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Kim KA, Kim H, Ha EJ, Yoon BC, Kim DJ. Artificial Intelligence-Enhanced Neurocritical Care for Traumatic Brain Injury : Past, Present and Future. J Korean Neurosurg Soc 2024; 67:493-509. [PMID: 38186369 PMCID: PMC11375068 DOI: 10.3340/jkns.2023.0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024] Open
Abstract
In neurointensive care units (NICUs), particularly in cases involving traumatic brain injury (TBI), swift and accurate decision-making is critical because of rapidly changing patient conditions and the risk of secondary brain injury. The use of artificial intelligence (AI) in NICU can enhance clinical decision support and provide valuable assistance in these complex scenarios. This article aims to provide a comprehensive review of the current status and future prospects of AI utilization in the NICU, along with the challenges that must be overcome to realize this. Presently, the primary application of AI in NICU is outcome prediction through the analysis of preadmission and high-resolution data during admission. Recent applications include augmented neuromonitoring via signal quality control and real-time event prediction. In addition, AI can integrate data gathered from various measures and support minimally invasive neuromonitoring to increase patient safety. However, despite the recent surge in AI adoption within the NICU, the majority of AI applications have been limited to simple classification tasks, thus leaving the true potential of AI largely untapped. Emerging AI technologies, such as generalist medical AI and digital twins, harbor immense potential for enhancing advanced neurocritical care through broader AI applications. If challenges such as acquiring high-quality data and ethical issues are overcome, these new AI technologies can be clinically utilized in the actual NICU environment. Emphasizing the need for continuous research and development to maximize the potential of AI in the NICU, we anticipate that this will further enhance the efficiency and accuracy of TBI treatment within the NICU.
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Affiliation(s)
- Kyung Ah Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - Hakseung Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - Eun Jin Ha
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Byung C Yoon
- Department of Radiology, Stanford University School of Medicine, VA Palo Alto Heath Care System, Palo Alto, CA, USA
| | - Dong-Joo Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
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2
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Agrawal S, Abecasis F, Jalloh I. Neuromonitoring in Children with Traumatic Brain Injury. Neurocrit Care 2024; 40:147-158. [PMID: 37386341 PMCID: PMC10861621 DOI: 10.1007/s12028-023-01779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
Traumatic brain injury remains a major cause of mortality and morbidity in children across the world. Current management based on international guidelines focuses on a fixed therapeutic target of less than 20 mm Hg for managing intracranial pressure and 40-50 mm Hg for cerebral perfusion pressure across the pediatric age group. To improve outcome from this complex disease, it is essential to understand the pathophysiological mechanisms responsible for disease evolution by using different monitoring tools. In this narrative review, we discuss the neuromonitoring tools available for use to help guide management of severe traumatic brain injury in children and some of the techniques that can in future help with individualizing treatment targets based on advanced cerebral physiology monitoring.
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Affiliation(s)
- Shruti Agrawal
- Department of Paediatric Intensive Care, Cambridge University Hospitals National Health Service Foundation Trust, Level 3, Box 7, Addenbrookes Hospital Hills Road, Cambridge, UK.
- University of Cambridge, Cambridge, UK.
| | - Francisco Abecasis
- Paediatric Intensive Care Unit, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ibrahim Jalloh
- University of Cambridge, Cambridge, UK
- Department of Neurosurgery, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
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3
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Usuah J, Jesuyajolu D, Bankole O, Ojo O. Improvised intracranial pressure monitoring devices for traumatic brain injury management in a low-income environment: A single-centre randomised study demonstrating feasibility. BRAIN & SPINE 2023; 3:101737. [PMID: 37383472 PMCID: PMC10293291 DOI: 10.1016/j.bas.2023.101737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/17/2023] [Accepted: 04/03/2023] [Indexed: 06/30/2023]
Abstract
Background The high cost and non-availability of standard ICP monitoring devices limit their use in low- and middle-income countries like Nigeria. This study aims to demonstrate the use of an improvised intraventricular ICP monitoring device as a feasible alternative. Research question Are improvised ICP Monitoring devices feasible and effective in resource-constrained settings? Materials and methods The study was a prospective single-institution investigation involving 54 adult patients that presented with severe TBI (GCS of 3-8) within 72 h of injury and required operative intervention. All patients underwent craniotomy or primary decompressive craniectomy (DC) to evacuate traumatic mass lesions. 14-day in-hospital mortality was used as a primary endpoint of the study. 25 patients had ICP monitoring postoperatively using the improvised device. Results The modified ICP device was replicated using a feeding tube and a manometer with 0.9% saline as a coupling agent. Based on hourly ICP recording (up to 72 h), patients were observed as having high ICP (>27 cm H2O) and normal ICP (27 cm H2O). In the ICP-monitored group, raised ICP was detected more than in the clinically assessed group (84% vs 12% p= <0.001). Discussion and conclusion There was a 3-time higher mortality rate among the non-ICP monitored participants (31%) compared to the ICP-monitored participants (12%), although this did not reach statistical significance due to the small sample size. This preliminary study has shown that this modified ICP monitoring system is a relatively feasible alternative for diagnosing and treating elevated ICP in severe TBI in resource-constrained environments.
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Affiliation(s)
- John Usuah
- Neurosurgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Neurosurgery, Queen Elizabeth Hospital, University Hospital, Birmingham, United Kingdom
| | - Damilola Jesuyajolu
- Department of Neurosurgery, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Olufemi Bankole
- Neurosurgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Omotayo Ojo
- Neurosurgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
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Davies DJ, Hadis M, Di Pietro V, Lazzarino G, Forcione M, Harris G, Stevens AR, Soon WC, Goldberg Oppenheimer P, Milward M, Belli A, Palin WM. Photobiomodulation reduces hippocampal apoptotic cell death and produces a Raman spectroscopic “signature”. PLoS One 2022; 17:e0264533. [PMID: 35239693 PMCID: PMC8893683 DOI: 10.1371/journal.pone.0264533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/11/2022] [Indexed: 11/18/2022] Open
Abstract
Apoptotic cell death within the brain represents a significant contributing factor to impaired post-traumatic tissue function and poor clinical outcome after traumatic brain injury. After irradiation with light in the wavelength range of 600–1200 nm (photobiomodulation), previous investigations have reported a reduction in apoptosis in various tissues. This study investigates the effect of 660 nm photobiomodulation on organotypic slice cultured hippocampal tissue of rats, examining the effect on apoptotic cell loss. Tissue optical Raman spectroscopic changes were evaluated. A significantly higher proportion of apoptotic cells 62.8±12.2% vs 48.6±13.7% (P<0.0001) per region were observed in the control group compared with the photobiomodulation group. After photobiomodulation, Raman spectroscopic observations demonstrated 1440/1660 cm-1 spectral shift. Photobiomodulation has the potential for therapeutic utility, reducing cell loss to apoptosis in injured neurological tissue, as demonstrated in this in vitro model. A clear Raman spectroscopic signal was observed after apparent optimal irradiation, potentially integrable into therapeutic light delivery apparatus for real-time dose metering.
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Affiliation(s)
- David J. Davies
- Department of Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham’ Edgbaston, Birmingham, United Kingdom
- * E-mail:
| | - Mohammed Hadis
- Photobiology Research Group, School of Dentistry, College of Medical and Dental Science, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Valentina Di Pietro
- Department of Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Giuseppe Lazzarino
- Department of Chemical Sciences, Laboratory of Biochemistry, University of Catania, Catania, Italy
| | - Mario Forcione
- Department of Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham’ Edgbaston, Birmingham, United Kingdom
| | - Georgia Harris
- Faculty of Chemical and Biological Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Andrew R. Stevens
- Department of Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham’ Edgbaston, Birmingham, United Kingdom
| | - Wai Cheong Soon
- Department of Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Pola Goldberg Oppenheimer
- Faculty of Chemical and Biological Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Michael Milward
- Photobiology Research Group, School of Dentistry, College of Medical and Dental Science, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Antonio Belli
- Department of Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham’ Edgbaston, Birmingham, United Kingdom
| | - William M. Palin
- Photobiology Research Group, School of Dentistry, College of Medical and Dental Science, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
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Monitoring cerebrovascular reactivity in pediatric traumatic brain injury: comparison of three methods. Childs Nerv Syst 2021; 37:3057-3065. [PMID: 34212250 DOI: 10.1007/s00381-021-05263-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To study three different methods of monitoring cerebral autoregulation in children with severe traumatic brain injury. METHODS Prospective cohort study of all children admitted to the pediatric intensive care unit at a university-affiliated hospital with severe TBI over a 4-year period to study three different methods of monitoring cerebral autoregulation: pressure-reactivity index (PRx), transcranial Doppler derived mean flow velocity index (Mx), and near-infrared spectroscopy derived cerebral oximetry index (COx). RESULTS Twelve patients were included in the study, aged 5 months to 17 years old. An empirical regression analyzing dependence of PRx on cerebral perfusion pressure (CPP) displayed the classic U-shaped distribution, with low PRx values (< 0.3) reflecting intact auto-regulation, within the CPP range of 50-100 mmHg. The optimal CPP was 75-80 mmHg for PRx and COx. The correlation coefficients between the three indices were as follows: PRx vs Mx, r = 0.56; p < 0.0001; PRx vs COx, r = 0.16; p < 0.0001; and COx vs Mx, r = 0.15; p = 0.022. The mean PRx with a cutoff value of 0.3 predicted correctly long-term outcome (p = 0.015). CONCLUSIONS PRx seems to be the most robust index to access cerebrovascular reactivity in children with TBI and has promising prognostic value. Optimal CPP calculation is feasible with PRx and COx.
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Zhong W, Ji Z, Sun C. A Review of Monitoring Methods for Cerebral Blood Oxygen Saturation. Healthcare (Basel) 2021; 9:healthcare9091104. [PMID: 34574878 PMCID: PMC8466732 DOI: 10.3390/healthcare9091104] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/13/2021] [Accepted: 07/31/2021] [Indexed: 01/02/2023] Open
Abstract
In recent years, cerebral blood oxygen saturation has become a key indicator during the perioperative period. Cerebral blood oxygen saturation monitoring is conducive to the early diagnosis and treatment of cerebral ischemia and hypoxia. The present study discusses the three most extensively used clinical methods for cerebral blood oxygen saturation monitoring from different aspects: working principles, relevant parameters, current situations of research, commonly used equipment, and relative advantages of different methods. Furthermore, through comprehensive comparisons of the methods, we find that near-infrared spectroscopy (NIRS) technology has significant potentials and broad applications prospects in terms of cerebral oxygen saturation monitoring. Despite the current NIRS technology, the only bedside non-invasive cerebral oxygen saturation monitoring technology, still has many defects, it is more in line with the future development trend in the field of medical and health, and will become the main method gradually.
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Affiliation(s)
- Wentao Zhong
- College of Bioengineering, Chongqing University, Chongqing 400044, China; (W.Z.); (C.S.)
| | - Zhong Ji
- College of Bioengineering, Chongqing University, Chongqing 400044, China; (W.Z.); (C.S.)
- Key Laboratory of Biorheological Science and Technology, Chongqing University, Ministry of Education, Chongqing 400044, China
- Correspondence:
| | - Changlong Sun
- College of Bioengineering, Chongqing University, Chongqing 400044, China; (W.Z.); (C.S.)
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7
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Correlation between Glasgow coma scale and Jugular venous oxygen saturation in severe traumatic brain injury. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2013.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Davies DJ, Clancy M, Dehghani H, Lucas SJE, Forcione M, Yakoub KM, Belli A. Cerebral Oxygenation in Traumatic Brain Injury: Can a Non-Invasive Frequency Domain Near-Infrared Spectroscopy Device Detect Changes in Brain Tissue Oxygen Tension as Well as the Established Invasive Monitor? J Neurotrauma 2018; 36:1175-1183. [PMID: 29877139 DOI: 10.1089/neu.2018.5667] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The cost and highly invasive nature of brain monitoring modality in traumatic brain injury patients currently restrict its utility to specialist neurological intensive care settings. We aim to test the abilities of a frequency domain near-infrared spectroscopy (FD-NIRS) device in predicting changes in invasively measured brain tissue oxygen tension. Individuals admitted to a United Kingdom specialist major trauma center were contemporaneously monitored with an FD-NIRS device and invasively measured brain tissue oxygen tension probe. Area under the curve receiver operating characteristic (AUROC) statistical analysis was utilized to assess the predictive power of FD-NIRS in detecting both moderate and severe hypoxia (20 and 10 mm Hg, respectively) as measured invasively. Sixteen individuals were prospectively recruited to the investigation. Severe hypoxic episodes were detected in nine of these individuals, with the NIRS demonstrating a broad range of predictive abilities (AUROC 0.68-0.88) from relatively poor to good. Moderate hypoxic episodes were detected in seven individuals with similar predictive performance (AUROC 0.576-0.905). A variable performance in the predictive powers of this FD-NIRS device to detect changes in brain tissue oxygen was demonstrated. Consequently, this enhanced NIRS technology has not demonstrated sufficient ability to replace the established invasive measurement.
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Affiliation(s)
- David James Davies
- 1 National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Michael Clancy
- 1 National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Hamid Dehghani
- 2 School of Computer Science, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Samuel John Edwin Lucas
- 3 School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mario Forcione
- 1 National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Kamal Makram Yakoub
- 1 National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Antonio Belli
- 1 National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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9
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Pagkalos I, Rogers ML, Boutelle MG, Drakakis EM. A High-Performance Application Specific Integrated Circuit for Electrical and Neurochemical Traumatic Brain Injury Monitoring. Chemphyschem 2018; 19:1215-1225. [PMID: 29388305 PMCID: PMC6016079 DOI: 10.1002/cphc.201701119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 01/25/2018] [Indexed: 11/11/2022]
Abstract
This paper presents the first application specific integrated chip (ASIC) for the monitoring of patients who have suffered a Traumatic Brain Injury (TBI). By monitoring the neurophysiological (ECoG) and neurochemical (glucose, lactate and potassium) signals of the injured human brain tissue, it is possible to detect spreading depolarisations, which have been shown to be associated with poor TBI patient outcome. This paper describes the testing of a new 7.5 mm2 ASIC fabricated in the commercially available AMS 0.35 μm CMOS technology. The ASIC has been designed to meet the demands of processing the injured brain tissue's ECoG signals, recorded by means of depth or brain surface electrodes, and neurochemical signals, recorded using microdialysis coupled to microfluidics-based electrochemical biosensors. The potentiostats use switchedcapacitor charge integration to record currents with 100 fA resolution, and allow automatic gain changing to track the falling sensitivity of a biosensor. This work supports the idea of a "behind the ear" wireless microplatform modality, which could enable the monitoring of currently non-monitored mobile TBI patients for the onset of secondary brain injury.
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10
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Cerebral Oxygenation Under General Anesthesia Can Be Safely Preserved in Patients in Prone Position: A Prospective Observational Study. J Neurosurg Anesthesiol 2018; 29:291-297. [PMID: 27271235 DOI: 10.1097/ana.0000000000000319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effects of prone position (PP) on cerebral tissue metabolism are not well known. The aim of this investigation was to evaluate regional cerebral oxygen desaturation in patients undergoing lumbar spine surgery in PP during routine anesthesia management. MATERIALS AND METHODS Between July 2013 and October 2013, 50 consecutive patients undergoing lumbar spine surgery under general anesthesia in PP were enrolled. The anesthetic technique was standardized. Using near-infrared spectroscopy, bilateral regional cerebrovascular oxygen saturation was recorded during the surgery. RESULTS After 30 and 60 minutes of prone repositioning, significant decreases in bilateral regional cerebral oxygen saturation were observed compared with the values in the supine position (from 76.24% to 73.18% at 30 min and 72.76% at 60 min on the right side and from 77.06% to 73.76% at 30 min and 72.92% at 60 min on the left side; P<0.05). These changes were not clinically important and returned to supine values after 90 minutes of prone positioning. Decreases in cerebral oxygen saturation were accompanied by reductions in heart rate and mean arterial pressure (P<0.05). Older age and higher perioperative risk had a significant effect on the reduction of cerebral oxygen values (P<0.05). CONCLUSIONS The results of our study show that margin of safety against impaired cerebral oxygenation can be maintained in PP. Preventing bradycardia and arterial hypotension is crucial. Older patients and those at higher perioperative risk need more meticulous attention.
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Dash HH, Chavali S. Management of traumatic brain injury patients. Korean J Anesthesiol 2018; 71:12-21. [PMID: 29441170 PMCID: PMC5809702 DOI: 10.4097/kjae.2018.71.1.12] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 01/07/2023] Open
Abstract
Traumatic brain injury (TBI) has been called the ‘silent epidemic’ of modern times, and is the leading cause of mortality and morbidity in children and young adults in both developed and developing nations worldwide. In recent years, the treatment of TBI has undergone a paradigm shift. The management of severe TBI is ideally based on protocol-based guidelines provided by the Brain Trauma Foundation. The aims and objectives of its management are prophylaxis and prompt management of intracranial hypertension and secondary brain injury, maintenance of cerebral perfusion pressure, and ensuring adequate oxygen delivery to injured brain tissue. In this review, the authors discuss protocol-based approaches to the management of severe TBI as per recent guidelines.
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Affiliation(s)
- Hari Hara Dash
- Department of Anesthesiology and Pain Medicine, Fortis Memorial Research Institute, Gurgaon, India
| | - Siddharth Chavali
- Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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12
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Dempsey EM, El-Khuffash AF. Objective cardiovascular assessment in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2018; 103:F72-F77. [PMID: 29127152 DOI: 10.1136/archdischild-2017-313837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/11/2017] [Accepted: 10/18/2017] [Indexed: 11/04/2022]
Abstract
Traditionally, cardiovascular well-being was essentially based on whether the mean blood pressure was above or below a certain value. However, this singular crude method of assessment provides limited insight into overall cardiovascular well-being. Echocardiography has become increasingly used and incorporated into clinical care. New objective modality assessments of cardiovascular status continue to evolve and are being evaluated and incorporated into clinical care. In this review article, we will discuss some of the recent advances in objective assessment of cardiovascular well-being, including the concept of multimodal monitoring. Sophisticated haemodynamic monitoring systems are being developed, including mechanisms of data acquisition and analysis. Their incorporation into clinical care represents an exciting next stage in the management of the infant with cardiovascular compromise.
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Affiliation(s)
- Eugene M Dempsey
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland.,INFANT, Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Afif Faisal El-Khuffash
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.,Department of Paediatrics, School of Medicine, The Royal College of Surgeons in Ireland, Dublin, Ireland
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13
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Guglielmetti C, Chou A, Krukowski K, Najac C, Feng X, Riparip LK, Rosi S, Chaumeil MM. In vivo metabolic imaging of Traumatic Brain Injury. Sci Rep 2017; 7:17525. [PMID: 29235509 PMCID: PMC5727520 DOI: 10.1038/s41598-017-17758-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
Complex alterations in cerebral energetic metabolism arise after traumatic brain injury (TBI). To date, methods allowing for metabolic evaluation are highly invasive, limiting our understanding of metabolic impairments associated with TBI pathogenesis. We investigated whether 13C MRSI of hyperpolarized (HP) [1-13C] pyruvate, a non-invasive metabolic imaging method, could detect metabolic changes in controlled cortical injury (CCI) mice (n = 57). Our results show that HP [1-13C] lactate-to-pyruvate ratios were increased in the injured cortex at acute (12/24 hours) and sub-acute (7 days) time points after injury, in line with decreased pyruvate dehydrogenase (PDH) activity, suggesting impairment of the oxidative phosphorylation pathway. We then used the colony-stimulating factor-1 receptor inhibitor PLX5622 to deplete brain resident microglia prior to and after CCI, in order to confirm that modulations of HP [1-13C] lactate-to-pyruvate ratios were linked to microglial activation. Despite CCI, the HP [1-13C] lactate-to-pyruvate ratio at the injury cortex of microglia-depleted animals at 7 days post-injury remained unchanged compared to contralateral hemisphere, and PDH activity was not affected. Altogether, our results demonstrate that HP [1-13C] pyruvate has great potential for in vivo non-invasive detection of cerebral metabolism post-TBI, providing a new tool to monitor the effect of therapies targeting microglia/macrophages activation after TBI.
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Affiliation(s)
- Caroline Guglielmetti
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA.,Surbeck Laboratory of Advanced Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States
| | - Austin Chou
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA.,Brain and Spinal Injury Center, University of California, 1001 Potrero Ave, Bldg. 1, Room 101, San Francisco, CA, 94110, USA
| | - Karen Krukowski
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA.,Brain and Spinal Injury Center, University of California, 1001 Potrero Ave, Bldg. 1, Room 101, San Francisco, CA, 94110, USA
| | - Chloe Najac
- Surbeck Laboratory of Advanced Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States
| | - Xi Feng
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA.,Brain and Spinal Injury Center, University of California, 1001 Potrero Ave, Bldg. 1, Room 101, San Francisco, CA, 94110, USA
| | - Lara-Kirstie Riparip
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA.,Brain and Spinal Injury Center, University of California, 1001 Potrero Ave, Bldg. 1, Room 101, San Francisco, CA, 94110, USA
| | - Susanna Rosi
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA. .,Brain and Spinal Injury Center, University of California, 1001 Potrero Ave, Bldg. 1, Room 101, San Francisco, CA, 94110, USA. .,Department of Neurological Surgery, University of California, San Francisco, CA, USA. .,Weill Institute for Neuroscience, University of California, San Francisco, CA, USA. .,Kavli Institute of Fundamental Neuroscience, University of California, San Francisco, CA, USA.
| | - Myriam M Chaumeil
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA. .,Surbeck Laboratory of Advanced Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States.
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14
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Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability in patients with trauma. Management strategies must focus on preventing secondary injury by avoiding hypotension and hypoxia and maintaining appropriate cerebral perfusion pressure (CPP), which is a surrogate for cerebral blood flow. CPP can be maintained by increasing mean arterial pressure, decreasing intracranial pressure, or both. The goal should be euvolemia and avoidance of hypotension. Other factors that deserve important consideration in the acute management of patients with TBI are venous thromboembolism, stress ulcer, and seizure prophylaxis, as well as nutritional and metabolic optimization.
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Affiliation(s)
- Michael A. Vella
- Chief Resident in General Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Medical Center North, CCC-4312, 1161 21st Avenue South, Nashville, TN 37232-2730,
| | - Marie Crandall
- Professor of Surgery, Division of Acute Care Surgery, Department of Surgery, University of Florida, Jacksonville, 655 West 8th Street, Jacksonville, FL 32209,
| | - Mayur B. Patel
- Assistant Professor of Surgery, Neurosurgery, Hearing & Speech Sciences, Division of Trauma, Surgical Critical Care, and Emergency General Surgery, Department of Surgery, Section of Surgical Sciences, Center for Health Services Research, Vanderbilt Brain Institute, Vanderbilt University Medical Center, 1211 21 Avenue South, Medical Arts Building, Suite 404, Nashville, TN 37212,
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15
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Mateo J, Payen D, Ghout I, Vallée F, Lescot T, Welschbillig S, Tazarourte K, Azouvi P, Weiss JJ, Aegerter P, Vigué B. Impact of extended monitoring-guided intensive care on outcome after severe traumatic brain injury: A prospective multicentre cohort study (PariS-TBI study). Brain Inj 2017; 31:1642-1650. [PMID: 28925746 DOI: 10.1080/02699052.2017.1370554] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We evaluated whether an integrated monitoring with systemic and specific monitoring affect mortality and disability in adults with severe traumatic brain injury (sTBI). METHODS Adults with severeTBI (Glasgow Coma Scale [GCS] ≤ 8) admitted alive in intensive care units (ICUs) were prospectively included. Primary endpoints were in-hospital 30-day mortality and extended Glasgow outcome score (GOSE) at 3 years. Association with the intensity of monitoring and outcome was studied by comparing a high level of monitoring (HLM) (systemic and ≥3 specific monitoring) and low level of monitoring (LLM) (systemic and 0-2 specific monitoring) and using inverse probability weighting procedure. RESULTS 476 patients were included and IPW was used to improve the balance between the two groups of treatments (HLM/LMM). Overall hospital mortality (at 30 days) was 43%, being significantly lower in HLM than LLM group (27% vs. 53%: RR, 1.63: 95% CI: 1.23-2.15). The 14-day hospital mortality was also lower in the HLM group than expected, based upon the CRASH prediction model (35%). At 3 years, disability was not significantly different between the monitoring groups. CONCLUSIONS After adjustment, HLM group improved short-term mortality but did not show any improvement in the 3-year outcome compared with LLM.
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Affiliation(s)
- Joaquim Mateo
- a Department of Anesthesiology and Critical Care , Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 7 Diderot , Paris , France
| | - Didier Payen
- a Department of Anesthesiology and Critical Care , Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 7 Diderot , Paris , France
| | - Idir Ghout
- b Unité de Recherche Clinique Paris-Ouest , Hôpital Ambroise Paré, AP-HP , Boulogne , France
| | - Fabrice Vallée
- a Department of Anesthesiology and Critical Care , Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 7 Diderot , Paris , France
| | - Thomas Lescot
- c Department of Anesthesiology and Critical Care , Pitié-Salpêtrière University Hospital, APHP, University Paris 6 , Paris , France
| | - Stephane Welschbillig
- a Department of Anesthesiology and Critical Care , Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 7 Diderot , Paris , France
| | - Karim Tazarourte
- d SAMU 77, Mobile Care Unit , Marc Jacquet Hospital , Melun , France
| | - Philippe Azouvi
- e Department of Physical Medicine and Rehabilitation , Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris , Garches , France
| | - Jean-Jacques Weiss
- f Department of Public Health , Centre Ressources Francilien du Traumatisme Crânien , Paris , France
| | - Philippe Aegerter
- g UMR-S 1168, INSERM , Université Versailles St-Quentin , Paris , France
| | - Bernard Vigué
- h Department of Anesthesiology and Intensive Care , Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Sud , Le Kremlin Bicêtre , France
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Limnuson K, Narayan RK, Chiluwal A, Bouton C. Development of a brain monitoring system for multimodality investigation in awake rats. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:4487-4490. [PMID: 28269275 DOI: 10.1109/embc.2016.7591724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Multimodal brain monitoring is an important approach to gain insight into brain function, modulation, and pathology. We have developed a unique micromachined neural probe capable of real-time continuous monitoring of multiple physiological, biochemical and electrophysiological variables. However, to date, it has only been used in anesthetized animals due to a lack of an appropriate interface for awake animals. We have developed a versatile headstage for recording the small neural signal and bridging the sensors to the remote sensing units for multimodal brain monitoring in awake rats. The developed system has been successfully validated in awake rats by simultaneously measuring four cerebral variables: electrocorticography, oxygen tension, temperature and cerebral blood flow. Reliable signal recordings were obtained with minimal artifacts from movement and environmental noise. For the first time, multiple variables of cerebral function and metabolism were simultaneously recorded from awake rats using a single neural probe. The system is envisioned for studying the effects of pharmacologic treatments, mapping the development of central nervous system diseases, and better understanding normal cerebral physiology.
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Weigl W, Milej D, Janusek D, Wojtkiewicz S, Sawosz P, Kacprzak M, Gerega A, Maniewski R, Liebert A. Application of optical methods in the monitoring of traumatic brain injury: A review. J Cereb Blood Flow Metab 2016; 36:1825-1843. [PMID: 27604312 PMCID: PMC5094301 DOI: 10.1177/0271678x16667953] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/28/2016] [Accepted: 07/18/2016] [Indexed: 01/19/2023]
Abstract
We present an overview of the wide range of potential applications of optical methods for monitoring traumatic brain injury. The MEDLINE database was electronically searched with the following search terms: "traumatic brain injury," "head injury," or "head trauma," and "optical methods," "NIRS," "near-infrared spectroscopy," "cerebral oxygenation," or "cerebral oximetry." Original reports concerning human subjects published from January 1980 to June 2015 in English were analyzed. Fifty-four studies met our inclusion criteria. Optical methods have been tested for detection of intracranial lesions, monitoring brain oxygenation, assessment of brain perfusion, and evaluation of cerebral autoregulation or intracellular metabolic processes in the brain. Some studies have also examined the applicability of optical methods during the recovery phase of traumatic brain injury . The limitations of currently available optical methods and promising directions of future development are described in this review. Considering the outstanding technical challenges, the limited number of patients studied, and the mixed results and opinions gathered from other reviews on this subject, we believe that optical methods must remain primarily research tools for the present. More studies are needed to gain confidence in the use of these techniques for neuromonitoring of traumatic brain injury patients.
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Affiliation(s)
- Wojciech Weigl
- Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, Akademiska Hospital, Uppsala, Sweden
| | - Daniel Milej
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Dariusz Janusek
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Stanisław Wojtkiewicz
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Piotr Sawosz
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Michał Kacprzak
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Anna Gerega
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Roman Maniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Adam Liebert
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
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18
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Development and application of a microfabricated multimodal neural catheter for neuroscience. Biomed Microdevices 2016; 18:8. [PMID: 26780443 DOI: 10.1007/s10544-016-0034-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We present a microfabricated neural catheter for real-time continuous monitoring of multiple physiological, biochemical and electrophysiological variables that are critical to the diagnosis and treatment of evolving brain injury. The first generation neural catheter was realized by polyimide-based micromachining and a spiral rolling packaging method. The mechanical design and electrical operation of the microsensors were optimized and tailored for multimodal monitoring in rat brain such that the potential thermal, chemical and electrical crosstalk among the microsensors as well as errors from micro-environmental fluctuations are minimized. In vitro cytotoxicity analyses suggest that the developed neural catheters are minimally toxic to rat cortical neuronal cultures. In addition, in vivo histopathology results showed neither acute nor chronic inflammation for 7 days post implantation. The performance of the neural catheter was assessed in an in vivo needle prick model as a translational replica of a "mini" traumatic brain injury. It successfully monitored the expected transient brain oxygen, temperature, regional cerebral blood flow, and DC potential changes during the passage of spreading depolarization waves. We envisage that the developed multimodal neural catheter can be used to decipher the causes and consequences of secondary brain injury processes with high spatial and temporal resolution while reducing the potential for iatrogenic injury inherent to current use of multiple invasive probes.
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Limnuson K, Narayan RK, Chiluwal A, Golanov EV, Bouton CE, Li C. A User-Configurable Headstage for Multimodality Neuromonitoring in Freely Moving Rats. Front Neurosci 2016; 10:382. [PMID: 27594826 PMCID: PMC4990626 DOI: 10.3389/fnins.2016.00382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/05/2016] [Indexed: 11/21/2022] Open
Abstract
Multimodal monitoring of brain activity, physiology, and neurochemistry is an important approach to gain insight into brain function, modulation, and pathology. With recent progress in micro- and nanotechnology, micro-nano-implants have become important catalysts in advancing brain research. However, to date, only a limited number of brain parameters have been measured simultaneously in awake animals in spite of significant recent progress in sensor technology. Here we have provided a cost and time effective approach to designing a headstage to conduct a multimodality brain monitoring in freely moving animals. To demonstrate this method, we have designed a user-configurable headstage for our micromachined multimodal neural probe. The headstage can reliably record direct-current electrocorticography (DC-ECoG), brain oxygen tension (PbrO2), cortical temperature, and regional cerebral blood flow (rCBF) simultaneously without significant signal crosstalk or movement artifacts for 72 h. Even in a noisy environment, it can record low-level neural signals with high quality. Moreover, it can easily interface with signal conditioning circuits that have high power consumption and are difficult to miniaturize. To the best of our knowledge, this is the first time where multiple physiological, biochemical, and electrophysiological cerebral variables have been simultaneously recorded from freely moving rats. We anticipate that the developed system will aid in gaining further insight into not only normal cerebral functioning but also pathophysiology of conditions such as epilepsy, stroke, and traumatic brain injury.
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Affiliation(s)
- Kanokwan Limnuson
- Cushing Neuromonitoring Laboratory, The Feinstein Institute for Medical Research Manhasset, NY, USA
| | - Raj K Narayan
- Cushing Neuromonitoring Laboratory, The Feinstein Institute for Medical ResearchManhasset, NY, USA; Department of Neurosurgery, Hofstra Northwell School of MedicineHempstead, NY, USA
| | - Amrit Chiluwal
- Department of Neurosurgery, Hofstra Northwell School of Medicine Hempstead, NY, USA
| | - Eugene V Golanov
- Cushing Neuromonitoring Laboratory, The Feinstein Institute for Medical Research Manhasset, NY, USA
| | - Chad E Bouton
- Center for Bioelectronic Medicine, The Feinstein Institute for Medical Research Manhasset, NY, USA
| | - Chunyan Li
- Cushing Neuromonitoring Laboratory, The Feinstein Institute for Medical ResearchManhasset, NY, USA; Department of Neurosurgery, Hofstra Northwell School of MedicineHempstead, NY, USA; Center for Bioelectronic Medicine, The Feinstein Institute for Medical ResearchManhasset, NY, USA
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20
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Abstract
PURPOSE OF REVIEW Maintenance of adequate blood flow and oxygen to the brain is one of the principal endpoints of all surgery and anesthesia. During operations in general anesthesia, however, the brain is at particular risk for silent ischemia. Despite this risk, the brain still remains one of the last monitored organs in clincial anesthesiology. RECENT FINDINGS Transcranial Doppler (TCD) sonography and near-infrared spectroscopy (NIRS) experience a revival as these noninvasive technologies help to detect silent cerebral ischemia. TCD allows for quantification of blood flow velocities in basal intracranial arteries. TCD-derived variables such as the pulsatility index might hint toward diminished cognitive reserve or raised intracranial pressure. NIRS allows for assessment of regional cerebral oxygenation. Monitoring should be performed during high-risk surgery for silent cerebral ischemia and special circumstances during critical care medicine. Both techniques allow for the assessment of cerebrovascular autoregulation and individualized management of cerebral hemodynamics. SUMMARY TCD and NIRS are noninvasive monitors that anesthesiologists apply to tailor cerebral oxygen delivery, aiming to safeguard brain function in the perioperative period.
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Makarenko S, Griesdale DE, Gooderham P, Sekhon MS. Multimodal neuromonitoring for traumatic brain injury: A shift towards individualized therapy. J Clin Neurosci 2016; 26:8-13. [PMID: 26755455 DOI: 10.1016/j.jocn.2015.05.065] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 05/30/2015] [Indexed: 01/08/2023]
Abstract
Multimodal neuromonitoring in the management of traumatic brain injury (TBI) enables clinicians to make individualized management decisions to prevent secondary ischemic brain injury. Traditionally, neuromonitoring in TBI patients has consisted of a combination of clinical examination, neuroimaging and intracranial pressure monitoring. Unfortunately, each of these modalities has its limitations and although pragmatic, this simplistic approach has failed to demonstrate improved outcomes, likely owing to an inability to consider the underlying heterogeneity of various injury patterns. As neurocritical care has evolved, so has our understanding of underlying disease pathophysiology and patient specific considerations. Recent additions to the multimodal neuromonitoring platform include measures of cerebrovascular autoregulation, brain tissue oxygenation, microdialysis and continuous electroencephalography. The implementation of neurocritical care teams to manage patients with advanced brain injury has led to improved outcomes. Herein, we present a narrative review of the recent advances in multimodal neuromonitoring and highlight the utility of dedicated neurocritical care.
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Affiliation(s)
- Serge Makarenko
- Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Donald E Griesdale
- Department of Anaesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada; Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, Room 2438, Jim Pattison Pavilion, 2nd Floor, 899 West 12th Avenue, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Peter Gooderham
- Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Mypinder S Sekhon
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, Room 2438, Jim Pattison Pavilion, 2nd Floor, 899 West 12th Avenue, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
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22
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Caldwell M, Moroz T, Hapuarachchi T, Bainbridge A, Robertson NJ, Cooper CE, Tachtsidis I. Modelling Blood Flow and Metabolism in the Preclinical Neonatal Brain during and Following Hypoxic-Ischaemia. PLoS One 2015; 10:e0140171. [PMID: 26445281 PMCID: PMC4596480 DOI: 10.1371/journal.pone.0140171] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/22/2015] [Indexed: 11/18/2022] Open
Abstract
Hypoxia-ischaemia (HI) is a major cause of neonatal brain injury, often leading to long-term damage or death. In order to improve understanding and test new treatments, piglets are used as preclinical models for human neonates. We have extended an earlier computational model of piglet cerebral physiology for application to multimodal experimental data recorded during episodes of induced HI. The data include monitoring with near-infrared spectroscopy (NIRS) and magnetic resonance spectroscopy (MRS), and the model simulates the circulatory and metabolic processes that give rise to the measured signals. Model extensions include simulation of the carotid arterial occlusion used to induce HI, inclusion of cytoplasmic pH, and loss of metabolic function due to cell death. Model behaviour is compared to data from two piglets, one of which recovered following HI while the other did not. Behaviourally-important model parameters are identified via sensitivity analysis, and these are optimised to simulate the experimental data. For the non-recovering piglet, we investigate several state changes that might explain why some MRS and NIRS signals do not return to their baseline values following the HI insult. We discover that the model can explain this failure better when we include, among other factors such as mitochondrial uncoupling and poor cerebral blood flow restoration, the death of around 40% of the brain tissue.
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Affiliation(s)
- Matthew Caldwell
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Tracy Moroz
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom; CoMPLEX, University College London, London, United Kingdom
| | - Tharindi Hapuarachchi
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom; CoMPLEX, University College London, London, United Kingdom
| | - Alan Bainbridge
- Medical Physics and Bioengineering, UCLH NHS Foundation Trust, London, United Kingdom
| | - Nicola J Robertson
- Insititute for Women's Health, University College London, London, United Kingdom
| | - Chris E Cooper
- Biological Sciences, University of Essex, Colchester, United Kingdom
| | - Ilias Tachtsidis
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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Abstract
PURPOSE OF REVIEW To review recent evidence concerning the interactions between hemodynamic and perfusion parameters during septic shock resuscitation, and to propose some basic foundations for a more comprehensive perfusion assessment. RECENT FINDINGS Several recent studies have expanded our knowledge about the physiologic determinants and limitations of currently used perfusion parameters such as central venous oxygen saturation and lactate. Macrohemodynamic, metabolic, peripheral and microcirculatory parameters tend to change in parallel in response to fluid loading during initial resuscitation. In contrast, perfusion markers are poorly correlated in patients who evolve with a persistent circulatory dysfunction. Therefore, assessment of perfusion status based solely on a single parameter can lead to inaccurate or misleading conclusions. SUMMARY All individual perfusion parameters have extensive limitations to adequately reflect tissue perfusion during persistent sepsis-related circulatory dysfunction. A multimodal approach integrating macrohemodynamic, metabolic, peripheral and eventually microcirculatory perfusion parameters may overcome those limitations. This approach may also provide a thorough understanding on the predominant driving forces of hypoperfusion, and lead to physiologically oriented interventions.
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Francis R, Khan B, Alexandrakis G, Florence J, MacFarlane D. NIR light propagation in a digital head model for traumatic brain injury (TBI). BIOMEDICAL OPTICS EXPRESS 2015; 6:3256-67. [PMID: 26417498 PMCID: PMC4574654 DOI: 10.1364/boe.6.003256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/03/2015] [Accepted: 08/03/2015] [Indexed: 05/07/2023]
Abstract
Near infrared spectroscopy (NIRS) is capable of detecting and monitoring acute changes in cerebral blood volume and oxygenation associated with traumatic brain injury (TBI). Wavelength selection, source-detector separation, optode density, and detector sensitivity are key design parameters that determine the imaging depth, chromophore separability, and, ultimately, clinical usefulness of a NIRS instrument. We present simulation results of NIR light propagation in a digital head model as it relates to the ability to detect intracranial hematomas and monitor the peri-hematomal tissue viability. These results inform NIRS instrument design specific to TBI diagnosis and monitoring.
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Affiliation(s)
- Robert Francis
- Raytheon, 1601 N Plano Rd, Richardson, TX 75081, USA
- Department of Electrical Engineering, University of Texas Dallas, 800 W Campbell Rd, Richardson, TX 75080, USA
| | - Bilal Khan
- Department of Electrical Engineering, University of Texas Dallas, 800 W Campbell Rd, Richardson, TX 75080, USA
- Department of Bioengineering, University of Texas Arlington, 500 UTA Boulevard, Arlington, TX 76010, USA
| | - George Alexandrakis
- Department of Bioengineering, University of Texas Arlington, 500 UTA Boulevard, Arlington, TX 76010, USA
| | - James Florence
- Department of Electrical Engineering, University of Texas Dallas, 800 W Campbell Rd, Richardson, TX 75080, USA
| | - Duncan MacFarlane
- Department of Electrical Engineering, University of Texas Dallas, 800 W Campbell Rd, Richardson, TX 75080, USA
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Belle A, Thiagarajan R, Soroushmehr SMR, Navidi F, Beard DA, Najarian K. Big Data Analytics in Healthcare. BIOMED RESEARCH INTERNATIONAL 2015; 2015:370194. [PMID: 26229957 PMCID: PMC4503556 DOI: 10.1155/2015/370194] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 05/26/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023]
Abstract
The rapidly expanding field of big data analytics has started to play a pivotal role in the evolution of healthcare practices and research. It has provided tools to accumulate, manage, analyze, and assimilate large volumes of disparate, structured, and unstructured data produced by current healthcare systems. Big data analytics has been recently applied towards aiding the process of care delivery and disease exploration. However, the adoption rate and research development in this space is still hindered by some fundamental problems inherent within the big data paradigm. In this paper, we discuss some of these major challenges with a focus on three upcoming and promising areas of medical research: image, signal, and genomics based analytics. Recent research which targets utilization of large volumes of medical data while combining multimodal data from disparate sources is discussed. Potential areas of research within this field which have the ability to provide meaningful impact on healthcare delivery are also examined.
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Affiliation(s)
- Ashwin Belle
- Emergency Medicine Department, University of Michigan, Ann Arbor, MI 48109, USA
- University of Michigan Center for Integrative Research in Critical Care (MCIRCC), Ann Arbor, MI 48109, USA
| | - Raghuram Thiagarajan
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - S. M. Reza Soroushmehr
- Emergency Medicine Department, University of Michigan, Ann Arbor, MI 48109, USA
- University of Michigan Center for Integrative Research in Critical Care (MCIRCC), Ann Arbor, MI 48109, USA
| | - Fatemeh Navidi
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Daniel A. Beard
- University of Michigan Center for Integrative Research in Critical Care (MCIRCC), Ann Arbor, MI 48109, USA
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kayvan Najarian
- Emergency Medicine Department, University of Michigan, Ann Arbor, MI 48109, USA
- University of Michigan Center for Integrative Research in Critical Care (MCIRCC), Ann Arbor, MI 48109, USA
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Caldwell M, Hapuarachchi T, Highton D, Elwell C, Smith M, Tachtsidis I. BrainSignals Revisited: Simplifying a Computational Model of Cerebral Physiology. PLoS One 2015; 10:e0126695. [PMID: 25961297 PMCID: PMC4427507 DOI: 10.1371/journal.pone.0126695] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
Multimodal monitoring of brain state is important both for the investigation of healthy cerebral physiology and to inform clinical decision making in conditions of injury and disease. Near-infrared spectroscopy is an instrument modality that allows non-invasive measurement of several physiological variables of clinical interest, notably haemoglobin oxygenation and the redox state of the metabolic enzyme cytochrome c oxidase. Interpreting such measurements requires the integration of multiple signals from different sources to try to understand the physiological states giving rise to them. We have previously published several computational models to assist with such interpretation. Like many models in the realm of Systems Biology, these are complex and dependent on many parameters that can be difficult or impossible to measure precisely. Taking one such model, BrainSignals, as a starting point, we have developed several variant models in which specific regions of complexity are substituted with much simpler linear approximations. We demonstrate that model behaviour can be maintained whilst achieving a significant reduction in complexity, provided that the linearity assumptions hold. The simplified models have been tested for applicability with simulated data and experimental data from healthy adults undergoing a hypercapnia challenge, but relevance to different physiological and pathophysiological conditions will require specific testing. In conditions where the simplified models are applicable, their greater efficiency has potential to allow their use at the bedside to help interpret clinical data in near real-time.
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Affiliation(s)
- Matthew Caldwell
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Tharindi Hapuarachchi
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, University College London, London, UK
| | - David Highton
- Neurocritical Care Unit, University College Hospitals, London, UK
| | - Clare Elwell
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Martin Smith
- Neurocritical Care Unit, University College Hospitals, London, UK
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
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27
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Windowed multitaper correlation analysis of multimodal brain monitoring parameters. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:124325. [PMID: 25821507 PMCID: PMC4363616 DOI: 10.1155/2015/124325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/16/2015] [Indexed: 11/18/2022]
Abstract
Although multimodal monitoring sets the standard in daily practice of neurocritical care, problem-oriented analysis tools to interpret the huge amount of data are lacking. Recently a mathematical model was presented that simulates the cerebral perfusion and oxygen supply in case of a severe head trauma, predicting the appearance of distinct correlations between arterial blood pressure and intracranial pressure. In this study we present a set of mathematical tools that reliably detect the predicted correlations in data recorded at a neurocritical care unit. The time resolved correlations will be identified by a windowing technique combined with Fourier-based coherence calculations. The phasing of the data is detected by means of Hilbert phase difference within the above mentioned windows. A statistical testing method is introduced that allows tuning the parameters of the windowing method in such a way that a predefined accuracy is reached. With this method the data of fifteen patients were examined in which we found the predicted correlation in each patient. Additionally it could be shown that the occurrence of a distinct correlation parameter, called scp, represents a predictive value of high quality for the patients outcome.
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Skoglund K, Hillered L, Purins K, Tsitsopoulos PP, Flygt J, Engquist H, Lewén A, Enblad P, Marklund N. The neurological wake-up test does not alter cerebral energy metabolism and oxygenation in patients with severe traumatic brain injury. Neurocrit Care 2015; 20:413-26. [PMID: 23934408 DOI: 10.1007/s12028-013-9876-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The neurological wake-up test (NWT) is used to monitor the level of consciousness in patients with traumatic brain injury (TBI). However, it requires interruption of sedation and may elicit a stress response. We evaluated the effects of the NWT using cerebral microdialysis (MD), brain tissue oxygenation (PbtiO2), jugular venous oxygen saturation (SjvO2), and/or arterial-venous difference (AVD) for glucose, lactate, and oxygen in patients with severe TBI. METHODS Seventeen intubated TBI patients (age 16-74 years) were sedated using continuous propofol infusion. All patients received intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring in addition to MD, PbtiO2 and/or SjvO2. Up to 10 days post-injury, ICP, CPP, PbtiO2 (51 NWTs), MD (49 NWTs), and/or SjvO2 (18 NWTs) levels during propofol sedation (baseline) and NWT were compared. MD was evaluated at a flow rate of 1.0 μL/min (28 NWTs) or the routine 0.3 μL/min rate (21 NWTs). RESULTS The NWT increased ICP and CPP levels (p < 0.05). Compared to baseline, interstitial levels of glucose, lactate, pyruvate, glutamate, glycerol, and the lactate/pyruvate ratio were unaltered by the NWT. Pathological SjvO2 (<50 % or >71 %; n = 2 NWTs) and PbtiO2 (<10 mmHg; n = 3 NWTs) values were rare at baseline and did not change following NWT. Finally, the NWT did not alter the AVD of glucose, lactate, or oxygen. CONCLUSIONS The NWT-induced stress response resulted in increased ICP and CPP levels although it did not negatively alter focal neurochemistry or cerebral oxygenation in TBI patients.
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Affiliation(s)
- Karin Skoglund
- Department of Neuroscience, Neurosurgery, Uppsala University Hospital, Uppsala University, 75185, Uppsala, Sweden
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Zweifel C, Dias C, Smielewski P, Czosnyka M. Continuous time-domain monitoring of cerebral autoregulation in neurocritical care. Med Eng Phys 2014; 36:638-45. [DOI: 10.1016/j.medengphy.2014.03.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 02/24/2014] [Accepted: 03/10/2014] [Indexed: 12/26/2022]
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Papadopoulos DC, Papamichalis P, Filippidis A, Karangelis D, Bekiari TH, Fountas KN, Vretzakis G, Paterakis KN, Komnos A. Correlation of thermal Doppler flowmetry and microdialysis values in patients with severe subarachnoid hemorrhage and traumatic brain injury. Crit Care 2014. [PMCID: PMC4069486 DOI: 10.1186/cc13647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kirkman MA, Smith M. Intracranial pressure monitoring, cerebral perfusion pressure estimation, and ICP/CPP-guided therapy: a standard of care or optional extra after brain injury? Br J Anaesth 2013; 112:35-46. [PMID: 24293327 DOI: 10.1093/bja/aet418] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Measurement of intracranial pressure (ICP) and mean arterial pressure (MAP) is used to derive cerebral perfusion pressure (CPP) and to guide targeted therapy of acute brain injury (ABI) during neurointensive care. Here we provide a narrative review of the evidence for ICP monitoring, CPP estimation, and ICP/CPP-guided therapy after ABI. Despite its widespread use, there is currently no class I evidence that ICP/CPP-guided therapy for any cerebral pathology improves outcomes; indeed some evidence suggests that it makes no difference, and some that it may worsen outcomes. Similarly, no class I evidence can currently advise the ideal CPP for any form of ABI. 'Optimal' CPP is likely patient-, time-, and pathology-specific. Further, CPP estimation requires correct referencing (at the level of the foramen of Monro as opposed to the level of the heart) for MAP measurement to avoid CPP over-estimation and adverse patient outcomes. Evidence is emerging for the role of other monitors of cerebral well-being that enable the clinician to employ an individualized multimodality monitoring approach in patients with ABI, and these are briefly reviewed. While acknowledging difficulties in conducting robust prospective randomized studies in this area, such high-quality evidence for the utility of ICP/CPP-directed therapy in ABI is urgently required. So, too, is the wider adoption of multimodality neuromonitoring to guide optimal management of ICP and CPP, and a greater understanding of the underlying pathophysiology of the different forms of ABI and what exactly the different monitoring tools used actually represent.
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Affiliation(s)
- M A Kirkman
- Neurocritical Care Unit, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, Queen Square, London WC1N 3BG, UK
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35
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Baiguera S, Del Gaudio C, Lucatelli E, Kuevda E, Boieri M, Mazzanti B, Bianco A, Macchiarini P. Electrospun gelatin scaffolds incorporating rat decellularized brain extracellular matrix for neural tissue engineering. Biomaterials 2013; 35:1205-14. [PMID: 24215734 DOI: 10.1016/j.biomaterials.2013.10.060] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/20/2013] [Indexed: 12/20/2022]
Abstract
The fabrication of an instructive bioabsorbable scaffold is one of the main goals for tissue engineering applications. In this regard, genipin cross-linked gelatin scaffolds, produced by electrospinning, were tested as a platform to include decellularized rat brain extracellular matrix as an active agent to provide fundamental biochemical cues to the seeded cells. This approach is expected to furnish a suitable natural-based polymeric scaffold with sufficient temporal stability to support cell attachment and spreading, also providing tissue-specific signals that can contribute to the expression of the requested cellular phenotype. We first demonstrated the effectiveness of the proposed decellularization protocol and the cytocompatibility of the resulting brain matrix. Then, the in vitro biological assays of the conditioned electrospun scaffolds, using rat allogeneic mesenchymal stromal cells, confirmed their biocompatibility and showed a differentiative potential in presence of just 1% w/w decellularized rat brain extracellular matrix.
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Affiliation(s)
- Silvia Baiguera
- Advanced Center for Translational Regenerative Medicine (ACTREM), Karolinska Institutet, Stockholm, Sweden
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36
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Kramer AH, Zygun DA. Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years. Can J Anaesth 2013; 60:966-75. [PMID: 23877315 DOI: 10.1007/s12630-013-0001-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 07/11/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Few interventions have been proven to improve outcomes in neurocritical care patients. It is unknown whether outcomes in Canada have changed over time. We performed a cohort study in Southern Alberta to determine whether survival and discharge disposition have improved. METHODS Using prospectively collected data, we identified patients admitted to regional intensive care units (ICUs) over a more than 11-year period with traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), intracerebral hemorrhage, anoxic encephalopathy, central nervous system infection, or status epilepticus. Four sequential time periods of 2.8 years were compared, as were periods before and after various practice modifications were introduced. Logistic regression was used to adjust for patient age, Glasgow Coma Scale score, and case mix. RESULTS A total of 4,097 patients were assessed. The odds of death were lowest in the most recent time quartile (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.56 to 0.88, P < 0.01). The odds of being discharged home without the need for support services increased over time (OR 1.45, 95% CI 1.38 to 1.85, P = 0.003). Improvements were not the same for all diagnostic subgroups. They were statistically significant for patients with TBI and SAH. Neurocritical care consultative services, evidence-based protocols, and clustering of patients within a multidisciplinary ICU were associated with improved outcomes. Length of stay in an ICU increased among hospital survivors (4.6 vs 3.8 days, P < 0.01). CONCLUSIONS Mortality and discharge disposition of neurocritical care patients in Southern Alberta have improved over time. Practice modifications in the region were associated with positive outcome trends. Longer ICU length of stay may imply that intensivists are increasingly delaying decisions about withdrawing life-sustaining interventions.
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Affiliation(s)
- Andreas H Kramer
- Departments of Critical Care Medicine & Clinical Neurosciences, Foothills Medical Centre, Hotchkiss Brain Institute, University of Calgary, 3134 Hospital Dr NW, Calgary, AB, T2N 2T9, Canada,
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Schiavi P, Picetti E, Donelli V, Servadei F. Diagnosis and postoperative monitoring of a traumatic carotid-cavernous fistula by jugular venous oximetry: case report and literature review. Acta Neurochir (Wien) 2013; 155:1341-2. [PMID: 23494138 DOI: 10.1007/s00701-013-1676-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 02/24/2013] [Indexed: 10/27/2022]
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Abstract
Aneurysmal subarachnoid haemorrhage (SAH) is a devastating disease associated with high mortality and poor outcome in many survivors. Aggressive treatment by a comprehensive multidisciplinary team is associated with improved outcome, but the intensive care management of SAH presents significant challenges. Multimodal neuromonitoring may detect secondary insults before irreversible neuronal damage has occurred, and is increasingly being used to guide treatment. This article reviews current trends in the intensive care management of SAH from aspects of initial resuscitation to recent developments in the prevention and management of complications, including delayed cerebral ischaemia. Evidence from clinical trials and recent consensus guidance is reviewed.
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Affiliation(s)
- David Highton
- Academic Clinical Fellow in Anaesthesia and Critical Care, University College London Hospitals
| | - Martin Smith
- Consultant and Honorary Professor in Neurocritical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals
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Asgari S, Gonzalez N, Subudhi AW, Hamilton R, Vespa P, Bergsneider M, Roach RC, Hu X. Continuous detection of cerebral vasodilatation and vasoconstriction using intracranial pulse morphological template matching. PLoS One 2012; 7:e50795. [PMID: 23226385 PMCID: PMC3511284 DOI: 10.1371/journal.pone.0050795] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 10/23/2012] [Indexed: 12/05/2022] Open
Abstract
Although accurate and continuous assessment of cerebral vasculature status is highly desirable for managing cerebral vascular diseases, no such method exists for current clinical practice. The present work introduces a novel method for real-time detection of cerebral vasodilatation and vasoconstriction using pulse morphological template matching. Templates consisting of morphological metrics of cerebral blood flow velocity (CBFV) pulse, measured at middle cerebral artery using Transcranial Doppler, are obtained by applying a morphological clustering and analysis of intracranial pulse algorithm to the data collected during induced vasodilatation and vasoconstriction in a controlled setting. These templates were then employed to define a vasodilatation index (VDI) and a vasoconstriction index (VCI) for any inquiry data segment as the percentage of the metrics demonstrating a trend consistent with those obtained from the training dataset. The validation of the proposed method on a dataset of CBFV signals of 27 healthy subjects, collected with a similar protocol as that of training dataset, during hyperventilation (and CO2 rebreathing tests) shows a sensitivity of 92% (and 82%) for detection of vasodilatation (and vasoconstriction) and the specificity of 90% (and 92%), respectively. Moreover, the proposed method of detection of vasodilatation (vasoconstriction) is capable of rejecting all the cases associated with vasoconstriction (vasodilatation) and outperforms other two conventional techniques by at least 7% for vasodilatation and 19% for vasoconstriction.
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Affiliation(s)
- Shadnaz Asgari
- Department of Computer Engineering and Computer Science, California State University, Long Beach, California, United States of America
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States of America
| | - Nestor Gonzalez
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States of America
| | - Andrew W. Subudhi
- Department of Biology, University of Colorado, Colorado Springs, Colorado, United States of America
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, United States of America
| | - Robert Hamilton
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, United States of America
| | - Paul Vespa
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States of America
| | - Marvin Bergsneider
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, United States of America
| | - Robert C. Roach
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, United States of America
| | - Xiao Hu
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
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Ghosh A, Elwell C, Smith M. Review article: cerebral near-infrared spectroscopy in adults: a work in progress. Anesth Analg 2012; 115:1373-83. [PMID: 23144435 DOI: 10.1213/ane.0b013e31826dd6a6] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Near-infrared spectroscopy (NIRS) has potential as a noninvasive brain monitor across a spectrum of disorders. In the last decade, there has been a rapid expansion of clinical experience using NIRS to monitor cerebral oxygenation, and there is some evidence that NIRS-guided brain protection protocols might lead to a reduction in perioperative neurologic complications after cardiac surgery. However, there are no data to support the wider application of NIRS during routine surgery under general anesthesia, and its application in brain injury, where it might be expected to have a key monitoring role, is undefined. Although increasingly sophisticated apparatuses, including broadband and time-resolved spectroscopy systems, provide insights into the potential of NIRS to measure regional cerebral oxygenation, hemodynamics, and metabolism in real-time, these innovations have yet to translate into effective monitor-guided brain protection treatment strategies. NIRS has many potential advantages over other neuromonitoring techniques, but further investigation and technological advances are necessary before it can be introduced more widely into clinical practice.
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Affiliation(s)
- Arnab Ghosh
- Department of Neurocritical Care, Box 30, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, Queen Square, London WC1N 3BGUK
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41
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Abstract
This article presents an overview of intracranial monitoring techniques during the perioperative and intensive care management of neurologic patients. Various regional and global brain monitors are available; some modalities are well established whereas others are new to the clinical arena and their indications are still being evaluated. Indications for monitoring are reviewed, modalities critically evaluated, and future directions identified.
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Affiliation(s)
- Matthew A Kirkman
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals, Queen Square, London, UK
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Voigt C, Donat CK, Hartig W, Förschler A, Skardelly M, Stichtenoth D, Arendt T, Meixensberger J, Schuhmann MU. Effect of leukotriene inhibitors on evolution of experimental brain contusions. Neuropathol Appl Neurobiol 2012; 38:354-66. [DOI: 10.1111/j.1365-2990.2011.01211.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Huang KF, Hsu WC, Chiu WT, Wang JY. Functional improvement and neurogenesis after collagen-GAG matrix implantation into surgical brain trauma. Biomaterials 2012; 33:2067-75. [DOI: 10.1016/j.biomaterials.2011.11.040] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 11/18/2011] [Indexed: 12/29/2022]
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WEATHERALL A, SKOWNO J, LANSDOWN A, LUPTON T, GARNER A. Feasibility of cerebral near-infrared spectroscopy monitoring in the pre-hospital environment. Acta Anaesthesiol Scand 2012; 56:172-7. [PMID: 22236344 DOI: 10.1111/j.1399-6576.2011.02591.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a significant cause of death and severe disability from trauma. Pre-hospital care of patients with TBI may be aided by non-invasive monitoring of cerebral tissue oxygenation. This pilot observational study was designed to assess if cerebral tissue oximetry using near-infrared spectroscopy (NIRS) is feasible in the pre-hospital and transport environment. METHODS After ethics committee review, we undertook a feasibility trial in healthy volunteers, transported by road ambulance or helicopter, to assess if monitoring signals could be obtained in the outside environment and during patient transport. RESULTS A total of 33 road ambulance transports and 32 helicopter transports were undertaken. For monitoring commenced outdoors, 33 of 66 probes applied (50%) provided adequate monitoring signal. For road transports, 33 out of 33 transports (100%) resulted in successful bilateral monitoring for more than 70% of the sampling period. For helicopter transports, four transports were cut short by battery failure during the mission and 24 of 28 transports (85.7%) resulted in successful bilateral monitoring for more than 70% of the sampling period. While patient and transport platform movement did not impact on monitoring signals, exposure to ambient light provided a challenge in obtaining monitoring signals that is nevertheless manageable with increased probe shielding. CONCLUSIONS NIRS monitoring is feasible in the pre-hospital environment, opening up the possibility for further research of the role of this modality in this setting.
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Affiliation(s)
| | - J. SKOWNO
- Department of Anaesthesia; The Children's Hospital at Westmead; Sydney; NSW; Australia
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45
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Moroz T, Banaji M, Robertson NJ, Cooper CE, Tachtsidis I. Computational modelling of the piglet brain to simulate near-infrared spectroscopy and magnetic resonance spectroscopy data collected during oxygen deprivation. J R Soc Interface 2012; 9:1499-509. [PMID: 22279158 PMCID: PMC3367814 DOI: 10.1098/rsif.2011.0766] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We describe a computational model to simulate measurements from near-infrared spectroscopy (NIRS) and magnetic resonance spectroscopy (MRS) in the piglet brain. Piglets are often subjected to anoxic, hypoxic and ischaemic insults, as experimental models for human neonates. The model aims to help interpret measurements and increase understanding of physiological processes occurring during such insults. It is an extension of a previous model of circulation and mitochondrial metabolism. This was developed to predict NIRS measurements in the brains of healthy adults i.e. concentration changes of oxyhaemoglobin and deoxyhaemoglobin and redox state changes of cytochrome c oxidase (CCO). We altered and enhanced the model to apply to the anaesthetized piglet brain. It now includes metabolites measured by 31P-MRS, namely phosphocreatine, inorganic phosphate and adenosine triphosphate (ATP). It also includes simple descriptions of glycolysis, lactate dynamics and the tricarboxylic acid (TCA) cycle. The model is described, and its simulations compared with existing measurements from piglets during anoxia. The NIRS and MRS measurements are predicted well, although this requires a reduction in blood pressure autoregulation. Predictions of the cerebral metabolic rate of oxygen consumption (CMRO2) and lactate concentration, which were not measured, are given. Finally, the model is used to investigate hypotheses regarding changes in CCO redox state during anoxia.
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Affiliation(s)
- Tracy Moroz
- CoMPLEX, University College London, London, UK.
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46
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Smith M. Shedding light on the adult brain: a review of the clinical applications of near-infrared spectroscopy. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2011; 369:4452-69. [PMID: 22006901 DOI: 10.1098/rsta.2011.0242] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Near-infrared spectroscopy (NIRS) has potential as a non-invasive brain monitor in a wide range of clinical scenarios. In the last decade, there has been a rapid expansion of clinical experience using NIRS to monitor cerebral oxygenation, particularly in cardiac surgery, where there is some evidence that NIRS-guided brain protection protocols might lead to a reduction in peri-operative neurological complications. There are no data to support the wider application of NIRS to monitor cerebral oxygenation during routine anaesthesia and surgery, and its application in brain injury, where it might be expected to have a key monitoring role, is as yet undefined. Technological developments, including the introduction of broadband and time-resolved spectrometers that are capable of reliably measuring changes in oxidized cytochrome c oxidase, offer real potential for a single NIRS-based device to provide multi-site, regional monitoring of cerebral metabolic status as well as oxygenation and haemodynamics.
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Affiliation(s)
- Martin Smith
- Department of Neurocritical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, Queen Square, London WC1N 3BG, UK.
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47
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Abstract
Traumatic brain injury presents a significant impact on patients in terms of morbidity and mortality. Pathology is heterogeneous and is often associated with secondary deterioration. This paper reviews both clinical and research modes of monitoring to detect deterioration and compares what is available to the ideal. Intracranial pressure measurement, jugular venous oxygen saturation, microdialysis and cerebral oxygen monitoring are among the variables described and future research-based modalities are explored.
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Affiliation(s)
- Steven D Vidgeon
- Specialist Registrar, Anaesthetics and Intensive Care, Academic Neurosciences Centre, Institute of Psychiatry, King's College London. Intensive Care Unit, King's College Hospital, London
| | - Anthony J Strong
- Emeritus Professor of Neurosurgery, King's College London, Academic Neurosciences Centre, Institute of Psychiatry
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Marion DW, Curley KC, Schwab K, Hicks, and the mTBI Diagnostics Wor RR. Proceedings of the Military mTBI Diagnostics Workshop, St. Pete Beach, August 2010. J Neurotrauma 2011; 28:517-26. [DOI: 10.1089/neu.2010.1638] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Donald W. Marion
- The Defense and Veterans Brain Injury Center, Walter Reed Army Medical Center, Washington, D.C
| | - Kenneth C. Curley
- Combat Casualty Care Directorate, U.S. Army Medical Research and Materiel Command, Ft. Detrick, Maryland
| | - Karen Schwab
- The Defense and Veterans Brain Injury Center, Walter Reed Army Medical Center, Washington, D.C
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49
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Papadopoulos DC, Komnos A, Filippidis AS, Chatzopoulos T, Fountas KN, Vretzakis G, Paterakis K, Karangelis D, Zafeiridis TK. Correlation of thermal Doppler flowmetry, brain tissue oxygen and microdialysis values in patients with severe subarachnoid hemorrhage and traumatic brain injury: a preliminary report. Crit Care 2011. [PMCID: PMC3066997 DOI: 10.1186/cc9743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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50
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Zink BJ, Szmydynger-Chodobska J, Chodobski A. Emerging concepts in the pathophysiology of traumatic brain injury. Psychiatr Clin North Am 2010; 33:741-56. [PMID: 21093676 DOI: 10.1016/j.psc.2010.08.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A complex set of molecular and functional reactions is set into motion by traumatic brain injury (TBI). New research that extends beyond pathological effects on neurons suggests a key role for the blood-brain barrier, neurovascular unit, arginine vasopressin, and neuroinflammation in the pathophysiology of TBI. The prevalence of molecular derangements in TBI holds promise for the identification and use of biomarkers to assess severity of injury, determine prognosis, and perhaps direct therapy. Hopefully, improved knowledge of these elements of pathophysiology will provide the mechanistic clues that lead to improved treatment of TBI.
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Affiliation(s)
- Brian J Zink
- Department of Emergency Medicine, Alpert Medical School of Brown, University Rhode Island Hospital & The Miriam Hospital, 593 Eddy Street, Claverick 2, Providence, RI 02903, USA.
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