arterial oxygenation. Therefore, regional cerebral oxygen saturation (rScO2) monitoring with near-infrared spectroscopy (NIRS) is of added value in neonatal intensive care. rScO2 represents oxygen supply to the brain, while cerebral fractional tissue oxygen extraction, which is the ratio between rScO2 and systemic arterial oxygen saturation, reflects cerebral oxygen utilization. The balance between oxygen supply and utilization provides insight in neonatal cerebral (patho-)physiology. This review highlights the potential and limitations of cerebral oxygenation monitoring with NIRS in the neonatal intensive care unit.
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Affiliation(s)
- Laura Marie Louise Dix
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; Monash Newborn, Monash Medical Centre, Melbourne, VIC, Australia
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht , Netherlands
| | - Petra Maria Anna Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht , Netherlands
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46
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Végh T. Cerebral Oximetry in General Anaesthesia. Turk J Anaesthesiol Reanim 2016; 44:247-249. [PMID: 27909605 DOI: 10.5152/tjar.2016.26092016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Tamás Végh
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary; Outcomes Research Consortium, Cleveland, USA
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47
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Cournoyer A, Denault A, Cossette S, Fortier A, Daoust R, Iseppon M, Chauny JM, Notebaert E. Reproducibility, interchangeability of measures, time to measure stabilization, and reference values of two tissue oximeters in healthy volunteers. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:97003. [PMID: 27637007 DOI: 10.1117/1.jbo.21.9.097003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/30/2016] [Indexed: 06/06/2023]
Abstract
This study aimed to compare two tissue oximeters, the INVOS 5100c and the Equanox 7600, in terms of their reproducibility and the interchangeability of their measures. In a randomized order, three measurements were taken at six different sites on both sides of the body in 53 healthy volunteers. Intraclass correlation coefficients (ICC) and within-subject standard deviation (Sw) were calculated for each device. The ICCs were compared using Fisher r-to-z transformation and the Sw were compared using paired-sample t-tests. We found no difference between the reproducibility of the INVOS {ICC=0.92 [95% confidence interval (CI) 0.90 to 0.93]} and Equanox [ICC=0.90 (95% CI 0.88 to 0.93)] in terms of ICCs (p=0.06). However, the Equanox [Sw=1.96 (95% CI 1.91 to 2.02)] showed a better Sw than the INVOS [Sw=2.11 (95% CI 2.05 to 2.17)] (p=0.019). Also, when compared directly to stable condition, the readings produced by the two oximeters varied considerably [ICC 0.43 (95% CI 0.36 to 0.49)]. When taken individually, both tissue oximeters displayed good reproducibility, the Equanox being slightly better than the INVOS in terms of absolute reproducibility. However, when compared, the oximeters showed poor interdevices agreement. Reference values were also described.
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Affiliation(s)
- Alexis Cournoyer
- Université de Montréal, Faculty of Medicine, Department of Family Medicine and Emergency Medicine, 5400 Gouin Ouest, Montréal H4J 1C5, Canada
| | - André Denault
- Université de Montréal, Faculty of Medicine, Department of Anesthesia and Critical Care Division, 5000 Bélanger, Montréal H1T 1C8, Canada
| | - Sylvie Cossette
- Université de Montréal, Faculty of Nursing, 2375 Côte-Ste-Catherine, Montréal H3T 1A8, Canada
| | - Annik Fortier
- Montréal Health Innovations Coordinating Center, 4100 Molson #400, Montréal H1Y 3N1, Canada
| | - Raoul Daoust
- Université de Montréal, Faculty of Medicine, Department of Family Medicine and Emergency Medicine, 5400 Gouin Ouest, Montréal H4J 1C5, Canada
| | - Massimiliano Iseppon
- Université de Montréal, Faculty of Medicine, Department of Family Medicine and Emergency Medicine, 5400 Gouin Ouest, Montréal H4J 1C5, Canada
| | - Jean-Marc Chauny
- Université de Montréal, Faculty of Medicine, Department of Family Medicine and Emergency Medicine, 5400 Gouin Ouest, Montréal H4J 1C5, Canada
| | - Eric Notebaert
- Université de Montréal, Faculty of Medicine, Department of Family Medicine and Emergency Medicine, 5400 Gouin Ouest, Montréal H4J 1C5, Canada
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48
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Bailey SM, Mally PV. Review of splanchnic oximetry in clinical medicine. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:091306. [PMID: 27165703 DOI: 10.1117/1.jbo.21.9.091306] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/13/2016] [Indexed: 06/05/2023]
Abstract
Global tissue perfusion and oxygenation are important indicators of physiologic function in humans. The monitoring of splanchnic oximetry through the use of near-infrared spectroscopy (NIRS) is an emerging method used to assess tissue oxygenation status. Splanchnic tissue oxygenation (SrSO2) is thought to be potentially of high value in critically ill patients because gastrointestinal organs can often be the first to suffer ischemic injury. During conditions of hypovolemia, cardiac dysfunction, or decreased oxygen-carrying capacity, blood flow is diverted toward vital organs, such as the brain and the heart at the expense of the splanchnic circulation. While monitoring SrSO2 has great potential benefit, there are limitations to the technology and techniques. SrSO2 has been found to have a relatively high degree of variability that can potentially make it difficult to interpret. In addition, because splanchnic organs only lie near the skin surface in children and infants, and energy from currently available sensors only penetrates a few centimeters deep, it can be difficult to use clinically in a noninvasive manner in adults. Research thus far is showing that splanchnic oximetry holds great promise in the ability to monitor patient oxygenation status and detect disease states in humans, especially in pediatric populations.
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49
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Cournoyer A, Iseppon M, Chauny JM, Denault A, Cossette S, Notebaert É. Near-infrared Spectroscopy Monitoring During Cardiac Arrest: A Systematic Review and Meta-analysis. Acad Emerg Med 2016; 23:851-62. [PMID: 27028004 DOI: 10.1111/acem.12980] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/05/2016] [Accepted: 03/28/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tissue oximetry using near-infrared spectroscopy (NIRS) is a noninvasive monitor of cerebral oxygenation. This new technology has been used during cardiac arrest (CA) because of its ability to give measures in low-blood-flow situations. The aim of this study was to assess the evidence regarding the association between the types of NIRS measurements (mean, initial, and highest values) and resuscitation outcomes (return of spontaneous circulation [ROSC], survival to discharge, and good neurologic outcome) in patients undergoing cardiopulmonary resuscitation. METHODS This review was registered (Prospero CRD42015017380) and is reported as per the PRISMA guidelines. Medline, Embase, and CENTRAL were searched. All studies, except case reports and case series of fewer than five patients, reporting on adults that had NIRS monitoring during CA were eligible for inclusion. Two reviewers assessed the quality of the included articles and extracted the data. The outcome effect was standardized using standardized mean difference (SMD). RESULTS Twenty nonrandomized observational studies (15 articles and five conference abstracts) were included in this review, for a total of 2,436 patients. We found a stronger association between ROSC and mean NIRS values (SMD = 1.33; 95% confidence interval [CI] = 0.92 to 1.74) than between ROSC and initial NIRS measurements (SMD = 0.51; 95% CI = 0.23 to 0.78). There was too much heterogeneity among the highest NIRS measurements group to perform meta-analysis. Only two of the 75 patients who experienced ROSC had a mean NIRS saturation under 30%. Patients who survived to discharge and who had good neurologic outcome displayed superior combined initial and mean NIRS values than their counterparts (SMD = 1.63; 95% CI = 1.34 to 1.92; and SMD = 2.12; 95% CI = 1.14 to 3.10). CONCLUSIONS Patients with good resuscitation outcomes have significantly higher NIRS saturations during resuscitation than their counterparts. The types of NIRS measurements during resuscitation influenced the association between ROSC and NIRS saturation. Prolonged failure to obtain a NIRS saturation higher than 30% may be included in a multimodal approach to the decision of terminating resuscitation efforts (Class IIb, Level of Evidence C-Limited Data).
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Affiliation(s)
| | | | - Jean-Marc Chauny
- Université de Montréal; Montréal Québec
- Hôpital du Sacré-Cœur de Montréal; Montréal Québec
| | - André Denault
- Université de Montréal; Montréal Québec
- Montreal Heart Institute; Montréal Québec
- Centre Hospitalier de l'Université de Montréal; Montréal Québec
| | - Sylvie Cossette
- Université de Montréal; Montréal Québec
- Montreal Heart Institute; Montréal Québec
| | - Éric Notebaert
- Université de Montréal; Montréal Québec
- Hôpital du Sacré-Cœur de Montréal; Montréal Québec
- Cité de la Santé de Laval; Montréal Québec Canada
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50
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Chitnis D, Airantzis D, Highton D, Williams R, Phan P, Giagka V, Powell S, Cooper RJ, Tachtsidis I, Smith M, Elwell CE, Hebden JC, Everdell N. Towards a wearable near infrared spectroscopic probe for monitoring concentrations of multiple chromophores in biological tissue in vivo. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2016; 87:065112. [PMID: 27370501 PMCID: PMC4957669 DOI: 10.1063/1.4954722] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The first wearable multi-wavelength technology for functional near-infrared spectroscopy has been developed, based on a custom-built 8-wavelength light emitting diode (LED) source. A lightweight fibreless probe is designed to monitor changes in the concentrations of multiple absorbers (chromophores) in biological tissue, the most dominant of which at near-infrared wavelengths are oxyhemoglobin and deoxyhemoglobin. The use of multiple wavelengths enables signals due to the less dominant chromophores to be more easily distinguished from those due to hemoglobin and thus provides more complete and accurate information about tissue oxygenation, hemodynamics, and metabolism. The spectroscopic probe employs four photodiode detectors coupled to a four-channel charge-to-digital converter which includes a charge integration amplifier and an analogue-to-digital converter (ADC). Use of two parallel charge integrators per detector enables one to accumulate charge while the other is being read out by the ADC, thus facilitating continuous operation without dead time. The detector system has a dynamic range of about 80 dB. The customized source consists of eight LED dies attached to a 2 mm × 2 mm substrate and encapsulated in UV-cured epoxy resin. Switching between dies is performed every 20 ms, synchronized to the detector integration period to within 100 ns. The spectroscopic probe has been designed to be fully compatible with simultaneous electroencephalography measurements. Results are presented from measurements on a phantom and a functional brain activation study on an adult volunteer, and the performance of the spectroscopic probe is shown to be very similar to that of a benchtop broadband spectroscopy system. The multi-wavelength capabilities and portability of this spectroscopic probe will create significant opportunities for in vivo studies in a range of clinical and life science applications.
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Affiliation(s)
- Danial Chitnis
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Dimitrios Airantzis
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - David Highton
- Neurocritical Care Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London WC1N 3BG, United Kingdom
| | - Rhys Williams
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Phong Phan
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Vasiliki Giagka
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Samuel Powell
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Robert J Cooper
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Martin Smith
- Neurocritical Care Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London WC1N 3BG, United Kingdom
| | - Clare E Elwell
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Jeremy C Hebden
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - Nicholas Everdell
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
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