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Tagliabue S, Lindner C, da Prat IC, Sanchez-Guerrero A, Serra I, Kacprzak M, Maruccia F, Silva OM, Weigel UM, de Nadal M, Poca MA, Durduran T. Comparison of cerebral metabolic rate of oxygen, blood flow, and bispectral index under general anesthesia. NEUROPHOTONICS 2023; 10:015006. [PMID: 36911206 PMCID: PMC9993084 DOI: 10.1117/1.nph.10.1.015006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
SIGNIFICANCE The optical measurement of cerebral oxygen metabolism was evaluated. AIM Compare optically derived cerebral signals to the electroencephalographic bispectral index (BIS) sensors to monitor propofol-induced anesthesia during surgery. APPROACH Relative cerebral metabolic rate of oxygen ( rCMRO 2 ) and blood flow (rCBF) were measured by time-resolved and diffuse correlation spectroscopies. Changes were tested against the relative BIS (rBIS) ones. The synchronism in the changes was also assessed by the R-Pearson correlation. RESULTS In 23 measurements, optically derived signals showed significant changes in agreement with rBIS: during propofol induction, rBIS decreased by 67% [interquartile ranges (IQR) 62% to 71%], rCMRO 2 by 33% (IQR 18% to 46%), and rCBF by 28% (IQR 10% to 37%). During recovery, a significant increase was observed for rBIS (48%, IQR 38% to 55%), rCMRO 2 (29%, IQR 17% to 39%), and rCBF (30%, IQR 10% to 44%). The significance and direction of the changes subject-by-subject were tested: the coupling between the rBIS, rCMRO 2 , and rCBF was witnessed in the majority of the cases (14/18 and 12/18 for rCBF and 19/21 and 13/18 for rCMRO 2 in the initial and final part, respectively). These changes were also correlated in time ( R > 0.69 to R = 1 , p - values < 0.05 ). CONCLUSIONS Optics can reliably monitor rCMRO 2 in such conditions.
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Affiliation(s)
- Susanna Tagliabue
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Claus Lindner
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | | | - Angela Sanchez-Guerrero
- Vall d’Hebron University Hospital Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
| | - Isabel Serra
- Centre de Recerca Matemàtica, Bellaterra, Spain
- Barcelona Supercomputing Center—Centre Nacional de Supercomputació, Spain
| | - Michał Kacprzak
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Nalecz Institute of Biocybernetics and Biomedical Engineering PAS, Warsaw, Poland
| | - Federica Maruccia
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Vall d’Hebron University Hospital Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
| | - Olga Martinez Silva
- Vall d’Hebron University Hospital, Department of Anesthesiology, Barcelona, Spain
| | - Udo M. Weigel
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- HemoPhotonics S.L., Mediterranean Technology Park, Barcelona, Spain
| | - Miriam de Nadal
- Vall d’Hebron University Hospital, Department of Anesthesiology, Barcelona, Spain
- Universidad Autònoma de Barcelona, Plaça Cívica, Barcelona, Spain
| | - Maria A. Poca
- Vall d’Hebron University Hospital Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
- Universidad Autònoma de Barcelona, Plaça Cívica, Barcelona, Spain
- Vall d’Hebron University Hospital, Department of Neurosurgery, Barcelona, Spain
| | - Turgut Durduran
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
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Chiarini G, Cho SM, Whitman G, Rasulo F, Lorusso R. Brain Injury in Extracorporeal Membrane Oxygenation: A Multidisciplinary Approach. Semin Neurol 2021; 41:422-436. [PMID: 33851392 DOI: 10.1055/s-0041-1726284] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) represents an established technique to provide temporary cardiac and/or pulmonary support. ECMO, in veno-venous, veno-arterial or in extracorporeal carbon dioxide removal modality, is associated with a high rate of brain injuries. These complications have been reported in 7 to 15% of adults and 20% of neonates, and are associated with poor survival. Thromboembolic events, loss of cerebral autoregulation, alteration of the blood-brain barrier, and hemorrhage related to anticoagulation represent the main causes of severe brain injury during ECMO. The most frequent forms of acute neurological injuries in ECMO patients are intracranial hemorrhage (2-21%), ischemic stroke (2-10%), seizures (2-6%), and hypoxic-ischemic brain injury; brain death may also occur in this population. Other frequent complications are infarction (1-8%) and cerebral edema (2-10%), as well as neuropsychological and psychiatric sequelae, including posttraumatic stress disorder.
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Affiliation(s)
- Giovanni Chiarini
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.,Division of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University, Affiliated Hospital of Brescia, Brescia, Italy
| | - Sung-Min Cho
- Departments of Neurology, Anesthesiology, and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Glenn Whitman
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Frank Rasulo
- Division of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University, Affiliated Hospital of Brescia, Brescia, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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3
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Kadokura Y, Hayashida M, Kakemizu-Watanabe M, Yamamoto M, Endo D, Oishi A, Nakanishi K, Hata H. Cerebral oxygen saturation (rSO 2) during cardiopulmonary bypass (CPB) measured using the INVOS oximeter closely correlates with baseline rSO 2. J Artif Organs 2021; 24:433-441. [PMID: 33826034 DOI: 10.1007/s10047-021-01263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
Baseline cerebral regional saturation (rSO2) measured using the INVOS 5100C (Medtronic, MN, USA) varies widely among patients with cardiac and/or renal diseases. To identify significant correlates of baseline rSO2 and to investigate intraoperative rSO2 changes, we conducted a retrospective study in 494 patients undergoing on-pump cardiovascular surgery. Correlations between preoperative blood laboratory test variables and baseline rSO2 before anesthesia were examined. Intraoperative rSO2 changes were analyzed. Of all the variables examined, log-transformed B-type natriuretic peptide (BNP) most significantly and negatively correlated with baseline rSO2 (r = - 0.652, p < 0.0001). Intraoperatively, rSO2 showed the lowest value during cardiopulmonary bypass (CPB) (median rSO2: 56.2% during CPB vs. 63.9% at baseline, p < 0.0001). Although rSO2 during CPB correlated positively with hemoglobin concentration and oxygen delivery during CPB (r = 0.192, p < 0.0001; and r = 0.172, p = 0.0001, respectively), it correlated much more closely with baseline rSO2 (r = - 0.589, p < 0.0001). Thus, patients showing low baseline rSO2 primarily associated with preoperatively high BNP continued to show low rSO2 even during CPB independent of hemodynamics artificially controlled by CPB. Our findings suggest that low baseline rSO2 in patients with high BNP due to cardiac and/or renal diseases is more likely to result from tissue edema causing alterations in optical pathlength and thus in calculated rSO2 values, not readily modifiable with CPB, rather than actual cerebral hemodynamic alterations readily modifiable with CPB. These may partly explain why the INVOS oximeter is a trend monitor requiring baseline measures.
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Affiliation(s)
- Yumiko Kadokura
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Maho Kakemizu-Watanabe
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Makiko Yamamoto
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Daisuke Endo
- Department of Cardiovascular Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Atsumi Oishi
- Department of Cardiovascular Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Keisuke Nakanishi
- Department of Cardiovascular Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroaki Hata
- Department of Cardiovascular Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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4
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Kaya C, Cebeci H, Tomak L, Ozbalci GS. Prospective Randomized Trial Between Propofol Intravenous and Sevoflurane Inhaled Anesthesia on Cerebral Oximetry. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cengiz Kaya
- Department of Anesthesiology, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Halil Cebeci
- Department of Anesthesiology, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Leman Tomak
- Department of Biostatistics and Public Health, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Gokhan Selcuk Ozbalci
- Department of General Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
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5
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Near Infrared Spectroscopy in Anemia Detection and Management: A Systematic Review. Transfus Med Rev 2020; 35:22-28. [PMID: 32907764 DOI: 10.1016/j.tmrv.2020.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/19/2020] [Accepted: 07/26/2020] [Indexed: 01/28/2023]
Abstract
Red cell transfusions are intended to improve oxygen delivery to tissues. Although studies comparing hemoglobin concentration triggers for transfusion have been done, the hemoglobin threshold for clinical benefit remains uncertain. Direct measurement of tissue oxygenation with non-invasive near infrared spectroscopy has been proposed as a more physiological transfusion trigger, but its clinical role remains unclear. This systematic review examined the role of near infrared spectroscopy for detection of anemia and guiding transfusion decisions. Abstracts were identified up until May 2019 through searches of PubMed, EMBASE and The Web of Science. There were 69 studies meeting the inclusion criteria, most (n = 65) of which were observational studies. Tissue oxygen saturation had been measured in a wide range of clinical settings, with neonatal intensive care (n = 26) and trauma (n = 7) being most common. Correlations with hemoglobin concentration and tissue oxygenation were noted and there were correlations between changes in red cell mass and changes in tissue oxygenation through blood loss or transfusion. The value of tissue oxygenation for predicting transfusion was determined in only four studies, all using muscle oxygen saturation in the adult trauma setting. The overall sensitivity was low at 34% (27%-42%) and while it had better specificity at 78% (74%-82%), differing and retrospective approaches create a high level of uncertainty with respect to these conclusions. There were four prospective randomized studies involving 540 patients, in cardiac and neurological surgery and in neonates that compared near infrared spectroscopy to guide transfusion decisions with standard practice. These showed a reduction in the number of red cells transfused per patient (OR: 0.44 [0.09-0.79]), but not the number of patients who received transfusion (OR: 0.71 [0.46-1.10]), and no change in clinical outcomes. Measuring tissue oxygen saturation has potential to help guide transfusion; however, there is a lack of data upon which to recommend widespread implementation into clinical practice. Standardization of measurements is required and greater research into levels at which tissue oxygenation may lead to adverse clinical outcomes would help in the design of future clinical trials.
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6
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Effect of Hydroxyethyl Starch Loading on Glycocalyx Shedding and Cerebral Metabolism During Surgery. J Surg Res 2020; 246:274-283. [DOI: 10.1016/j.jss.2019.09.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 08/04/2019] [Accepted: 09/13/2019] [Indexed: 12/24/2022]
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7
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Guyon PW, Karamlou T, Ratnayaka K, El-Said HG, Moore JW, Rao RP. An Elusive Prize: Transcutaneous Near InfraRed Spectroscopy (NIRS) Monitoring of the Liver. Front Pediatr 2020; 8:563483. [PMID: 33330267 PMCID: PMC7711108 DOI: 10.3389/fped.2020.563483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/26/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction: We postulate a relationship between a transcutaneous hepatic NIRS measurement and a directly obtained hepatic vein saturation. If true, hepatic NIRS monitoring (in conjunction with the current dual-site cerebral-renal NIRS paradigm) might increase the sensitivity for detecting shock since regional oxygen delivery changes in the splanchnic circulation before the kidney or brain. We explored a reliable technique for hepatic NIRS monitoring as a prelude to rigorously testing this hypothesis. This proof-of-concept study aimed to validate hepatic NIRS monitoring by comparing hepatic NIRS measurements to direct hepatic vein samples obtained during cardiac catheterization. Method: IRB-approved prospective pilot study of hepatic NIRS monitoring involving 10 patients without liver disease who were already undergoing elective cardiac catheterization. We placed a NIRS monitor on the skin overlying liver during catheterization. Direct measurement of hepatic vein oxygen saturation during the case compared with simultaneous hepatic NIRS measurement. Results: There was no correlation between the Hepatic NIRS values and the directly measured hepatic vein saturation (R = -0.035; P = 0.9238). However, the Hepatic NIRS values correlated with the cardiac output (R = 0.808; P = 0.0047), the systolic arterial blood pressure (R = 0.739; P = 0.0146), and the diastolic arterial blood pressure (R = 0.7548; P = 0.0116). Conclusions: Using the technique described, hepatic NIRS does not correlate well with the hepatic vein saturation. Further optimization of the technique might provide a better measurement. Hepatic NIRS does correlate with cardiac output and thus may still provide a valuable additional piece of hemodynamic information when combined with other non-invasive monitoring.
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Affiliation(s)
- Peter W Guyon
- Division of Pediatric Cardiology, University of California San Diego School of Medicine, Rady Children's Hospital, San Diego, CA, United States
| | - Tara Karamlou
- Division of Pediatric Cardiothoracic Surgery, Cleveland Clinic Children's and the Heart Vascular and Thoracic Institute, Cleveland, OH, United States
| | - Kanishka Ratnayaka
- Division of Pediatric Cardiology, University of California San Diego School of Medicine, Rady Children's Hospital, San Diego, CA, United States
| | - Howaida G El-Said
- Division of Pediatric Cardiology, University of California San Diego School of Medicine, Rady Children's Hospital, San Diego, CA, United States
| | - John W Moore
- Division of Pediatric Cardiology, University of California San Diego School of Medicine, Rady Children's Hospital, San Diego, CA, United States
| | - Rohit P Rao
- Division of Pediatric Cardiology, University of California San Diego School of Medicine, Rady Children's Hospital, San Diego, CA, United States
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8
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Doctor A, Cholette JM, Remy KE, Argent A, Carson JL, Valentine SL, Bateman ST, Lacroix J. Recommendations on RBC Transfusion in General Critically Ill Children Based on Hemoglobin and/or Physiologic Thresholds From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 2018; 19:S98-S113. [PMID: 30161064 PMCID: PMC6125789 DOI: 10.1097/pcc.0000000000001590] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To present the consensus recommendations and supporting literature for RBC transfusions in general critically ill children from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. DESIGN Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children. METHODS The panel of 38 experts developed evidence-based and, when evidence was lacking, expert-based recommendations and research priorities regarding RBC transfusions in critically ill children. The subgroup on RBC transfusion in general critically ill children included six experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases from 1980 to May 30, 2017, using a combination of keywords to define concepts of RBC transfusion and critically ill children. Recommendation consensus was obtained using the Research and Development/UCLA Appropriateness Method. The results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. RESULTS Three adjudicators reviewed 4,399 abstracts; 71 papers were read, and 17 were retained. Three papers were added manually. The general Transfusion and Anemia Expertise Initiative subgroup developed, and all Transfusion and Anemia Expertise Initiative members voted on two good practice statements, six recommendations, and 11 research questions; in all instances, agreement was reached (> 80%). The good practice statements suggest a framework for RBC transfusion in PICU patients. The good practice statements and recommendations focus on hemoglobin as a threshold and/or target. The research questions focus on hemoglobin and physiologic thresholds for RBC transfusion, alternatives, and risk/benefit ratio of transfusion. CONCLUSIONS Transfusion and Anemia Expertise Initiative developed pediatric-specific good practice statements and recommendations regarding RBC transfusion management in the general PICU population, as well as recommendations to guide future research priorities. Clinical recommendations emphasized relevant hemoglobin thresholds, and research recommendations emphasized a need for further understanding of physiologic thresholds, alternatives to RBC transfusion, and hemoglobin thresholds in populations with limited pediatric literature.
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Affiliation(s)
- Allan Doctor
- Allan Doctor, MD, Professor of Pediatrics and Biochemistry, Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis Children’s Hospital, United States
| | - Jill M. Cholette
- Jill M. Cholette, MD, Associate Professor of Pediatrics, Medical Director, Pediatric Cardiac Care Center, University of Rochester, Golisano Children’s Hospital, United States
| | - Kenneth E. Remy
- Kenneth E. Remy, MD, MHSc, Assistant Professor of Pediatrics. Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis Children’s Hospital, United States
| | - Andrew Argent
- Andrew Argent, MD, Professor of Pediatrics, Medical Director, Paediatric Intensive Care, University of Cape Town and Red Cross War Memorial Children’s Hospital, South Africa
| | - Jeffrey L. Carson
- Jeffrey L. Carson, MD, Provost – New Brunswick Distinguished Professor of Medicine, Richard C. Reynolds Chair of General Internal Medicine; Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, United States
| | - Stacey L. Valentine
- Stacey L. Valentine, MD, MPH, Assistant Professor of Pediatrics, University of Massachusetts Medical School, United States
| | - Scot T. Bateman
- Scot T. Bateman, MD, Professor of Pediatrics, Division Chief of Pediatric Critical Care Medicine, University of Massachusetts Medical School, United States
| | - Jacques Lacroix
- Jacques Lacroix, MD, Professor of Pediatrics, Division of Pediatric Critical Care, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Canada
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Yamamoto M, Hayashida M, Kakemizu-Watanabe M, Ando N, Mukaida H, Kawagoe I, Yusuke S, Inada E. B-Type Natriuretic Peptide and Hemoglobin are Two Major Factors Significantly Associated With Baseline Cerebral Oxygen Saturation Measured Using the INVOS Oximeter in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth 2018; 32:187-196. [DOI: 10.1053/j.jvca.2017.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Indexed: 12/14/2022]
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10
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Yu Y, Zhang K, Zhang L, Zong H, Meng L, Han R. Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults. Cochrane Database Syst Rev 2018; 1:CD010947. [PMID: 29341066 PMCID: PMC6491319 DOI: 10.1002/14651858.cd010947.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Various techniques have been employed for the early detection of perioperative cerebral ischaemia and hypoxia. Cerebral near-infrared spectroscopy (NIRS) is increasingly used in this clinical scenario to monitor brain oxygenation. However, it is unknown whether perioperative cerebral NIRS monitoring and the subsequent treatment strategies are of benefit to patients. OBJECTIVES To assess the effects of perioperative cerebral NIRS monitoring and corresponding treatment strategies in adults and children, compared with blinded or no cerebral oxygenation monitoring, or cerebral oxygenation monitoring based on non-NIRS technologies, on the detection of cerebral oxygen desaturation events (CDEs), neurological outcomes, non-neurological outcomes and socioeconomic impact (including cost of hospitalization and length of hospital stay). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 12), Embase (1974 to 20 December 2016) and MEDLINE (PubMed) (1975 to 20 December 2016). We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing studies on 20 December 2016. We updated this search in November 2017, but these results have not yet been incorporated in the review. We imposed no language restriction. SELECTION CRITERIA We included all relevant randomized controlled trials (RCTs) dealing with the use of cerebral NIRS in the perioperative setting (during the operation and within 72 hours after the operation), including the operating room, the postanaesthesia care unit and the intensive care unit. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, assessed risk of bias and extracted data. For binary outcomes, we calculated the risk ratio (RR) and its 95% confidence interval (CI). For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. As we expected clinical and methodological heterogeneity between studies, we employed a random-effects model for analyses and we examined the data for heterogeneity (I2 statistic). We created a 'Summary of findings' table using GRADEpro. MAIN RESULTS We included 15 studies in the review, comprising a total of 1822 adult participants. There are 12 studies awaiting classification, and eight ongoing studies.None of the 15 included studies considered the paediatric population. Four studies were conducted in the abdominal and orthopaedic surgery setting (lumbar spine, or knee and hip replacement), one study in the carotid endarterectomy setting, and the remaining 10 studies in the aortic or cardiac surgery setting. The main sources of bias in the included studies related to potential conflict of interest from industry sponsorship, unclear blinding status or missing participant data.Two studies with 312 participants considered postoperative neurological injury, however no pooled effect estimate could be calculated due to discordant direction of effect between studies (low-quality evidence). One study (N = 126) in participants undergoing major abdominal surgery reported that 4/66 participants experienced neurological injury with blinded monitoring versus 0/56 in the active monitoring group. A second study (N = 195) in participants having coronary artery bypass surgery reported that 1/96 participants experienced neurological injury in the blinded monitoring group compared with 4/94 participants in the active monitoring group.We are uncertain whether active cerebral NIRS monitoring has an important effect on the risk of postoperative stroke because of the low number of events and wide confidence interval (RR 0.25, 95% CI 0.03 to 2.20; 2 studies, 240 participants; low-quality evidence).We are uncertain whether active cerebral NIRS monitoring has an important effect on postoperative delirium because of the wide confidence interval (RR 0.63, 95% CI 0.27 to 1.45; 1 study, 190 participants; low-quality evidence).Two studies with 126 participants showed that active cerebral NIRS monitoring may reduce the incidence of mild postoperative cognitive dysfunction (POCD) as defined by the original studies at one week after surgery (RR 0.53, 95% CI 0.30 to 0.95, I2 = 49%, low-quality evidence).Based on six studies with 962 participants, there was moderate-quality evidence that active cerebral oxygenation monitoring probably does not decrease the occurrence of POCD (decline in cognitive function) at one week after surgery (RR 0.62, 95% CI 0.37 to 1.04, I2 = 80%). The different type of monitoring equipment in one study could potentially be the cause of the heterogeneity.We are uncertain whether active cerebral NIRS monitoring has an important effect on intraoperative mortality or postoperative mortality because of the low number of events and wide confidence interval (RR 0.63, 95% CI 0.08 to 5.03, I2= 0%; 3 studies, 390 participants; low-quality evidence). There was no evidence to determine whether routine use of NIRS-based cerebral oxygenation monitoring causes adverse effects. AUTHORS' CONCLUSIONS The effects of perioperative active cerebral NIRS monitoring of brain oxygenation in adults for reducing the occurrence of short-term, mild POCD are uncertain due to the low quality of the evidence. There is uncertainty as to whether active cerebral NIRS monitoring has an important effect on postoperative stroke, delirium or death because of the low number of events and wide confidence intervals. The conclusions of this review may change when the eight ongoing studies are published and the 12 studies awaiting assessment are classified. More RCTs performed in the paediatric population and high-risk patients undergoing non-cardiac surgery (e.g. neurosurgery, carotid endarterectomy and other surgery) are needed.
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Affiliation(s)
- Yun Yu
- Beijing Tiantan Hospital, Capital Medical UniversityDepartment of AnesthesiologyNo.6 Tiantan XiliBeijingChina100050
| | - Kaiying Zhang
- Beijing Tiantan Hospital, Capital Medical UniversityDepartment of AnesthesiologyNo.6 Tiantan XiliBeijingChina100050
| | - Ling Zhang
- School of Public Health, Capital Medical UniversityDepartment of Epidemiology and Health StatisticsNo. 129 Mail Box, No. 10 Xitoutiao, YouanmenwaiBeijingChina100069
| | - Huantao Zong
- Beijing Tiantan Hospital, Capital Medical UniversityDepartment of UrologyNo.6 Tiantan XiliBeijingChina100050
| | - Lingzhong Meng
- Yale University School of MedicineDepartment of AnesthesiologyNew HavenConnecticutUSA
| | - Ruquan Han
- Beijing Tiantan Hospital, Capital Medical UniversityDepartment of AnesthesiologyNo.6 Tiantan XiliBeijingChina100050
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Abstract
Transfusion decision making (TDM) in the critically ill requires consideration of: (1) anemia tolerance, which is linked to active pathology and to physiologic reserve, (2) differences in donor RBC physiology from that of native RBCs, and (3) relative risk from anemia-attributable oxygen delivery failure vs hazards of transfusion, itself. Current approaches to TDM (e.g. hemoglobin thresholds) do not: (1) differentiate between patients with similar anemia, but dissimilar pathology/physiology, and (2) guide transfusion timing and amount to efficacy-based goals (other than resolution of hemoglobin thresholds). Here, we explore approaches to TDM that address the above gaps.
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Affiliation(s)
- Chris Markham
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, McDonnell Pediatric Research Building, Campus Box 8208, 660 South Euclid Avenue, St Louis, MO 63110-1093, USA
| | - Sara Small
- Social Systems Design Laboratory, Brown School of Social Work, Washington University, Campus Box 1196, 1 Brookings Drive, St Louis, MO 63130, USA
| | - Peter Hovmand
- Social Systems Design Laboratory, Brown School of Social Work, Washington University, Campus Box 1196, 1 Brookings Drive, St Louis, MO 63130, USA
| | - Allan Doctor
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, McDonnell Pediatric Research Building, Campus Box 8208, 660 South Euclid Avenue, St Louis, MO 63110-1093, USA.
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12
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Sun YI, Ferguson BS, Rogatzki MJ, McDonald JR, Gladden LB. Muscle Near-Infrared Spectroscopy Signals versus Venous Blood Hemoglobin Oxygen Saturation in Skeletal Muscle. Med Sci Sports Exerc 2017; 48:2013-20. [PMID: 27635772 DOI: 10.1249/mss.0000000000001001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The study aimed to examine the relationship between near-infrared spectroscopy (NIRS) signals and venous hemoglobin oxygen saturation (O2Hb%) and venous oxygen concentration (CvO2). METHODS Gastrocnemius muscles (GS) in six dogs were surgically isolated and pump perfused. NIRS signals were recorded, and venous blood samples were collected at constant flow rates (control flow, high flow, and low flow) at rest as well as during electrically stimulated tetanic muscle contractions at rates of one contraction per 2 s (1/2 s) and two contractions per 3 s (2/3 s). Similar data were also collected at three different inspired O2 percentages (12%, 21%, and 100%) with constant blood flow. RESULTS Complete data from five animals were analyzed; all data from one animal were deleted because of erratic oxy-NIRS signals. Venous O2Hb% ranged from 7.6% to 97.5% across the various experimental conditions. After the NIRS signals were normalized to the physiological range, a high linear correlation was seen between the deoxygenated heme signal (HHbMb%) and the venous O2Hb% (R = 0.92 ± 0.05), between the oxygenated heme signal (HbMbO2%) and the venous O2Hb% (R = 0.92 ± 0.03), between the HHbMb% and the CvO2 (R = 0.89 ± 0.06), and between the HbMbO2% and the CvO2 (R = 0.90 ± 0.05). The overall relationships between HHbMb%, HbMbO2%, and venous O2Hb% as well as between HHbMb%, HbMbO2%, and CvO2 were also linear and highly correlated with R values ranging from 0.81 to 0.90. CONCLUSION In this controlled canine muscle model, NIRS signals are highly correlated with venous O2Hb% and CvO2 across a wide range of physiological conditions. The practical application of our results is that for an individual muscle or perhaps muscle group, normalized NIRS HHbMb and HbMbO2 signals accurately reflect the mean venous O2 saturation of the interrogated muscle tissue.
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Affiliation(s)
- Y I Sun
- 1School of Kinesiology, Auburn University, Auburn, AL; 2Key Laboratory of Adolescent Health Assessment and Exercise Intervention, Ministry of Education, East China Normal University, Shanghai, CHINA; 3College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL; 4Department of Health and Human Performance, University of Wisconsin-Platteville, Platteville, WI
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Chien JS, Mohammed M, Eldik H, Ibrahim MM, Martinez J, Nichols SP, Wisniewski N, Klitzman B. Injectable Phosphorescence-based Oxygen Biosensors Identify Post Ischemic Reactive Hyperoxia. Sci Rep 2017; 7:8255. [PMID: 28811566 PMCID: PMC5558004 DOI: 10.1038/s41598-017-08490-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/11/2017] [Indexed: 11/09/2022] Open
Abstract
Novel injectable biosensors were used to measure interstitial oxygenation before, during, and after transient ischemia. It is well known that reactive hyperemia occurs following a period of ischemia. However, increased blood flow does not necessarily mean increased oxygen tension in the tissue. Therefore, the purpose of this study was to test the hypothesis that tissue reactive hyperoxia occurs following release of hind-limb tourniquet occlusions. Rats were injected with bilateral hind-limb biosensors and were simultaneously subjected to a unilateral femoral vessel ligation. After approximately one and three months, the rats underwent a series of oxygenation challenges, including transient hind-limb tourniquet occlusion. Along with the biosensors, near infrared spectroscopy was used to measure percent oxyhemoglobin in capillaries and laser Doppler flowmetry was used to measure blood flow. Post-occlusion reactive hyperemia was observed. It was accompanied by tissue reactive hyperoxia, affirming that the post-occlusion oxygen supply must have exceeded the expected increased oxygen consumption. The measurement of the physiologic phenomenon of reactive hyperoxia could prove clinically beneficial for both diagnosis and optimizing therapy.
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Affiliation(s)
- Jennifer S Chien
- Kenan Plastic Surgery Research Labs and Biomedical Engineering, Duke University Medical Center, Durham, NC, 27710, USA
| | - Mahmoud Mohammed
- Kenan Plastic Surgery Research Labs and Biomedical Engineering, Duke University Medical Center, Durham, NC, 27710, USA
| | - Hysem Eldik
- Kenan Plastic Surgery Research Labs and Biomedical Engineering, Duke University Medical Center, Durham, NC, 27710, USA
| | - Mohamed M Ibrahim
- Kenan Plastic Surgery Research Labs and Biomedical Engineering, Duke University Medical Center, Durham, NC, 27710, USA
| | - Jeremy Martinez
- Kenan Plastic Surgery Research Labs and Biomedical Engineering, Duke University Medical Center, Durham, NC, 27710, USA
| | - Scott P Nichols
- Profusa, Inc., 345 Allerton Ave, South San Francisco, CA, 94080, USA
| | | | - Bruce Klitzman
- Kenan Plastic Surgery Research Labs and Biomedical Engineering, Duke University Medical Center, Durham, NC, 27710, USA.
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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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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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Kim Y, Kim CK, Jung S, Ko SB. Brain Oxygen Monitoring via Jugular Venous Oxygen Saturation in a Patient with Fulminant Hepatic Failure. Korean J Crit Care Med 2016. [DOI: 10.4266/kjccm.2016.00143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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A comparative analysis of the effects of sevoflurane and propofol on cerebral oxygenation during steep Trendelenburg position and pneumoperitoneum for robotic-assisted laparoscopic prostatectomy. J Anesth 2016; 30:949-955. [PMID: 27565964 PMCID: PMC5097119 DOI: 10.1007/s00540-016-2241-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/13/2016] [Indexed: 11/17/2022]
Abstract
Purpose Steep Trendelenburg position and pneumoperitoneum during robotic-assisted laparoscopic prostatectomy (RALP) increase intracranial pressure (ICP) and may alter cerebral blood flow (CBF) and oxygenation. Volatile anesthetics and propofol have different effects on ICP, CBF, and cerebral metabolic rate and may have different impact on cerebral oxygenation during RALP. In this study, we measured jugular venous bulb oxygenation (SjO2) and regional oxygen saturation (SctO2) in patients undergoing RALP to evaluate cerebral oxygenation and compared the effects of sevoflurane and propofol. We also verified whether SctO2 may be an alternative to SjO2. Methods Fifty patients scheduled for RALP were randomly assigned to undergo sevoflurane (group S) or propofol (group P) anesthesia. SjO2, SctO2, mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), central venous pressure (CVP), partial pressures of arterial oxygen (PaO2) and carbon dioxide (PaCO2), hemoglobin concentration (Hb), Bispectral Index (BIS) and nasopharyngeal temperature (BT) were recorded 5 min before surgery commencement, 5 min after pneumoperitoneum, 5, 30, 60, 90, and 120 min after pneumoperitoneum in a Trendelenburg position, and after desufflation in a supine position. Results SjO2 was significantly higher in group S than in group P at all measurement points [group S vs. group P: 77 % (11) vs. 65 % (13), mean of all measurement points (1SD); p < 0.01]. Linear regression analysis (β = 0.106; r2 = 0.065; p = 0.004) shows a weak relationship between SjO2 and SctO2. Conclusions Sevoflurane maintains higher SjO2 levels than propofol during RALP. SctO2 does not accurately reflect SjO2.
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Rackebrandt K, Gehring H. Calibration and evaluation of a continuous wave multi-distance NIRS system in simulated desaturation investigations. Biomed Phys Eng Express 2016. [DOI: 10.1088/2057-1976/2/3/035017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Guo JY, Fang JY, Xu SR, Wei M, Huang WQ. Effects of propofol versus sevoflurane on cerebral oxygenation and cognitive outcome in patients with impaired cerebral oxygenation. Ther Clin Risk Manag 2016; 12:81-5. [PMID: 26848269 PMCID: PMC4723018 DOI: 10.2147/tcrm.s97066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Postoperative neurocognitive dysfunction induced by anesthetics, particularly in elderly patients with impaired oxygenation, is a common complication of surgery and is eliciting increased interest in clinical practice. To investigate the effects of anesthetics on neurocognition, we compared the effects of propofol versus sevoflurane on cerebral oxygenation and cognitive outcome in patients with impaired cerebral oxygenation undergoing general anesthesia. Methods Sixty-three patients with impaired cerebral oxygenation (jugular venous bulb oxygen saturation [SjvO2] <50%) or cerebral blood flow/cerebral metabolic rate of oxygen ([CBF/CMRO2] ≤15%) undergoing elective abdominal surgery were randomly allocated into propofol group (group P) or sevoflurane group (group S). The clinical parameters and jugular venous bulb blood gas analysis were monitored throughout the surgical procedure. Cognitive function was assessed with the mini-mental state examination and Montreal Cognitive Assessment at day 1 and day 7 following surgery. S100β protein in plasma was measured using enzyme-linked immunosorbent assay. Results The SjvO2 increased during anesthesia induction and surgery when compared to baseline but had no significant difference between group P and group S. When compared to baseline, the CBF/CMRO2 was increased only at the end of surgery and extubation in group P; however, the CBF/CMRO2 in group S was increased during anesthesia induction at 1 hour, 2 hours, end of surgery, and extubation. Furthermore, the CBF/CMRO2 in group S was significantly higher than that in group P during anesthesia induction at 1 hour, 2 hours, and end of surgery. S100β protein did not significantly change at extubation and 1 day after surgery in both groups when compared to baseline. There was no significant difference in mini-mental state examination and Montreal Cognitive Assessment scores between group P and group S at all time points. Conclusion Sevoflurane showed similar effects in postoperative neurocognitive function as propofol but could improve cerebral oxygenation in patients with impaired cerebral oxygenation.
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Affiliation(s)
- Jun-Ying Guo
- Department of Anesthesia, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jie-Yu Fang
- Department of Anesthesia, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - San-Rong Xu
- Department of Anesthesia, Zhangzhou Municipal Hospital of Fujian Province, Zhangzhou, Fujian, People's Republic of China
| | - Ming Wei
- Department of Anesthesia, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Wen-Qi Huang
- Department of Anesthesia, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
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Hernandez-Meza G, Izzetoglu M, Osbakken M, Green M, Izzetoglu K. Near-infrared spectroscopy for the evaluation of anesthetic depth. BIOMED RESEARCH INTERNATIONAL 2015; 2015:939418. [PMID: 26495317 PMCID: PMC4606411 DOI: 10.1155/2015/939418] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/23/2015] [Indexed: 01/30/2023]
Abstract
The standard-of-care guidelines published by the American Society of Anesthesiologists (ASA) recommend monitoring of pulse oximetry, blood pressure, heart rate, and end tidal CO2 during the use of anesthesia and sedation. This information can help to identify adverse events that may occur during procedures. However, these parameters are not specific to the effects of anesthetics or sedatives, and therefore they offer little, to no, real time information regarding the effects of those agents and do not give the clinician the lead-time necessary to prevent patient "awareness." Since no "gold-standard" method is available to continuously, reliably, and effectively monitor the effects of sedatives and anesthetics, such a method is greatly needed. Investigation of the use of functional near-infrared spectroscopy (fNIRS) as a method for anesthesia or sedation monitoring and for the assessment of the effects of various anesthetic drugs on cerebral oxygenation has started to be conducted. The objective of this paper is to provide a thorough review of the currently available published scientific studies regarding the use of fNIRS in the fields of anesthesia and sedation monitoring, comment on their findings, and discuss the future work required for the translation of this technology to the clinical setting.
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Affiliation(s)
- Gabriela Hernandez-Meza
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3508 Market Street, Suite 100, Philadelphia, PA 19104, USA
| | - Meltem Izzetoglu
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3508 Market Street, Suite 100, Philadelphia, PA 19104, USA
| | - Mary Osbakken
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3508 Market Street, Suite 100, Philadelphia, PA 19104, USA
| | - Michael Green
- Department of Anesthesiology, Drexel University College of Medicine, Hahnemann University Hospital, 245 N. 15th Street, MS 310, Philadelphia, PA 19102, USA
| | - Kurtulus Izzetoglu
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3508 Market Street, Suite 100, Philadelphia, PA 19104, USA
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Differential effects of phenylephrine and norepinephrine on peripheral tissue oxygenation during general anaesthesia. Eur J Anaesthesiol 2015; 32:571-80. [DOI: 10.1097/eja.0000000000000247] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The brain relaxation and cerebral metabolism in stroke volume variation-directed fluid therapy during supratentorial tumors resection: crystalloid solution versus colloid solution. J Neurosurg Anesthesiol 2015; 26:320-7. [PMID: 24487733 DOI: 10.1097/ana.0000000000000046] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Compared with goal-directed crystalloid therapy, goal-directed colloid therapy during high-risk surgery may improve postoperative outcome. Whether intraoperative fluid therapy based on goal-directed protocol with different types of fluid has distinctive effects on brain relaxation and cerebral metabolism during craniotomy remains unclear. METHODS Forty patients with supratentorial brain tumors undergoing craniotomy were randomly assigned to either a Ringer's Lactate-based goal-directed group (LR group, n=20) or a 6% hydroxyethyl starch-based goal-directed group (HES group, n=20). The goal was achieved by maintaining a target stroke volume variation (SVV<13%) by volume loading with LR or HES throughout the procedure. The primary outcome is brain relaxation scales, an indirect evaluation of ICP; secondary endpoints include cerebral metabolism variables (jugular venous oxygen saturation [SjvO(2)], arterial-jugular venous differences in oxygen [CajvO(2)], glucose [A-JvGD], lactate [A-JvLD], and cerebral extraction ratio for oxygen [CERO(2)]) and fluid volumes. RESULTS There is no significant difference between the LR and HES groups on brain relaxation scales (P=0.845), or measures of cerebral oxygenation and metabolism. Intragroup comparisons showed that CERO(2) increased by 14.3% (P=0.009, LR group) and 13.2% (P=0.032, HES group), respectively, and SjvO(2) was decreased by 8.8% (P=0.016, LR group) and 8.1% (P=0.026, HES group), respectively, after tumor removal, compared with baseline. During surgery, the LR group (3070±1138 mL) received more fluid than the HES group (2041±758 mL, P=0.002). CONCLUSIONS In patients undergoing supratentorial tumor resection, goal-directed HES therapy was not superior to goal-directed LR therapy for brain relaxation or cerebral metabolism, although less fluid was needed to maintain the target SVV in the HES-based group than in the LR-based group.
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Wally D, Velik-Salchner C. [Near-infrared spectroscopy during cardiopulmonary resuscitation and mechanical circulatory support: From the operating room to the intensive care unit]. Med Klin Intensivmed Notfmed 2015; 110:621-30. [PMID: 25917180 DOI: 10.1007/s00063-015-0012-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 01/07/2015] [Accepted: 01/13/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Near infrared spectroscopy (NIRS) allows continuous measurement of cerebral regional oxygen saturation (rSO2). It is a weighted saturation value derived from approximately 70-75 % venous, 20-25 % arterial and 2.5-5 % capillary blood. In contrast to pulse oximetry, NIRS is independent of pulsatile flow. Therefore, it is also applicable during extracorporeal circulation, cardiopulmonary resuscitation (CPR), and hypothermia. OBJECTIVES The purpose of this work is to describe the application of cerebral and somatic NIRS in cardiology and cardiac surgery patients in the operation room, during and after CPR, and during the intensive care unit stay. MATERIALS AND METHODS This article is based on peer-reviewed literature from PubMed. RESULTS Interventions based on decline of cerebral NIRS values during on-pump cardiac surgery can reduce major organ morbidity and mortality; however, the appearance of a postoperative cognitive dysfunction is scarcely influenced. Persisting of low cerebral oximetry values during resuscitation is a marker for not achieving return of spontaneous circulation under normothermia. NIRS is an additional method for monitoring that can be used during extracorporeal circulation. CONCLUSION NIRS is a rapidly available, user-friendly, and noninvasive method for continuous measurement of rSO2. NIRS provides additional information about tissue oxygenation especially during resuscitation and extracorporeal circulatory assist support. Recommendations concerning the use of NIRS for standard monitoring during resuscitation and mechanical circulatory support are not currently available. Further studies are required to show if use of NIRS can reduce pulse control and hands-off times during resuscitation and if use of NIRS can improve outcome after CPR and mechanical circulatory support.
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Affiliation(s)
- D Wally
- Universitätsklinik für Anästhesie und Intensivmedizin, Department für Operative Medizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Corinna Velik-Salchner
- Universitätsklinik für Anästhesie und Intensivmedizin, Department für Operative Medizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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Kumagai M, Ogawa S, Doe A, Suzuki K. Cerebral oxygenation measured by near-infrared spectroscopy and jugular vein oxygen saturation during robotic-assisted laparoscopic radical prostatectomy under total intravenous anaesthesia. Int J Med Robot 2014; 11:302-307. [PMID: 25331731 DOI: 10.1002/rcs.1629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND The effects of total intravenous anaesthesia (TIVA) on cerebral oxygenation in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP) have not been investigated. We examined the changes in jugular venous oxygen saturation (SjvO2 ) and regional cerebral tissue oxygen saturation (rSO2 ) during RALP under TIVA. Whether rSO2 could reflect SjvO2 was also examined. METHODS Forty patients (ASA 1-2) undergoing RALP were enrolled. Measurements were obtained at eight time points during the operation. RESULTS SjvO2 did not decrease at any measurement point, whereas rSO2 fell significantly 120 min after pneumoperitoneum in a steep Trendelenburg position (p <0.01). There was a weak correlation between SjvO2 and rSO2 (Pearson correlation coefficient =0.34; p <0.01). Bland-Altman analysis showed a wide interval for the limit of agreement (47%) between the two measurements. CONCLUSIONS These findings suggested that TIVA could be safely used for RALP. It was also demonstrated that rSO2 did not accurately reflect SjvO2 during RALP. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Motoi Kumagai
- Department of Anaesthesiology, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Shohei Ogawa
- Department of Anaesthesiology, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Aya Doe
- Department of Anaesthesiology, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kenji Suzuki
- Department of Anaesthesiology, School of Medicine, Iwate Medical University, Morioka, Japan
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Steppan J, Hogue CW. Cerebral and tissue oximetry. Best Pract Res Clin Anaesthesiol 2014; 28:429-39. [PMID: 25480772 DOI: 10.1016/j.bpa.2014.09.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 09/10/2014] [Accepted: 09/16/2014] [Indexed: 01/20/2023]
Abstract
The use of near-infrared spectroscopy (NIRS) has been increasingly adopted in cardiac surgery to measure regional cerebral oxygen saturation. This method takes advantage of the fact that light in the near-infrared spectrum penetrates tissue, including bone and muscle. Sensors are placed at fixed distances from a light emitter, and algorithms subtract superficial light absorption from deep absorption to provide an index of tissue oxygenation. Although the popularity of NIRS monitoring is growing, definitive data that prove outcome benefits with its use remain sparse. Therefore, widespread, routine use of NIRS as a standard-of-care monitor cannot be recommended at present. Recent investigations have focused on the use of NIRS in subgroups that may benefit from NIRS monitoring, such as pediatric patients. Furthermore, a novel application of processed NIRS information for monitoring cerebral autoregulation and tissue oxygenation (e.g., kidneys and the gut) is promising.
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Affiliation(s)
- Jochen Steppan
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Charles W Hogue
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Does sevoflurane preserve regional cerebral oxygen saturation measured by near-infrared spectroscopy better than propofol? ACTA ACUST UNITED AC 2014; 33:e59-65. [DOI: 10.1016/j.annfar.2013.12.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 12/30/2013] [Indexed: 11/23/2022]
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27
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Ahn A, Yang J, Inigo-Santiago L, Parnia S. A feasibility study of cerebral oximetry monitoring during the post-resuscitation period in comatose patients following cardiac arrest. Resuscitation 2014; 85:522-6. [DOI: 10.1016/j.resuscitation.2013.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 11/05/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022]
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Nielsen HB. Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery. Front Physiol 2014; 5:93. [PMID: 24672486 PMCID: PMC3955969 DOI: 10.3389/fphys.2014.00093] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 02/21/2014] [Indexed: 02/02/2023] Open
Abstract
Near-infrared spectroscopy (NIRS) is used to monitor regional cerebral oxygenation (rScO2) during cardiac surgery but is less established during non-cardiac surgery. This systematic review aimed (i) to determine the non-cardiac surgical procedures that provoke a reduction in rScO2 and (ii) to evaluate whether an intraoperative reduction in rScO2 influences postoperative outcome. The PubMed and Embase database were searched from inception until April 30, 2013 and inclusion criteria were intraoperative NIRS determined rScO2 in adult patients undergoing non-cardiac surgery. The type of surgery and number of patients included were recorded. There was included 113 articles and evidence suggests that rScO2 is reduced during thoracic surgery involving single lung ventilation, major abdominal surgery, hip surgery, and laparoscopic surgery with the patient placed in anti-Tredelenburg's position. Shoulder arthroscopy in the beach chair and carotid endarterectomy with clamped internal carotid artery (ICA) also cause pronounced cerebral desaturation. A >20% reduction in rScO2 coincides with indices of regional and global cerebral ischemia during carotid endarterectomy. Following thoracic surgery, major orthopedic, and abdominal surgery the occurrence of postoperative cognitive dysfunction (POCD) might be related to intraoperative cerebral desaturation. In conclusion, certain non-cardiac surgical procedures is associated with an increased risk for the occurrence of rScO2. Evidence for an association between cerebral desaturation and postoperative outcome parameters other than cognitive dysfunction needs to be established.
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Affiliation(s)
- Henning B Nielsen
- Department of Anesthesia, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
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Yu Y, Zhang K, Zhang L, Zong H, Meng L, Han R. Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults. Hippokratia 2014. [DOI: 10.1002/14651858.cd010947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yun Yu
- Beijing Tiantan Hospital, Capital Medical University; Department of Anesthesiology; No.6 Tiantan Xili Beijing China 100050
| | - Kaiying Zhang
- Beijing Tiantan Hospital, Capital Medical University; Department of Anesthesiology; No.6 Tiantan Xili Beijing China 100050
| | - Ling Zhang
- School of Public Health, Capital Medical University; Department of Epidemiology and Biostatistics; No. 129 Mail Box, No. 10 Xitoutiao, Youanmenwai Beijing China 100069
| | - Huantao Zong
- Beijing Tiantan Hospital, Capital Medical University; Department of Urology; No.6 Tiantan Xili Beijing China 100050
| | - Lingzhong Meng
- University of California San Francisco; Department of Anesthesia and Perioperative Care; 521 Parnassus Avenue, Room C-450 San Francisco California USA 94143
| | - Ruquan Han
- Beijing Tiantan Hospital, Capital Medical University; Department of Anesthesiology; No.6 Tiantan Xili Beijing China 100050
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Cho SY, Kim SJ, Jeong CW, Jeong CY, Chung SS, Lee J, Yoo KY. Under General Anesthesia Arginine Vasopressin Prevents Hypotension but Impairs Cerebral Oxygenation During Arthroscopic Shoulder Surgery in the Beach Chair Position. Anesth Analg 2013; 117:1436-43. [DOI: 10.1213/ane.0b013e3182a8fa97] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Silva A, Venâncio C, Ortiz AL, Souza AP, Amorim P, Ferreira DA. The effect of high doses of remifentanil in brain near-infrared spectroscopy and in electroencephalographic parameters in pigs. Vet Anaesth Analg 2013; 41:153-62. [PMID: 24119044 DOI: 10.1111/vaa.12091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 03/20/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the effects of a high remifentanil bolus dose on pig's electroencephalographic indices and on brain regional and global oxygenation. STUDY DESIGN Prospective experimental study. ANIMALS Twelve healthy Large-White male pigs, age 3 months and weight 26.2 ± 3.6 kg. METHODS Anaesthesia was induced with intravenous propofol 4 mg kg⁻¹, then maintained with constant rate infusions of propofol (15 mg kg⁻¹ hour⁻¹) and remifentanil (0.3 μg kg⁻¹ minute⁻¹). Following instrumentation, all pigs received a 5 μg kg⁻¹ remifentanil bolus. The responses of jugular venous oxygen saturation, cardiac output and cerebral oxygen saturation to the remifentanil bolus were studied. The Bispectral index, spectral edge frequency 95%, total power, approximate entropy and permutation entropy were also studied. Repeated measures anova and Pearson correlation were used to analyze the effect of remifentanil bolus on these variables until 5 minutes after the bolus. RESULTS Cardiac output and cerebral oxygen saturation decreased significantly after the remifentanil bolus from 4.6 ± 0.9 to 3.8 ± 1.0 L minute⁻¹ and from 65 ± 6 to 62 ± 1% (p < 0.05), respectively. No significant changes were observed in the jugular venous oxygen saturation (p > 0.05) nor in any of the electroencephalogram derived indices (p > 0.05). Correlation analysis revealed strong positive significant correlations between cerebral oxygen saturation and cardiac output (r = 0.82, p < 0.001) and between cerebral oxygen saturation and approximate entropy (r = 0.65, p < 0.001). CONCLUSIONS AND CLINICAL RELEVANCE The effect caused by the remifentanil bolus on the brain oxygenation seems to be better reflected by the cerebral oxygen saturation than the jugular venous oxygen saturation. The effect of remifentanil on the electroencephalogram may not be reflected in indices derived from the electroencephalogram, but the potential of the approximate entropy in reflecting changes caused by opioids on the electroencephalogram should be further investigated.
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Affiliation(s)
- Aura Silva
- Toxicology, REQUIMTE, Faculdade de Farmácia da Universidade do Porto, Porto, Portugal
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Jun IG, Shin WJ, Park YS, Song JG, Kim YK, Hwang GS. Factors affecting intraoperative changes in regional cerebral oxygen saturation in patients undergoing liver transplantation. Transplant Proc 2013; 45:245-50. [PMID: 23375309 DOI: 10.1016/j.transproceed.2012.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 10/09/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Regional oxygen saturation (rSO(2)) is a sensitive marker of cerebral hypoperfusion during liver transplantation. However, bilirubin absorbs near-infrared light, resulting in falsely low rSO(2) values. We sought to determine whether rSO(2) values vary in response to bilirubin concentrations during liver transplantation and to assess whether rSO(2) changes were associated with factors reflecting cerebral oxygen delivery in patients with hyperbilirubinemia. METHODS Measurements of rSO(2) values continuous cardiac output (CO), mean arterial pressure, central venous pressure, body temperature, arterial blood gas analysis, and laboratory parameters were simultaneously performed at 1 hour after the surgical incision (baseline) and at 3 predetermined times during the anhepatic and neohepatic phases in 95 end-stage liver disease patients including 67 males of Child A/B/C/29/29/37 categories respectively. Relationships between changes in parameters were evaluated by correlation and multivariate regression analyses. RESULTS The 273 measurements revealed changes in rSO(2) (range, -18% to 40%) to correlate significantly with alterations in hemoglobin (Hb), serum glucose, lactate, prothrombin time, pH, partial arterial CO(2) pressure (PaCO(2)), and CO, but not with serum total bilirubin (TB). Multivariate linear regression analysis revealed that changes in Hb, CO, PaCO(2), and pH were independent of rSO(2) changes during liver transplantation. CONCLUSIONS Our findings showed that rSO(2) changes were independently associated with factors reflecting cerebral oxygen delivery, such as Hb, CO, PaCO(2), and pH, whereas rSO(2) values did not correlate with changes in bilirubin concentrations, indicating that rSO(2) changes reveal cerebral oxygen balance regardless of TB levels among patients undergoing liver transplantation.
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Affiliation(s)
- I-G Jun
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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ALEXANDER BS, GELB AW, MANTULIN WW, CERUSSI AE, TROMBERG BJ, YU Z, LEE C, MENG L. Impact of stepwise hyperventilation on cerebral tissue oxygen saturation in anesthetized patients: a mechanistic study. Acta Anaesthesiol Scand 2013; 57:604-12. [PMID: 23278596 DOI: 10.1111/aas.12054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND While the decrease in blood carbon dioxide (CO2 ) secondary to hyperventilation is generally accepted to play a major role in the decrease of cerebral tissue oxygen saturation (SctO2 ), it remains unclear if the associated systemic hemodynamic changes are also accountable. METHODS Twenty-six patients (American Society of Anesthesiologists I-II) undergoing nonneurosurgical procedures were anesthetized with either propofol-remifentanil (n = 13) or sevoflurane (n = 13). During a stable intraoperative period, ventilation was adjusted stepwise from hypoventilation to hyperventilation to achieve a progressive change in end-tidal CO2 (ETCO2 ) from 55 to 25 mmHg. Minute ventilation, SctO2 , ETCO2 , mean arterial pressure (MAP), and cardiac output (CO) were recorded. RESULTS Hyperventilation led to a SctO2 decrease from 78 ± 4% to 69 ± 5% (Δ = -9 ± 4%, P < 0.001) in the propofol-remifentanil group and from 81 ± 5% to 71 ± 7% (Δ = -10 ± 3%, P < 0.001) in the sevoflurane group. The decreases in SctO2 were not statistically different between these two groups (P = 0.5). SctO2 correlated significantly with ETCO2 in both groups (P < 0.001). SctO2 also correlated significantly with MAP (P < 0.001) and CO (P < 0.001) during propofol-remifentanil, but not sevoflurane (P = 0.4 and 0.5), anesthesia. CONCLUSION The main mechanism responsible for the hyperventilation-induced decrease in SctO2 is hypocapnia during both propofol-remifentanil and sevoflurane anesthesia. Hyperventilation-associated increase in MAP and decrease in CO during propofol-remifentanil, but not sevoflurane, anesthesia may also contribute to the decrease in SctO2 but to a much smaller degree.
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Affiliation(s)
- B. S. ALEXANDER
- Irvine School of Medicine; University of California; Irvine; CA; USA
| | - A. W. GELB
- Department of Anesthesia and Perioperative Care; University of California; San Francisco; CA; USA
| | - W. W. MANTULIN
- Beckman Laser Institute; University of California; Irvine; CA; USA
| | - A. E. CERUSSI
- Beckman Laser Institute; University of California; Irvine; CA; USA
| | - B. J. TROMBERG
- Beckman Laser Institute; University of California; Irvine; CA; USA
| | - Z. YU
- Department of Statistics; University of California; Irvine; CA; USA
| | - C. LEE
- Department of Anesthesiology and Perioperative Care; University of California; Irvine; CA; USA
| | - L. MENG
- Department of Anesthesiology; Duke University Medical Center; Durham; NC; USA
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Vernick WJ, Gutsche JT. Pro: Cerebral Oximetry Should be a Routine Monitor During Cardiac Surgery. J Cardiothorac Vasc Anesth 2013; 27:385-9. [DOI: 10.1053/j.jvca.2012.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Indexed: 12/13/2022]
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Hyttel-Sorensen S, Kleiser S, Wolf M, Greisen G. Calibration of a prototype NIRS oximeter against two commercial devices on a blood-lipid phantom. BIOMEDICAL OPTICS EXPRESS 2013; 4:1662-72. [PMID: 24049687 PMCID: PMC3771837 DOI: 10.1364/boe.4.001662] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 06/27/2013] [Accepted: 06/28/2013] [Indexed: 05/02/2023]
Abstract
In a blood-lipid liquid phantom the prototype near-infrared spectroscopy oximeter OxyPrem was calibrated against the INVOS® 5100c adult sensor in respect to values of regional tissue oxygen haemoglobin saturation (rStO2) for possible inclusion in the randomised clinical trial - SafeBoosC. In addition different commercial NIRS oximeters were compared on changing haemoglobin oxygen saturation and compared against co-oximetry. The best calibration was achieved with a simple offset and a linear scaling of the OxyPrem rStO2 values. The INVOS adult and pediatric sensor gave systematically different values, while the difference between the NIRO® 300 and the two INVOS sensors were magnitude dependent. The co-oximetry proved unreliable on such low haemoglobin and high Intralipid levels.
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Affiliation(s)
- Simon Hyttel-Sorensen
- Department of Neonatology, National University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, DK-2100, Denmark
| | - Stefan Kleiser
- Biomedical Optics Research Laboratory, Division of Neonatology, University Hospital of Zürich 8091 Zürich, Switzerland
| | - Martin Wolf
- Biomedical Optics Research Laboratory, Division of Neonatology, University Hospital of Zürich 8091 Zürich, Switzerland
| | - Gorm Greisen
- Department of Neonatology, National University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, DK-2100, Denmark
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Abstract
Cerebral oximetry allows continuous real-time and non-invasive monitoring of cerebral oxygen saturation (cSO(2)), by measuring oxyhaemoglobin and deoxyhaemoglobin near infrared light absorption, similarly to pulse oximetry. cSO(2) measurement predominantly reflects brain venous compartment, and is correlated with jugular venous saturation. As jugular venous saturation, cSO(2) must therefore be interpreted as a measure of balance between transport and consumption of O(2) in the brain. Cerebral oximetry should be used as a trend monitoring, because its accuracy is insufficient to be considered as reliable measure of absolute value of ScO(2). In adult, correction of intraoperative cerebral desaturation reduces hospital stay, heavy morbidity and mortality, and serious postoperative neurocognitive impairment after cardiac and major abdominal surgery. In children, the occurrence of intra- and postoperative cerebral desaturations during congenital heart surgery is associated with increased neurological morbi-mortality. Cerebral oximetry could be a useful monitoring during anaesthesia of (ex) preterm neonates, due to the risk of impaired cerebral blood flow autoregulation in these patients.
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Apostolidou I, Morrissette G, Sarwar MF, Konia MR, Kshettry VR, Wahr JA, Lobbestael AA, Nussmeier NA. Cerebral Oximetry During Cardiac Surgery: The Association Between Cerebral Oxygen Saturation and Perioperative Patient Variables. J Cardiothorac Vasc Anesth 2012; 26:1015-21. [DOI: 10.1053/j.jvca.2012.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Indexed: 12/13/2022]
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Ghoneimy YE, Regal M, El-Tahan M, Deria A, Jehani YA, Matthani M. Changes in cerebral oxygenation in patients with pulmonary dysfunction after lung resection. Semin Cardiothorac Vasc Anesth 2012; 17:72-81. [PMID: 23108413 DOI: 10.1177/1089253212463968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lung resection would be associated with lower jugular bulb oxygen saturation (SjvO₂) values in patients with moderate to severe pulmonary dysfunction. We aimed to study the effects of lung resections on the postoperative changes in SjvO₂, incidence of SjvO₂ < 50%, pulmonary functions, cerebral blood flow equivalent (CBFE), and arterial to jugular difference in oxygen content (AjvDO₂) in the patients with pulmonary dysfunction. Fifty-three patients scheduled for lung resection were allocated on the basis of forced vital capacity (FVC %) and forced expiratory volume in 1 second (FEV(1)%) into the following: good FVC and FEV₁ (n = 14), mild (n = 14), moderate (n = 13), and severe (n = 12) pulmonary dysfunction groups. After lung resections, patients with pulmonary dysfunctions had significantly lower SjvO₂, CBFE, FEV₁, and FVC (P < .001), higher AjvDO₂ (P < .001), and frequent episodes with SjvO₂ < 50% (P < .03). Perioperative changes in FEV₁ had a significant negative correlation with SjvO₂ desaturation (P < .002). Patients with pulmonary dysfunction showed significant SjvO₂ < 50% after lung resection, which is correlated to the perioperative changes in FEV₁.
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In vivo optical spectroscopy monitoring in a new model of muscular compartment syndrome. Br J Anaesth 2012; 109:561-5. [DOI: 10.1093/bja/aes223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rao RP, Danduran MJ, Loomba RS, Dixon JE, Hoffman GM. Near-infrared spectroscopic monitoring during cardiopulmonary exercise testing detects anaerobic threshold. Pediatr Cardiol 2012; 33:791-6. [PMID: 22349729 DOI: 10.1007/s00246-012-0217-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 12/09/2011] [Indexed: 10/28/2022]
Abstract
Cardiopulmonary exercise testing (CPET) provides assessment of the integrative responses involving the pulmonary, cardiovascular, and skeletal muscle systems. Application of exercise testing remains limited to children who are able to understand and cooperate with the exercise protocol. Near-infrared spectroscopy (NIRS) provides a noninvasive, continuous method to monitor regional tissue oxygenation (rSO2). Our specific aim was to predict anaerobic threshold (AT) during CPET noninvasively using two-site NIRS monitoring. Achievement of a practical noninvasive technology for estimating AT will increase the compatibility of CPET. Patients without structural or acquired heart disease were eligible for inclusion if they were ordered to undergo CPET by a cardiologist. Data from 51 subjects was analyzed. The ventilatory anaerobic threshold (VAT) was computed on [Formula: see text] and respiratory quotient post hoc using the standard V-slope method. The inflection points of the regional rSO2 time-series were identified as the noninvasive regional NIRS AT for each of the two monitored regions (cerebral and kidney). AT calculation made using an average of kidney and brain NIRS matched the calculation made by VAT for the same patient. Two-site NIRS monitoring of visceral organs is a predictor of AT.
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Affiliation(s)
- Rohit P Rao
- Sections of Cardiology and Critical Care, Phoenix Children's Hospital, Phoenix, AZ, USA.
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JEONG H, LEE SH, JANG EA, CHUNG SS, LEE J, YOO KY. Retracted: Haemodynamics and cerebral oxygenation during arthroscopic shoulder surgery in beach chair position under general anaesthesia. Acta Anaesthesiol Scand 2012; 56:872-9. [DOI: 10.1111/j.1399-6576.2012.02716.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2012] [Indexed: 11/28/2022]
Affiliation(s)
- H. JEONG
- Department of Anesthesiology and Pain Medicine; Chonnam National University Medical School; Gwangju; South Korea
| | - S. H. LEE
- Department of Anesthesiology and Pain Medicine; Chonnam National University Medical School; Gwangju; South Korea
| | - E. A. JANG
- Department of Anesthesiology and Pain Medicine; Chonnam National University Medical School; Gwangju; South Korea
| | - S. S. CHUNG
- Department of Anesthesiology; School of Dentistry; Chonnam National University Medical School; Gwangju; South Korea
| | - J. LEE
- Department of Physiology; Chonnam National University Medical School; Gwangju; South Korea
| | - K. Y. YOO
- Department of Anesthesiology and Pain Medicine; Chonnam National University Medical School; Gwangju; South Korea
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Danduran MJ, Dixon JE, Rao RP. Near infrared spectroscopy describes physiologic payback associated with excess postexercise oxygen consumption in healthy controls and children with complex congenital heart disease. Pediatr Cardiol 2012; 33:95-102. [PMID: 21892649 DOI: 10.1007/s00246-011-0097-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 08/19/2011] [Indexed: 10/17/2022]
Abstract
Exercise creates a physiologic burden with recovery from such effort crucial to adaptation. Excess postexercise oxygen consumption (EPOC) refers to the body's increased metabolic need after work. This investigation was designed to determine the role of near infrared spectroscopy (NIRS) in the description of exercise recovery in healthy controls (NL) and children with congenital heart disease (CHD). Subjects were recruited with exercise testing performed to exhaustion. Exercise time (EXT), heart rate (HR), and oxygen consumption (VO(2)) were measured. Four-site NIRS (brain, kidney, deltoid, and vastus lateralis) were measured during exercise and into recovery to establish trends. Fifty individuals were recruited for each group (NL = 26 boys and 24 girls; CHD = 33 boys and 17 girls). Significant differences existed between EXT, VO(2), and peak HR (P < 0.01). NIRS values were examined at four distinct intervals: rest, peak work, and 2 and 5 min after exercise. Significant cerebral hyperemia was seen in children with CHD post exercise when compared to normal individuals in whom redistribution patterns were directed to somatic muscles. These identified trends support an immediate compensation of organ systems to re-establish homeostasis in peripheral beds through enhanced perfusion. Noninvasive NIRS monitoring helps delineate patterns of redistribution associated with EPOC in healthy adolescents and children with CHD.
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Affiliation(s)
- Michael J Danduran
- Herma Heart Center, Children's Hospital of Wisconsin, PO Box 1997, Milwaukee, WI 53201-1997, USA.
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Song JG, Jeong SM, Shin WJ, Jun IG, Shin K, Huh IY, Kim YK, Hwang GS. Laboratory Variables Associated with Low Near-Infrared Cerebral Oxygen Saturation in Icteric Patients Before Liver Transplantation Surgery. Anesth Analg 2011; 112:1347-52. [DOI: 10.1213/ane.0b013e318214b2b0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Near infrared spectroscopy: guided tilt table testing for syncope. Pediatr Cardiol 2010; 31:674-9. [PMID: 20204346 DOI: 10.1007/s00246-010-9683-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
Abstract
Syncope is transient loss of consciousness. Neurocardiogenic syncope (NCS) is the most common cause of syncope. Head-up tilt-table test (HUTT) has been used to demonstrate physiologic events during graded orthostatic challenge in individuals with significant handicap from NCS. Near-infrared spectroscopy (NIRS) provides a noninvasive, continuous method to monitor trends of regional tissue oxygenation (rSO2). We hypothesize that multisite NIRS monitoring will show differential desaturation patterns in the brain and renal vascular beds during postural stresses. All patients age 7-21 years old scheduled to undergo HUTT were recruited. Two probes for NIRS monitoring were placed on the forehead and above the left paravertebral level at the T10 to L1 space. These leads were attached to the Somanetics monitor (Somanetics, Troy MI). Tissue saturations (rSO2) obtained at two sites were recorded at rest, during the test, and throughout a 5-min recovery period. All data routinely obtained in HUTT were included in the research study database. Thirteen patients were recruited. The average age was 12.9 years. Five patients had a positive tilt-table test. The patients with syncope had rSO2 trends distinctly different from the normal subjects. In these patients, cerebral rSO2 showed a sudden decreasing trend from hypoperfusion, soon followed by various clinical symptoms. The cerebral rSO2 trend, which showed a dramatic increase, was paralleled by renal rSO2. These rSO2 trends were progressive until the patient was brought back to the supine position, which resulted in the rSO2 in both beds returning to baseline. Multisite NIRS-guided HUTT shows differential trends in the different vascular beds during postural gravitational stresses, and these patterns underlie the systemic oxygen consumption to flow-coupling dynamics observed during syncope.
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Volatile induction/maintenance of anaesthesia with sevoflurane increases jugular venous oxygen saturation and lumbar cerebrospinal fluid pressure in patients undergoing craniotomy. Eur J Anaesthesiol 2010; 27:369-76. [DOI: 10.1097/eja.0b013e32832edc70] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth 2010; 103 Suppl 1:i3-13. [PMID: 20007987 DOI: 10.1093/bja/aep299] [Citation(s) in RCA: 527] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Continuous real-time monitoring of the adequacy of cerebral perfusion can provide important therapeutic information in a variety of clinical settings. The current clinical availability of several non-invasive near-infrared spectroscopy (NIRS)-based cerebral oximetry devices represents a potentially important development for the detection of cerebral ischaemia. In addition, a number of preliminary studies have reported on the application of cerebral oximetry sensors to other tissue beds including splanchnic, renal, and spinal cord. This review provides a synopsis of the mode of operation, current limitations and confounders, clinical applications, and potential future uses of such NIRS devices.
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Affiliation(s)
- J M Murkin
- Department of Anesthesiology and Perioperative Medicine, University Hospital-LHSC, University of Western Ontario, Rm C3-112, 339 Windermere Rd, London, ON, Canada N6A 5A5.
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Rao RP, Danduran MJ, Hoffman GM, Ghanayem NS, Berger S, Frommelt PC. Cerebral hemodynamics in the presence of decreased systemic venous compliance in patients with Fontan physiology may limit anaerobic exercise capacity. Pediatr Cardiol 2010; 31:208-14. [PMID: 19915888 DOI: 10.1007/s00246-009-9585-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 10/23/2009] [Indexed: 11/26/2022]
Abstract
Patients who have had the Fontan procedure report poor exercise performance. Fontan subjects can tolerate a higher level of sub maximal activity than might be anticipated from VO2, suggesting a different mechanism of exercise limitation. Near-infrared spectroscopy (NIRS) provides a non-invasive, continuous method to monitor regional tissue oxygenation (rSO2) and thereby a window into regional oxygen supply-demand relationships. We hypothesized that Fontan patients would have altered rSO2 trends from normal population that might reflect the mechanisms of exercise limitation. All the patients without structural or acquired heart disease and Fontan patients were eligible for inclusion if they were ordered to undergo cardiopulmonary exercise testing (CPET). Four-site regional rSO2 were recorded continuously during exercise. The difference between the oxyhemoglobin saturation measured by pulse oximetry (SpO2) and NIRS (rSO2) was computed as the regional arterial-venous saturation difference (AVDO2). A total of 33 normal subjects and five Fontan subjects scheduled for CPET were recruited. None of the Fontan subjects had a fenestration of the conduit. In the cerebral circulation, the Fontan patients have a significantly higher initial slope of increasing AVDO2 compared with normals. After vAT, the AVDO2 slope is flat for Fontan patients (p = 0.02). There is also a substantially larger rebound of cerebral rSO2 than in normal subjects after QT (p < 0.0001). Reduced anaerobic exercise capacity in Fontan patients may be secondary to limitation of cerebral blood flow, secondary to low systemic venous compliance due to absence of a sub-pulmonary ventricle, and augmented hyperventilatory response during exercise.
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Affiliation(s)
- Rohit P Rao
- Department of Pediatrics, Division of Cardiology and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA.
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Wylie GR, Graber HL, Voelbel GT, Kohl AD, DeLuca J, Pei Y, Xu Y, Barbour RL. Using co-variations in the Hb signal to detect visual activation: a near infrared spectroscopic imaging study. Neuroimage 2009; 47:473-81. [PMID: 19398013 DOI: 10.1016/j.neuroimage.2009.04.056] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 03/30/2009] [Accepted: 04/15/2009] [Indexed: 10/20/2022] Open
Abstract
The premise of this report is that functional Near Infrared Spectroscopy (fNIRS) imaging data contain valuable physiological information that can be extracted by using analysis techniques that simultaneously consider the components of the measured hemodynamic response [i.e., levels of oxygenated, deoxygenated and total hemoglobin (oxyHb, deoxyHb and totalHb, respectively)]. We present an algorithm for examining the spatiotemporal co-variations among the Hb components, and apply it to the data obtained from a demonstrational study that employed a well-established visual stimulation paradigm: a contrast-reversing checkerboard. Our results indicate that the proposed method can identify regions of tissue that participate in the hemodynamic response to neuronal activation, but are distinct from the areas identified by conventional analyses of the oxyHb, deoxyHb and totalHb data. A discussion is provided that compares these findings to other recent studies using fNIRS techniques.
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Affiliation(s)
- Glenn R Wylie
- Neuropsychology and Neuroscience Laboratory, Kessler Foundation Research Center, 300 Executive Drive, Suite 10, West Orange, New Jersey 07052, USA.
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Measurement of regional tissue bed venous weighted oximetric trends during exercise by near infrared spectroscopy. Pediatr Cardiol 2009; 30:465-71. [PMID: 19225827 DOI: 10.1007/s00246-009-9393-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Revised: 12/26/2008] [Accepted: 01/21/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET) is limited to children able to tolerate the equipment. Modification of instrumentation to reduce invasiveness will open CPET to a wider population. Near Infrared Spectroscopy (NIRS) devices measure regional oxyhemoglobin saturation (rSO2). We aim to predict anaerobic threshold (AT) during CPET using multiorgan NIRS monitoring. METHODS AND RESULTS Nineteen subjects were recruited. NIRS probes were placed on the forehead, para vertebral space, vastus lateralis, and deltoid muscle (rSO2 C, rSO2 R, rSO2 L and rSO2 A). rSO2 was recorded at six second intervals at rest, exercise, and through a five minute recovery period. The AT was computed using the v-slope method. AT was also predicted using NIRS data by identifying the inflection point of the rSO2 trends for all the four sites. AT can be estimated by the point of slope change of rSO2 R, rSO2 C and the four-site composite measure. CONCLUSIONS Multisite NIRS monitoring of visceral organs is a potential predictor of AT. This allows for monitoring in all forms of exercise over a wide age range.
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