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Martin N, Urbina T. Follow-up of a Term Infant with a Prenatal Diagnosis of Double-Outlet Right Ventricle. Neoreviews 2024; 25:e466-e473. [PMID: 38945967 DOI: 10.1542/neo.25-7-e466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 07/02/2024]
Affiliation(s)
- Nicole Martin
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD
| | - Theresa Urbina
- Department of Neonatology, Walter Reed National Military Medical Center, Bethesda, MD
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
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2
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Surangsrirat D, Srikun O, Sangawitayakorn C, Wannasetdecho T, Puanglamjeak M, Birdi P, Kirkup J, Chana K. Nondestructive Measurement Technique for Substandard Amoxicillin Based on Thermal Approach. ACS OMEGA 2024; 9:19378-19384. [PMID: 38708267 PMCID: PMC11064199 DOI: 10.1021/acsomega.4c00536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 05/07/2024]
Abstract
In this study, we introduce a new nondestructive measurement technique based on a thermal approach for the determination of substandard amoxicillin. The quality control of amoxicillin is critical for patient safety, and one of the essential parameters for its evaluation is the content of the active ingredient. Traditional methods for assessing amoxicillin content are defined by their time-consuming nature, reliance on skilled personnel, and frequent necessity for specific reagents. The proposed device aims to provide a rapid and low-cost alternative that can accurately measure the amoxicillin content without damaging the sample. The method validation results indicate coefficient of determination (R2) exceeding 0.99, with percent recoveries falling within the range of 98.70-103.40%. The calculated values for limit of detection and limit of quantitation were determined to be 28.11 and 85.17 mg/L, respectively. Our experiments employed amoxicillin samples with predetermined concentrations, all of which were below the standard quality. It was observed that the proposed analytical device effectively quantifies the amoxicillin content in aqueous solutions. Each measurement took no more than 10 min, underscoring the efficiency of the analysis process. The experiments were validated through independent testing at the Government Pharmaceutical Organization in Thailand and the department of engineering science in Oxford, which provides strong evidence for the effectiveness and robustness of the technique. Overall, this study demonstrates the feasibility of using a thermal approach for the nondestructive measurement of substandard amoxicillin.
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Affiliation(s)
- Decho Surangsrirat
- Digital
Healthcare Platform Innovation Group, National
Science and Technology Development Agency, Pathum Thani 12120, Thailand
| | - Onsiri Srikun
- Pharmaceutical
Ingredient Research Group, The Government
Pharmaceutical Organization, Bangkok 10400, Thailand
| | - Chaksawat Sangawitayakorn
- Pharmaceutical
Ingredient Research Group, The Government
Pharmaceutical Organization, Bangkok 10400, Thailand
| | - Titasmith Wannasetdecho
- Digital
Healthcare Platform Innovation Group, National
Science and Technology Development Agency, Pathum Thani 12120, Thailand
| | - Mananya Puanglamjeak
- Digital
Healthcare Platform Innovation Group, National
Science and Technology Development Agency, Pathum Thani 12120, Thailand
| | - Prab Birdi
- Proxisense
Limited, Cody Technology
Park, Hampshire GU14 0LX, England
| | - Joe Kirkup
- Proxisense
Limited, Cody Technology
Park, Hampshire GU14 0LX, England
| | - Kam Chana
- Proxisense
Limited, Cody Technology
Park, Hampshire GU14 0LX, England
- Department
of Engineering Science, University of Oxford, Oxford OX1 3PJ, England
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3
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Miles M, Davenport P, Mathur S, Goligher EC, Rozenberg D, Reid WD. Intermittent neck flexion induces greater sternocleidomastoid deoxygenation than inspiratory threshold loading. Eur J Appl Physiol 2024; 124:1151-1161. [PMID: 37923886 DOI: 10.1007/s00421-023-05338-6] [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: 05/18/2023] [Accepted: 10/08/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE To compare deoxygenation of the sternocleidomastoid, scalenes, and diaphragm/intercostals (Dia/IC) during submaximal intermittent neck flexion (INF) versus submaximal inspiratory threshold loading (ITL) in healthy adults. METHODS Fourteen participants performed a randomized, cross-over, repeated measures design. After evaluation of maximal inspiratory pressures (MIP) and maximum voluntary contraction (MVC) for isometric neck flexion, participants were randomly assigned to submaximal ITL or INF until task failure. At least 2 days later, they performed the submaximal exercises in the opposite order. ITL or INF targeted 50 ± 5% of the MIP or MVC, respectively, until task failure. Near-infrared spectroscopy (NIRS) was applied to evaluate changes of deoxy-hemoglobin (ΔHHb), oxy-hemoglobin (ΔO2Hb), total hemoglobin (ΔtHb), and tissue saturation of oxygen (StO2) of the sternocleidomastoid, scalenes, and Dia/IC. Breathlessness and perceived exertion were evaluated using Borg scales. RESULTS Initially during INF, sternocleidomastoid HHb slope was greatest compared to the scalenes and Dia/IC. At isotime (6.5-7 min), ΔtHb (a marker of blood volume) and ΔO2Hb of the sternocleidomastoid were higher during INF than ITL. Sternocleidomastoid HHb, O2Hb, and tHb during INF also increased at quartile and task failure timepoints. In contrast, scalene ΔO2Hb was higher during ITL than INF at isotime. Further, Dia/IC O2Hb and tHb increased during ITL at the third quartile and at task failure. Borg scores were lower at task failure during INF compared to ITL. CONCLUSION Intermittent INF induces significant metabolic activity of the sternocleidomastoid and a lower perception of effort, which may provide an alternative inspiratory muscle training approach for mechanically ventilated patients.
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Affiliation(s)
- Melissa Miles
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Paul Davenport
- Department of Physiological Sciences, University of Florida, Gainesville, FL, USA
| | - Sunita Mathur
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queens University, Kingston, ON, Canada
| | - Ewan C Goligher
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Dmitry Rozenberg
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
- KITE Research Institute-Toronto Rehab, University Health Network, Toronto, ON, Canada.
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4
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Meng W, Wang Q, Xu Q, Gao H, Zhou Y, Shao W. Biomarkers in the Severity of Necrotizing Enterocolitis in Preterm Infants: A Pilot Study. Int J Gen Med 2024; 17:1017-1023. [PMID: 38505145 PMCID: PMC10950000 DOI: 10.2147/ijgm.s446378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
Background The occurrence of necrotizing enterocolitis (NEC) is a common and severe disease of the digestive system in neonates. This study aims to assess the value of the intestinal tissue oxygen saturation (rintSO2) combined with the levels of procalcitonin (PCT) and mean platelet volume (MPV) in predicting the severity of NEC in preterm infants. Methods This experiment was a retrospective cohort study conducted in the Department of Pediatrics, Hongqi Hospital Affiliated to Mudanjiang Medical University between January 2017 and July 2022. Premature neonates with NEC were enrolled and divided into mild-moderate NEC group and severe NEC group according to Bell's stage. The general information data, rintSO2 and blood parameters such as the white blood cell (WBC) count, platelet count (PLT), PCT, MPV, red blood cell distribution width (RDW), hemoglobin (Hb), C-reactive protein (CRP) were compared between the two groups. Results A total of 122 patients were enrolled, including 79 mild-moderate NEC and 43 severe NEC. The rintSO2 was lower in severe group than in mild-moderate group (P = 0.042), the PCT and MPV were both higher in severe group than in mild-moderate group (P = 0.048, P = 0.049). The results of logistic regression suggested that the rintSO2 (OR = 1.491, P = 0.003), PCT (OR = 3.071, P = 0.001) and MPV (OR = 4.027, P = 0.015) were independent predictive factors for severity of NEC. The area under the curve (AUC) of the rintSO2 combined with PCT and MPV showed good diagnostic ability in the severity of NEC. Conclusion The rintSO2 combined with PCT and MPV may be considered as the early biomarkers in the severity of NEC and could help us to diagnose the case early with early treatment with better prognosis.
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Affiliation(s)
- Wei Meng
- Department of Pediatric Internal Medicine, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
| | - Qing Wang
- Department of Pediatric Internal Medicine, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
| | - Qingyu Xu
- Department of Pediatrics Surgery, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People's Republic China
| | - Hongli Gao
- Department of Digestive Endoscopy Center, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
| | - Yunjun Zhou
- Department of Pediatric Internal Medicine, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
| | - Wei Shao
- Department of Pediatric Internal Medicine, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
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5
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Marin T, Moore J. Understanding Near-Infrared Spectroscopy: An Update. Crit Care Nurs Clin North Am 2024; 36:41-50. [PMID: 38296375 DOI: 10.1016/j.cnc.2023.08.001] [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] [Indexed: 02/08/2024]
Abstract
Near-infrared spectroscopy (NIRS) is a novel technology that uses infrared light to noninvasively and continuously measure regional oxygen extraction in real time at the bedside. Neonatal research using this device supports its use as an adjunct to routine cardiovascular monitoring because NIRS serves as a surrogate marker for end-organ perfusion and can detect minute changes in cerebral, intestinal, and kidney tissue beds. Multiple conditions affecting premature infants are frequently associated with hypoperfusion; therefore, methods to detect early tissue-specific perfusion alterations may substantially improve the clinician's ability to intervene and prevent further deterioration.
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Affiliation(s)
- Terri Marin
- Department of Nursing Science, Augusta University, College of Nursing, 1120 15th Street, EC-4350, Augusta, GA 30912, USA.
| | - James Moore
- Department of Pediatrics, Division of Neonatology, University of Connecticut School of Medicine, 10 Columbus Boulevard, Hartford, CT 06106, USA
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6
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Kaiser HA, Bauer T, Riva T, Greif R, Riedel T, Theiler L, Nabecker S. Carbon dioxide and cardiac output as major contributors to cerebral oxygenation during apnoeic oxygenation. Sci Rep 2024; 14:3617. [PMID: 38351038 PMCID: PMC10864331 DOI: 10.1038/s41598-023-49238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/06/2023] [Indexed: 02/16/2024] Open
Abstract
Apnoeic oxygenation has experienced a resurgence in interest in critical care and perioperative medicine. However, its effect on cerebral oxygenation and factors influencing it, have not yet been investigated in detail. By using near-infrared spectroscopy, we intended to provide further evidence for the safety of apnoeic oxygenation and to increase our understanding of the association between cerebral perfusion, haemodynamic, respiratory and demographic factors. In this secondary analysis of a prospective randomized controlled noninferiority trial, we recruited 125 patients, who underwent surgery under general anaesthesia with neuromuscular blockade. Arterial blood samples were taken every 2 min for a total of 15 min under apnoeic oxygenation with 100% oxygen. Near-infrared spectroscopy and cardiac output were continuously measured. Statistical analysis was performed using uni- and multivariable statistics. Ninety-one complete data sets were analysed. In six patients the SpO2 fell below 92% (predefined study termination criterion). The significant average increase of cerebral oxygenation was 0.5%/min and 2.1 mmHg/min for the arterial pressure of carbon dioxide (paCO2). The median cardiac output increased significantly from 5.0 l/min (IQR 4.5-6.0) to 6.5 l/min (IQR 5.7-7.5). The most significant effect on cerebral oxygenation was exhibited by the variable paCO2 and non-specific patient factors, followed by cardiac output and paO2. Apnoeic oxygenation proves to have a high safety profile while significantly increasing cerebral oxygenation, paCO2 and cardiac output. In reverse, NIRS might act as a reliable clinical surrogate of paCO2 and cardiac output during stable arterial oxygenation.
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Grants
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
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Affiliation(s)
- Heiko Andreas Kaiser
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Bauer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Unit for Research and Innovation, Department of Paediatric Anaesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - Robert Greif
- University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Thomas Riedel
- Department of Paediatrics, Cantonal Hospital Graubünden, Chur, Switzerland
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, University Children's Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Theiler
- Department of Anaesthesia, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Sabine Nabecker
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Anaesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, Canada.
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7
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Rahman S, Iskandarova A, Horowitz ME, Sanghavi KK, Aziz KT, Durr N, Giladi AM. Assessing Hand Perfusion With Eulerian Video Magnification and Waveform Extraction. J Hand Surg Am 2024; 49:186.e1-186.e9. [PMID: 35963795 DOI: 10.1016/j.jhsa.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/06/2022] [Accepted: 06/22/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Timely and accurate triage of upper extremity injuries is critical, but current perfusion monitoring technologies have shortcomings. These limitations are especially pronounced in patients with darker skin tones. This pilot study evaluates a Eulerian Video Magnification (EVM) algorithm combined with color channel waveform extraction to enable video-based measurement of hand and finger perfusion. METHODS Videos of 10 volunteer study participants with Fitzpatrick skin types III-VI were taken in a controlled environment during normal perfusion and tourniquet-induced ischemia. Videos were EVM processed, and red/green/blue color channel characteristics were extracted to produce waveforms. These videos were assessed by surgeons with a range of expertise in hand injuries. The videos were randomized and presented in 1 of 3 ways: unprocessed, EVM processed, and EVM with waveform output (EVM+waveform). Survey respondents indicated whether the video showed an ischemic or perfused hand or if they were unable to tell. We used group comparisons to evaluate response accuracy across video types, skin tones, and respondent groups. RESULTS Of the 51 providers to whom the surveys were sent, 25 (49%) completed them. Using the Pearson χ2 test, the frequencies of correct responses were significantly higher in the EVM+waveform category than in the unprocessed or EVM videos. Additionally, the agreement was higher among responses to the EVM+waveform questions than among responses to the unprocessed or EVM processed. The accuracy and agreement from the EVM+waveform group were consistent across all skin pigmentations evaluated. CONCLUSIONS Video-based EVM processing combined with waveform extraction from color channels improved the surgeon's ability to identify tourniquet-induced finger ischemia via video across all skin types tested. CLINICAL RELEVANCE Eulerian Video Magnification with waveform extraction improved the assessment of perfusion in the distal upper extremity and has potential future applications, including triage, postsurgery vascular assessment, and telemedicine.
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Affiliation(s)
- Shihab Rahman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD
| | - Aygul Iskandarova
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | | | - Kavya K Sanghavi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Health Research Institute, Hyattsville, MD
| | - Keith T Aziz
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
| | - Nicholas Durr
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD
| | - Aviram M Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
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8
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Raets M, Dirix M, Hütten MC. Cerebral near-infrared spectroscopy for early recognition of impending cardiac tamponade in a preterm neonate. BMJ Case Rep 2023; 16:e256014. [PMID: 38087490 PMCID: PMC10728941 DOI: 10.1136/bcr-2023-256014] [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] [Indexed: 12/18/2023] Open
Abstract
Cardiac tamponade is a rare but life-threatening complication of umbilical venous catheter (UVC) placement in neonates. Mortality rates are high; therefore, early diagnosis is important. We present a case of a preterm infant with a UVC in situ who underwent a laparotomy on the first day of life for pneumoperitoneum secondary to meconium ileus. The operation was uneventful; however, 2 hours after surgery, the patient developed cardiac tamponade, requiring resuscitation and pericardiocentesis. In retrospect, near-infrared spectroscopy (NIRS) showed a gradual decline in cerebral oxygenation (crSO2) in the 30 min prior to the cardiac arrest, while other vital signs were within normal ranges. Our case demonstrates that cerebral NIRS monitoring can serve as an additional clinical marker for early recognition of impending cardiac tamponade.
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Affiliation(s)
- Marlou Raets
- Pediatrics, Maastricht University Medical Centre+, MosaKids Children's Hospital, Maastricht, The Netherlands
| | - Marc Dirix
- Surgery, Maastricht University Medical Centre+, MosaKids Children's Hospital, Maastricht, The Netherlands
| | - Matthias Christian Hütten
- Pediatrics, Maastricht University Medical Centre+, MosaKids Children's Hospital, Maastricht, The Netherlands
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9
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Jufar AH, May CN, Booth LC, Evans RG, Cochrane AD, Marino B, Birchall I, Hood SG, McCall PR, Sanders RD, Yao ST, Ortega-Bernal V, Skene A, Bellomo R, Miles LF, Lankadeva YR. Effects of dexmedetomidine on kidney and brain tissue microcirculation and histology in ovine cardiopulmonary bypass: a randomised controlled trial. Anaesthesia 2023; 78:1481-1492. [PMID: 37880924 DOI: 10.1111/anae.16152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/27/2023]
Abstract
Cardiac surgery requiring cardiopulmonary bypass is associated with postoperative acute kidney injury and neurocognitive disorders, including delirium. Intra-operative inflammation and/or impaired tissue perfusion/oxygenation are thought to be contributors to these outcomes. It has been hypothesised that these problems may be ameliorated by the highly selective α2 -agonist, dexmedetomidine. We tested the effects of dexmedetomidine on renal and cerebral microcirculatory tissue perfusion, oxygenation and histology in a clinically relevant ovine model. Sixteen sheep were studied while conscious, after induction of anaesthesia and during 2 h of cardiopulmonary bypass. Eight sheep were allocated randomly to receive an intravenous infusion of dexmedetomidine (0.4-0.8 μg.kg-1 .h-1 ) from induction of anaesthesia to the end of cardiopulmonary bypass, and eight to receive an equivalent volume of matched placebo (0.9% sodium chloride). Commencement of cardiopulmonary bypass decreased renal medullary tissue oxygenation in the placebo group (mean (95%CI) 5.96 (4.24-7.23) to 1.56 (0.84-2.09) kPa, p = 0.001), with similar hypoxic levels observed in the dexmedetomidine group (6.33 (5.33-7.07) to 1.51 (0.33-2.39) kPa, p = 0.002). While no differences in kidney function (i.e. reduced creatinine clearance) were evident, a greater incidence of histological renal tubular injury was observed in sheep receiving dexmedetomidine (7/8 sheep) compared with placebo (2/8 sheep), p = 0.041. Graded on a semi-quantitative scale (0-3), median (IQR [range]) severity of histological renal tubular injury was higher in the dexmedetomidine group compared with placebo (1.5 (1-2 [0-3]) vs. 0 (0-0.3 [0-1]) respectively, p = 0.013). There was no difference in cerebral tissue microglial activation (neuroinflammation) between the groups. Dexmedetomidine did not reduce renal medullary hypoxia or cerebral neuroinflammation in sheep undergoing cardiopulmonary bypass.
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Affiliation(s)
- A H Jufar
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - C N May
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - L C Booth
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - R G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - A D Cochrane
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - B Marino
- Cell Saving and Perfusion Resources, Melbourne, Australia
| | - I Birchall
- Neurohistology Laboratory, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - S G Hood
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - P R McCall
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - R D Sanders
- Central Clinical School and NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - S T Yao
- Cardiovascular Neuroscience Laboratory, Department of Anatomy and Physiology, University of Melbourne, Melbourne, Australia
| | - V Ortega-Bernal
- Cardiovascular Neuroscience Laboratory, Department of Anatomy and Physiology, University of Melbourne, Melbourne, Australia
| | - A Skene
- Department of Anatomical Pathology, Austin Health, Melbourne, Australia
| | - R Bellomo
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - L F Miles
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - Y R Lankadeva
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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10
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Bailey SM, Mally PV. Near-Infrared Spectroscopy to Guide and Understand Effects of Red Blood Cell Transfusion. Clin Perinatol 2023; 50:895-910. [PMID: 37866855 DOI: 10.1016/j.clp.2023.07.006] [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] [Indexed: 10/24/2023]
Abstract
This review is a summary of available evidence regarding the use of near-infrared spectroscopy (NIRS) to help better guide and understand the effects of red blood cell (RBC) transfusion in neonatal patients. We review recent literature demonstrating the changes that take place in regional tissue oxygen saturation (rSO2) resulting from RBC transfusion. We also discuss in detail if any correlation exists between rSO2 and hemoglobin values in neonates. Finally, we review studies that have evaluated the use of NIRS as a transfusion guide during neonatal intensive care.
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Affiliation(s)
- Sean M Bailey
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital NYU Langone, 317 East 34th Street, Suite 902, New York, NY 10016, USA.
| | - Pradeep V Mally
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital NYU Langone, 317 East 34th Street, Suite 902, New York, NY 10016, USA
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11
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Marin T, Ghosh S, Cockfield C, Mundy C, Mansuri A, Stansfield BK. Routine Diaper Change Alters Kidney Oxygenation in Premature Infants: A Non-A Priori Analysis. Adv Neonatal Care 2023; 23:450-456. [PMID: 37253178 DOI: 10.1097/anc.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Reduction in oxygen delivery to developing kidneys of premature infants may be an important source for acute kidney injury in premature infants. PURPOSE To describe changes in continuous kidney oxygenation (RrSO 2 ) measures before, during, and after routine diaper changes. METHODS Non-a priori analysis of a prospective cohort that received continuous measurement of RrSO 2 with near-infrared spectroscopy (NIRS) over the first 14 days of life demonstrating acute RrSO 2 drops surrounding diaper changes. RESULTS In total, 26 of 38 (68%) infants (≤1800 g) from our cohort exhibited acute drops in RrSO 2 that temporally correlated with diaper changes. Mean (SD) RrSO 2 baseline prior to each diaper change event was 71.1 (13.2), dropped to 59.3 (11.6) during diaper change, and recovered to 73.3 (13.2). There was a significant difference between means when comparing baseline to diaper change ( P < .001; 95% CI, 9.9 to 13.8) and diaper change to recovery ( P < .001; 95% CI, -16.9 to -11.2). The mean decrease in RrSO 2 during diaper change averaged 12 points (17%) below 15-minute RrSO 2 mean prior to diaper change, with quick recovery to prediaper change levels. No decreases in SpO 2 , blood pressure, or heart rate were documented during the intermittent kidney hypoxic events. IMPLICATIONS FOR PRACTICE AND RESEARCH Routine diaper changes in preterm infants may increase the risk for acute reductions in RrSO 2 as measured by NIRS; however, the impact on kidney health remains unknown. Larger prospective cohort studies assessing kidney function and outcomes related to this phenomenon are needed.
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Affiliation(s)
- Terri Marin
- Department of Nursing Science, College of Nursing (Dr Marin), Department of Biostatistics (Dr Ghosh), Division of Neonatology, Department of Pediatrics (Drs Cockfield, Mundy, and Stansfield), and Department of Pediatric Nephrology (Dr Mansuri), Medical College of Georgia, and Vascular Biology Center (Dr Stansfield), Augusta University, Augusta, Georgia
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Brochhagen J, Coll Barroso MT, Baumgart C, Wasmus DT, Freiwald J, Hoppe MW. Age, sex, endurance capacity, and chronic heart failure affect central and peripheral factors of oxygen uptake measured by non-invasive and continuous technologies: support of pioneer work using invasive or non-continuous measures. Front Sports Act Living 2023; 5:1218948. [PMID: 37731479 PMCID: PMC10507902 DOI: 10.3389/fspor.2023.1218948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction It is known that maximum oxygen uptake depends on age, sex, endurance capacity, and chronic heart failure. However, due to the required invasive or often applied non-continuous approaches, less is known on underlying central and peripheral factors. Thus, this study aimed to investigate the effects of age, sex, endurance capacity, and chronic heart failure on non-invasively and continuously measured central and peripheral factors of oxygen uptake. Methods 15 male children (11 ± 1 years), 15 male (24 ± 3 years) and 14 female recreationally active adults (23 ± 2 years), 12 male highly trained endurance athletes (24 ± 3 years), and 10 male elders (59 ± 6 years) and 10 chronic heart failure patients (62 ± 7 years) were tested during a cardiopulmonary exercise test on a cycling ergometer until exhaustion for: blood pressure, heart rate, stroke volume, cardiac output, cardiac power output, vastus lateralis muscle oxygen saturation, and (calculated) arterio-venous oxygen difference. For the non-invasive and continuous measurement of stroke volume and muscle oxygen saturation, bioreactance analysis and near-infrared spectroscopy were used, respectively. A two-factor repeated measure ANOVA and partial eta-squared effect sizes (η p 2 ) were applied for statistical analyses at rest, 80, and 100% of oxygen uptake. Results For the age effect, there were statistically significant group differences for all factors (p ≤ .033; η p 2 ≥ .169 ). Concerning sex, there were group differences for all factors (p ≤ .010; η p 2 ≥ .223 ), except diastolic blood pressure and heart rate (p ≥ .698; η p 2 ≤ .006 ). For the effect of endurance capacity, there were no group differences for any of the factors (p ≥ .065; η p 2 ≤ .129 ). Regarding chronic heart failure, there were group differences for the heart rate and arterio-venous oxygen difference (p ≤ .037; η p 2 ≥ .220 ). Discussion Age, sex, endurance capacity, and chronic heart failure affect central and peripheral factors of oxygen uptake measured by non-invasive and continuous technologies. Since most of our findings support pioneer work using invasive or non-continuous measures, the validity of our applied technologies is indirectly confirmed. Our outcomes allow direct comparison between different groups serving as reference data and framework for subsequent studies in sport science and medicine aiming to optimise diagnostics and interventions in athletes and patients.
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Affiliation(s)
- Joana Brochhagen
- Movement and Training Science, Faculty of Sport Science, Leipzig University, Leipzig, Germany
| | | | - Christian Baumgart
- Department of Movement and Training Science, Faculty of Humanities and Social Sciences, Institute of Sport Science, University of Wuppertal, Wuppertal, Germany
| | - Daniel T. Wasmus
- Movement and Training Science, Faculty of Sport Science, Leipzig University, Leipzig, Germany
| | - Jürgen Freiwald
- Department of Movement and Training Science, Faculty of Humanities and Social Sciences, Institute of Sport Science, University of Wuppertal, Wuppertal, Germany
| | - Matthias W. Hoppe
- Movement and Training Science, Faculty of Sport Science, Leipzig University, Leipzig, Germany
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Delrue C, De Bruyne S, Speeckaert MM. The Potential Use of Near- and Mid-Infrared Spectroscopy in Kidney Diseases. Int J Mol Sci 2023; 24:ijms24076740. [PMID: 37047712 PMCID: PMC10094824 DOI: 10.3390/ijms24076740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Traditional renal biomarkers such as serum creatinine and albuminuria/proteinuria are rather insensitive since they change later in the course of the disease. In order to determine the extent and type of kidney injury, as well as to administer the proper therapy and enhance patient management, new techniques for the detection of deterioration of the kidney function are urgently needed. Infrared spectroscopy is a label-free and non-destructive technique having the potential to be a vital tool for quick and inexpensive routine clinical diagnosis of kidney disorders. The aim of this review is to provide an overview of near- and mid-infrared spectroscopy applications in patients with acute kidney injury and chronic kidney disease (e.g., diabetic nephropathy and glomerulonephritis).
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Affiliation(s)
- Charlotte Delrue
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Sander De Bruyne
- Department of Diagnostic Sciences, Ghent University Hospital, 9000 Ghent, Belgium
| | - Marijn M. Speeckaert
- Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
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Wakamatsu Y, Nakanishi K, Satoh T, Kawasaki S, Amano A. Use of Renal Near-Infrared Spectroscopy and Urinary Neutrophil Gelatinase-Associated Lipocalin Monitoring as Indicators of Acute Kidney Injury in Pediatric Cardiac Surgery. J Clin Med 2023; 12:jcm12062085. [PMID: 36983088 PMCID: PMC10056572 DOI: 10.3390/jcm12062085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
Acute kidney injury (AKI) is a common complication following cardiac surgery under cardiopulmonary bypass (CPB) in children. A prospective study for examining urinary neutrophil gelatinase-associated lipocalin (NGAL) and renal near-infrared spectroscopy (NIRS) trends during AKI was conducted among pediatric patients undergoing cardiac surgery with CPB. Urinary NGAL showed a significant difference between intensive care unit admission (0 h) and 2 h post-admission (p < 0.001) and remained significant up to 4 h (p < 0.05). The renal NIRS in the AKI group showed a significant rate of decrease and lower values during the intraoperative period (p < 0.05). The cumulative median saturation of renal regional saturation of oxygen (rSO2) during CPB was 1637.5% min in the AKI group and 943.0% min in the non-AKI group. The median renal rSO2 scores at a reduction of 20% and 25% were significantly higher (p < 0.001) in the AKI group. Our results suggest that monitoring renal rSO2 scores and limiting their decline might be useful in preventing AKI. The combination of NGAL, renal rSO2, and renal rSO2 scores might be useful in the early diagnosis of AKI during pediatric cardiac surgery.
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Affiliation(s)
- Yoshihito Wakamatsu
- Department of Clinical Engineering, Juntendo University School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Keisuke Nakanishi
- Cardiology Department, Pediatric and Congenital Cardiac Surgery Division, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Correspondence:
| | - Takanori Satoh
- Department of Clinical Engineering, Juntendo University School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Shiori Kawasaki
- Cardiology Department, Pediatric and Congenital Cardiac Surgery Division, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Atsushi Amano
- Cardiology Department, Pediatric and Congenital Cardiac Surgery Division, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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Evaluation of renal oxygenation by near-infrared spectroscopy during endoscopic injection of bulking agents in children with vesicoureteral reflux. Pediatr Surg Int 2023; 39:116. [PMID: 36773203 DOI: 10.1007/s00383-023-05407-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Near infrared spectroscopy (NIRS) is the measuring of regional tissue oxygenation (rSO2) by interpreting oxyhemoglobin and deoxyhemoglobin signals that come back by transmitting near infrared light to tissues. The effect of endourological interventions on renal perfusion in children is largely unknown. AIMS To evaluate the effects of endoscopic injection of bulking agents (EIBA) for vesicoureteral reflux (VUR) on renal oxygenation (RO) using renal NIRS monitoring, which shows renal perfusion and oxygenation changes. STUDY DESIGN Case-control study. METHODS Group I had bilateral inguinal surgery, Group II cystoscopy, and Group III, EIBA for VUR with 30 patients in each group. During the operation, vital signs, peripheral oxygen saturation, end-tidal carbon dioxide, and renal regional oxygen saturation index (rSO2) values by bilateral renal NIRS monitoring were recorded. NIRS values before induction (T0) to postoperative (Tend) were determined. A 20% or more reduction in renal rSO2 (%20↓rSO2) was considered significant. Group III was also evaluated as subgroup III-A (not having "%20↓rSO2") and subgroup III-B ("%20↓rSO2"). RESULTS The rSO2 decrease was observed in the first 5 min for both sides in group III. The most significant drop was at T30 for the right kidney and a significant decrease in rSO2, 20% or more, was observed in 6 renal units of 4 patients having higher SFU grading and renal scar in group III. CONCLUSION EIBA may transitionally impair renal oxygenation. Higher SFU grading and renal scar may increase the risk of renal hypoxia during EIBA.
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Kawaguchi T, Tsukuda J, Onoe R, Morisawa K, Yoshida T, Hayashi K, Fujitani S. Association between regional cerebral oxygen saturation and outcome of patients with out-of-hospital cardiac arrest: An observational study. Resusc Plus 2023; 13:100343. [PMID: 36686324 PMCID: PMC9852783 DOI: 10.1016/j.resplu.2022.100343] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/03/2022] [Accepted: 12/09/2022] [Indexed: 01/15/2023] Open
Abstract
Aim This study aimed to evaluate the association between cerebral oxygen saturation (StO2) and return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Methods We retrospectively evaluated the data of patients with OHCA to determine the association between ROSC and various StO2 parameters (initial_StO2, final_StO2, mean_StO2, and Δ_StO2 [=final_StO2-initial_StO2]). Time-domain near-infrared spectroscopy was used to determine absolute StO2 values. Results Of the 108 patients with OHCA, 23 achieved ROSC. Although initial_StO2 values did not differ between the groups, final_StO2, mean_StO2, and Δ_StO2 were higher in the ROSC group than in the non-ROSC group. The cut-off values for initial_StO2, mean_StO2, and Δ_StO2 as predictors of ROSC were 35%, 30%, and 5%, respectively. The odds ratio for ROSC had markedly increased in the Δ_StO2 ≥ 5% subgroup (19.70 [6.06-64.11], p < 0.001). When the change in StO2 (=d_StO2) at 8 min from the initiation of StO2 measurement was assessed, the d_StO2 ≥ 5% subgroup had a higher odds ratio for ROSC than the d_StO2 < 5% subgroup (5.8 [1.78-18.85], p = 0.002), and this tendency was maintained until 20 min. In the evaluation using a two-by-two contingency table with initial_StO2 and Δ_StO2 as two parameters, 61.9% of the patients fell under the categories of initial_StO2 < 35% and Δ_StO2 < 5% and had the lowest rate of ROSC achievement (4.6%). In the Δ_StO2 ≥ 5% subgroup, approximately-two-thirds of the patients achieved ROSC irrespective of the initial_StO2 (initial_StO2 ≥ 35%, 66.7%; initial_StO2 < 35%, 60.0%). Conclusions Initial_StO2 and Δ_StO2 were associated with the achievement of ROSC.
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Affiliation(s)
- Takeshi Kawaguchi
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Jumpei Tsukuda
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Rika Onoe
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Kenichiro Morisawa
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Toru Yoshida
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Koichi Hayashi
- Department of Emergency and Critical Care Medicine, St. Marianna University, Yokohama City Seibu Hospital, 1197-1 Yasashi-cho, Asahi-ku, Yokohama, Kanagawa 241-0811, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan,Corresponding author at: Department of Emergency and Critical Care Medicine St. Marianna University School of Medicine 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
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Yang L, Bao Z, Zhang L, Lei X, Zhang L. Position management on pulmonary function and bronchopulmonary dysplasia in premature infants: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e062291. [PMID: 36521889 PMCID: PMC9756205 DOI: 10.1136/bmjopen-2022-062291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Bronchopulmonary dysplasia (BPD) is a common disease caused by various factors and mechanisms in premature infants. Owing to lung hypoplasia and the lack of alveolar surfactants in premature infants, oxygen therapy is often needed to maintain adequate breathing. Nevertheless, prolonged oxygen therapy can easily induce BPD, and there is currently no effective treatment. Therefore, the prevention of BPD in premature infants during hospitalisation is essential. Studies have revealed that the prone position can effectively improve the oxygenation of premature infants. However, a few studies have reported whether prone positioning can improve lung function and reduce BPD incidence. This trial will determine whether the prone position, compared with the supine position, can reduce BPD incidence and improve lung function in preterm infants. METHODS AND ANALYSIS This study protocol is for a single-centre, single-blind, randomised controlled trial of the prone position in premature infants. Following daily feeding, premature infants will be placed in the lateral position for 30 min; then they will be turned to the supine position (control group) or prone position (intervention group) for 2 hours each in the morning and afternoon. Moreover, infants in both groups will be placed in the supine or lateral position alternately according to their medical needs for the remaining time. The study begins when the premature infants are stable within 5 days after admission and ends when they are discharged from the hospital or at 36 weeks postmenstrual age. The primary outcome is the survival rate without BPD. The secondary outcomes include lung function parameters and lung oxygen saturation. ETHICS AND DISSEMINATION This trial is approved by the ethics committee of the Affiliated Hospital of Southwest Medical University, (ref approval no.KY2021186). The results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ChiCTR2100049847.
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Affiliation(s)
- Liu Yang
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Zhengrong Bao
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Neonatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Lianyu Zhang
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Neonatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Clinical Nursing Research Institute, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xiaoping Lei
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Neonatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Perinatology, Southwest Medical University, Luzhou, Sichuan, China
| | - Lingping Zhang
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Neonatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Clinical Nursing Research Institute, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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18
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Abdominal Near Infrared Spectroscopy can be reliably used to measure splanchnic oxygenation changes in preterm infants. J Perinatol 2022:10.1038/s41372-022-01576-2. [PMID: 36496514 DOI: 10.1038/s41372-022-01576-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/06/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Near-infrared spectroscopy (NIRS) allows assessment of regional tissue oxygen delivery and extraction. There are doubts regarding reliability of gut NIRS measurements. This study assesses reliability of NIRS for monitoring gut oxygenation. STUDY DESIGN Splanchnic tissue haemoglobin index (sTHI), tissue oxygenation index (sTOI) and fractional tissue oxygen extraction (sFTOE) changes during blood transfusion were measured using NIRS and compared to stable control infants. Infants were grouped into 3 chronological age groups: 1-7, 8-28 and ≥29 days of life. RESULTS sTHI, sTOI significantly increased, and sFTOE reduced following blood transfusion in all age group infants (n = 59), with no changes seen in control infants (n = 12). Baseline characteristics including gestational age and feed volumes did not differ between groups. CONCLUSION Gut perfusion measured by NIRS improved in infants who received blood transfusion, a change not seen in the control group, thus suggesting NIRS is a reliable method to measure splanchnic tissue oxygenation.
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Miyake Y, Fujiwara K, Kataoka K, Ochi T, Seo S, Koga H, Lane GJ, Nishimura K, Hayashida M, Yamataka A. Retroperitoneoscopic Surgery in Children Does Not Cause Pathological Desaturation in Cerebral/Renal Oxygenation on Near-Infrared Spectroscopy Compared with Laparoscopic and Thoracoscopic Surgery. J Laparoendosc Adv Surg Tech A 2022; 32:1260-1264. [PMID: 35904967 DOI: 10.1089/lap.2022.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: Cerebral and renal regional oxygen saturation (C-rSO2 and R-rSO2, respectively) were monitored using near-infrared spectroscopy in pediatric patients (range: 0.3-14.3 years) during minimally invasive surgery (MIS) taking at least 3 hours performed by laparoscopy (Lap), thoracoscopy (Tho), or retroperitoneoscopy (Ret) from January 2019 to December 2021. Materials and Methods: Criteria compared were operative time, preoperative/intraoperative hemoglobin, blood loss, mean arterial pressure, arterial partial pressure of carbon dioxide (PaCO2), peripheral oxygen saturation (SpO2), C-rSO2, and R-rSO2. Pathological desaturation (PD) was defined as >20% decrease from baseline, and statistical significance as P < .05. Results: Subjects (n = 79) were similar for gender, age, and body mass index. MIS procedures were: Lap = 45, Tho = 20, Ret = 14; one Lap case required conversion for severe adhesions, not PD. Intraoperative PaCO2 (mmHg) was significantly higher in Tho (maximum: 59.5 ± 17.0, minimum: 39.9 ± 7.5) versus Lap (maximum: 39.9 ± 5.1, minimum: 34.6 ± 3.9) and Ret (maximum: 37.8 ± 4.2, minimum: 35.0 ± 3.3); P < .0001 (maximum), P = .0013 (minimum). Minimum intraoperative SpO2 was significantly lower in Tho (P < .0001). Mean operative times were significantly shorter in Tho (259 ± 114 minutes) versus Lap (433 ± 154 minutes) and Ret (342 ± 100 minutes); P < .0001, respectively. PD was absent during Ret (C-rSO2: 0/14 = 0% and R-rSO2: 0/14 = 0%). Differences in PD for Lap (C-rSO2: 7/45 = 15.6% and R-rSO2: 10/45 = 22.2%) and Tho (C-rSO2: 9/20 = 45.0%, and R-rSO2: 7/20 = 35.0%) were significant; P = .0028 for C-rSO2 and P = .0497 for R-rSO2. Hemoglobin and blood loss were similar. Conclusions: PD was absent during Ret, despite longer operative times. If Ret is indicated for a procedure, neurodevelopmental sequelae of MIS could be minimized.
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Affiliation(s)
- Yuichiro Miyake
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kentaro Fujiwara
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kumi Kataoka
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Takanori Ochi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shogo Seo
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kinya Nishimura
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Baş SŞ, Onay M, Alıcı ÇA, Alıcı U, Tokar B. Monitoring renal oxygenation status by near-infrared spectroscopy during ureterorenoscopy in children. Turk J Med Sci 2022; 52:1958-1969. [PMID: 36945986 PMCID: PMC10390123 DOI: 10.55730/1300-0144.5544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND : Near-infrared spectroscopy (NIRS) monitoring demonstrates renal blood flow, perfusion, and oxygenation changes. This study aimed to evaluate the effects of pediatric endourological interventions (PEI) on regional oxygen saturation value (rSO2) usingrenal NIRS monitoring. METHODS Patients having bilateral inguinal surgery (group I), cystoscopy (group II), and ureterorenoscopy (group III), 20 patients in each group, were included in the study. NIRS values before induction (T0) and at 5 min (T5), 10 min (T10), 15 min (T15), 20 min (T20), 25 min (T25), 30 min (T30) of the surgical procedure, and at the postextubation (Tend) were determined. The amount of irrigation fluid was recorded in groups II and III. The ureterorenoscopy group was also evaluated as two subgroups, as group III-R with patients having a "20%↓rSO2" and as group III-NoR, not having a "20%↓rSO2". RESULTS The mean total volume of irrigation was higher in group III, but the difference was not significant between the subgroups III-R and III-NoR. Renal rSO2 decreased significantly in T25, T30, and T-end values in group III. "20%↓rSO2" was seen in 1 patient in group II and 7 patients in group III. In the subgroups III-R, all patients had an obstructive pathology and significant preoperative hydronephrosis with a mean renal pelvis AP diameter of 21.1 ± 16.4 mm. DISCUSSION Although rSO2 significantly improves postoperatively, our data may suggest that congenital and acquired obstructive pathologies with hydronephrosis, prolonged operative time with continuous irrigation, and instrument movement in a narrow lumen may increase intrarenal pressure and the risk of renal hypoxia in endourological interventions. Preoperative evaluation of kidney functions and a meticulously well-planned intervention can prevent possible complications.
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Affiliation(s)
- Sema Şanal Baş
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Meryem Onay
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Eskişehir Osmangazi University, Eskilşehir, Turkey
| | - Çiğdem Arslan Alıcı
- Department of Pediatric Surgery, Division of Pediatric Urology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Umut Alıcı
- Department of Pediatric Surgery, Division of Pediatric Urology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Baran Tokar
- Department of Pediatric Surgery, Division of Pediatric Urology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
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Bailey SM, Prakash SS, Verma S, Desai P, Kazmi S, Mally PV. Near-infrared spectroscopy in the medical management of infants. Curr Probl Pediatr Adolesc Health Care 2022; 52:101291. [PMID: 36404215 DOI: 10.1016/j.cppeds.2022.101291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Near-infrared spectroscopy (NIRS) is a technology that is easy to use and can provide helpful information about organ oxygenation and perfusion by measuring regional tissue oxygen saturation (rSO2) with near-infrared light. The sensors can be placed in different anatomical locations to monitor rSO2 levels in several organs. While NIRS is not without limitations, this equipment is now becoming increasingly integrated into modern healthcare practice with the goal of achieving better outcomes for patients. It can be particularly applicable in the monitoring of pediatric patients because of their size, and especially so in infant patients. Infants are ideal for NIRS monitoring as nearly all of their vital organs lie near the skin surface which near-infrared light penetrates through. In addition, infants are a difficult population to evaluate with traditional invasive monitoring techniques that normally rely on the use of larger catheters and maintaining vascular access. Pediatric clinicians can observe rSO2 values in order to gain insight about tissue perfusion, oxygenation, and the metabolic status of their patients. In this way, NIRS can be used in a non-invasive manner to either continuously or periodically check rSO2. Because of these attributes and capabilities, NIRS can be used in various pediatric inpatient settings and on a variety of patients who require monitoring. The primary objective of this review is to provide pediatric clinicians with a general understanding of how NIRS works, to discuss how it currently is being studied and employed, and how NIRS could be increasingly used in the near future, all with a focus on infant management.
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Affiliation(s)
- Sean M Bailey
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016.
| | - Shrawani Soorneela Prakash
- Division of Neonatology, Department of Pediatrics, NYCHHC/Lincoln Medical and Mental Health Center, Bronx, NY 10451
| | - Sourabh Verma
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Purnahamsi Desai
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Sadaf Kazmi
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
| | - Pradeep V Mally
- Division of Neonatology, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016
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22
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Sun Y, Liu Y, Yu W, Zhong Y. Regional impairment of deep gray matter perfusion in neonates with congenital heart disease revealed by arterial spin labeling MRI. Front Hum Neurosci 2022; 16:803006. [PMID: 36118973 PMCID: PMC9478434 DOI: 10.3389/fnhum.2022.803006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
The present study examined deep gray matter perfusion in neonates with congenital heart disease (CHD) with arterial spin labeling magnetic resonance imaging preoperatively. We found that neonates with cyanotic CHD showed lower right thalamus compared with controls and lower right basal ganglia perfusion compared with acyanotic CHD. When the CHD group was assessed as a whole, it showed slightly decreased left thalamus perfusion compared with controls. The results suggest that cardiac physiology plays a crucial part in changes in regional cerebral perfusion. Perfusion with arterial spin labeling may be a useful marker of high risk for impaired cerebral blood flow auto-regulation and cerebral hypoperfusion in neonates with CHD.
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Affiliation(s)
- Yan Sun
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yujie Liu
- Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenwen Yu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Yumin Zhong
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Yumin Zhong
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Vesoulis Z, Hopper A, Fairchild K, Zanelli S, Chalak L, Noroozi M, Liu J, Chock V. A phase-II clinical trial of targeted cerebral near infrared spectroscopy using standardized treatment guidelines to improve brain oxygenation in preterm infants (BOx-II): A study protocol. Contemp Clin Trials 2022; 120:106886. [PMID: 35995129 PMCID: PMC9489653 DOI: 10.1016/j.cct.2022.106886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/15/2022] [Accepted: 08/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mortality and brain injury are common adverse outcomes in infants born <28 weeks. Conventional pulse oximetry may not detect subclinical changes prior to deterioration and fails to detect changes within the brain. Increasing evidence supports the use of cerebral near-infrared spectroscopy (NIRS) in the early care of preterm infants, yet the impact of specific interventions on cerebral oxygenation and the relationship between cerebral hypoxia and brain injury on MRI remain to be determined. METHODS/DESIGN 100 infants <28 completed weeks of gestation will be recruited for a prospective, multicenter intervention trial. After informed consent, infants will undergo cerebral NIRS monitoring starting within 6 h of birth and continuing through 72 h. Infants with persistent cerebral desaturation will receive interventions following a standard treatment algorithm selected by the provider based on the patient's clinical condition. Providers will record the timing and choice of intervention(s) and term equivalent brain MRI will be performed for survivors. There are three objectives of this study: 1) to identify the relationship between cerebral hypoxia burden and brain injury on term-equivalent MRI. 2) to identify most common interventions after cerebral hypoxia, and 3) to quantify frequency of occult cerebral hypoxia events. DISCUSSION There is increasing evidence for the role of early cerebral NIRS monitoring in the neuroprotective care of preterm infants. This phase-II trial will provide essential data to improve the intervention approach, model the effect size of interventions on a wider extent of brain injury, and quantify the discrepancy between measurements of systemic and cerebral hypoxia.
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Affiliation(s)
| | - Andrew Hopper
- Loma Linda University, Loma Linda, CA, United States of America
| | - Karen Fairchild
- University of Virginia, Charlottesville, VA, United States of America
| | - Santina Zanelli
- University of Virginia, Charlottesville, VA, United States of America
| | - Lina Chalak
- University of Texas Southwest, Dallas, TX, United States of America
| | - Mona Noroozi
- Washington University, St. Louis, MO, United States of America
| | - Jessica Liu
- Stanford University, Palo Alto, CA, United States of America
| | - Valerie Chock
- Stanford University, Palo Alto, CA, United States of America
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Hu S, Lu A, Pan C, Zhang B, Wa YL, Qu W, Bai M. Limb Ischemia Complications of Veno-Arterial Extracorporeal Membrane Oxygenation. Front Med (Lausanne) 2022; 9:938634. [PMID: 35911410 PMCID: PMC9334727 DOI: 10.3389/fmed.2022.938634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to summarize and analyse the risk factors, clinical features, as well as prevention and treatment of limb ischemia complications in patients on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Methods We retrospectively analyzed 179 adult patients who had undergone V-A ECMO support in the Cardiac Care Unit of the First Hospital of Lanzhou University between March 2019 and December 2021. Patients were divided into the limb ischemia group (LI group) and the non-limb ischemia group (nLI group) according to whether limb ischemia occurred on the ipsilateral side of femoral artery cannulation. In the LI group, patients were salvaged with a distal perfusion cannula (DPC) according to each patient's clinical conditions. The baseline data and ECMO data were compared between the two groups, and risk factors for limb ischemia complications were screened using multiple logistic regression analysis. Results Overall, 19 patients (10.6%) had limb ischemia complications, of which 5 (2.8%) were improved after medication adjustment, 12 (8.4%) were salvaged with a DPC, and 2 had undergone surgical intervention. There were significant differences in terms of Extracorporeal Cardiopulmonary Resuscitation (ECPR), Intra-aortic balloon pump (IABP), peak vasoactive-inotropic score (VIS) within 24 h after ECMO (VIS-max), Left ventricular ejection fraction (LVEF), weaning from ECMO, and discharge rate between the two groups. ECPR, IABP, and VIS-max in the LI group were significantly higher than those in the nLI group, whereas weaning from ECMO, discharge rate, and LVEF were significantly lower in the LI group compared to those in the nLI group. Furthermore, multiple logistic regression analysis revealed that diabetes [odds ratio (OR) = 4.338, 95% confidence interval (CI): 1.193–15.772, P = 0.026], IABP (OR = 1.526, 95% CI: 1.038–22.026, P = 0.049) and VIS-max (OR = 1.054, 95% CI: 1.024–1.085, P < 0.001) were independent risk factors for limb ischemia complications in patients who underwent V-A ECMO. Conclusion Diabetes, prevalence of IABP and VIS-max value in analyzed groups were independent risk factors for predicting limb ischemia complications in patients who underwent V-A ECMO. The cannulation strategy should be optimized during the establishment of V-A ECMO, and limb ischemia should be systematically evaluated after ECMO establishment. A DPC can be used as a salvage intervention for the complications of critical limb ischemia.
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Affiliation(s)
- Sixiong Hu
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China
- Heart Center, The First Hospital of Lanzhou University, Lanzhou, China
- Gansu Key Laboratory for Cardiovascular Diseases of Gansu, Lanzhou, China
- Cardiovascular Clinical Research Center of Gansu, Lanzhou, China
| | - Andong Lu
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China
- Heart Center, The First Hospital of Lanzhou University, Lanzhou, China
- Gansu Key Laboratory for Cardiovascular Diseases of Gansu, Lanzhou, China
- Cardiovascular Clinical Research Center of Gansu, Lanzhou, China
- *Correspondence: Andong Lu
| | - Chenliang Pan
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China
- Heart Center, The First Hospital of Lanzhou University, Lanzhou, China
- Gansu Key Laboratory for Cardiovascular Diseases of Gansu, Lanzhou, China
- Cardiovascular Clinical Research Center of Gansu, Lanzhou, China
| | - Bo Zhang
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China
- Heart Center, The First Hospital of Lanzhou University, Lanzhou, China
- Gansu Key Laboratory for Cardiovascular Diseases of Gansu, Lanzhou, China
- Cardiovascular Clinical Research Center of Gansu, Lanzhou, China
| | - Yong ling Wa
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China
| | - Wenjing Qu
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China
| | - Ming Bai
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China
- Heart Center, The First Hospital of Lanzhou University, Lanzhou, China
- Gansu Key Laboratory for Cardiovascular Diseases of Gansu, Lanzhou, China
- Cardiovascular Clinical Research Center of Gansu, Lanzhou, China
- Ming Bai
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Miyake Y, Seo S, Kataoka K, Ochi T, Miyano G, Koga H, Lane GJ, Nishimura K, Inada E, Yamataka A. Significant neonatal intraoperative cerebral and renal oxygen desaturation identified with near-infrared spectroscopy. Pediatr Surg Int 2022; 38:737-742. [PMID: 35246727 DOI: 10.1007/s00383-022-05102-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Near-infrared spectroscopy (NIRS) was used to monitor intraoperative regional oxygen saturation (rSO2) during open (Op) and minimally invasive (MI) surgery performed in neonates (N) and children. MATERIALS AND METHODS NIRS sensors were applied to the forehead and flanks for cerebral rSO2 (C-rSO2) and renal rSO2 (R-rSO2), respectively. MI included laparoscopy (La), retroperitoneoscopy (Re) and thoracoscopy (Th). In children, Op and MI were major operations taking at least 3 h (MOp; MMI). Pathological desaturation (PD) was defined as > 20% deterioration in rSO2. RESULTS Mean ages at surgery were N: 5.2 ± 8.2 days, MOp: 2.4 ± 2.9 years, and MMI: 3.8 ± 4.3 years. Despite significantly shorter operative times in N (169 ± 94 min; p < 0.0001), PD was significantly worse; PD(C-rSO2): N = 14/35 (40.0%) versus MOp = 3/36 (8.3%) and MMI = 7/58 (12.1%); p = 0.0006, and PD(R-rSO2): N = 27/35 (77.1%) versus MOp = 6/36 (16.7%) and MMI = 7/58 (12.1%); p < 0.0001, respectively. PD(R-rSO2) occurred immediately with visceral reduction in NOp (Fig. 1) and PD was frequent during NMI(Th) (Fig. 2). rSO2 was stable throughout MOp and MMI (Fig. 3). Fig. 1 Pathological desaturation in renal rSO2 after visceral reduction for gastroschisis. Renal rSO2 deteriorated immediately after viscera were returned to the abdominal cavity rSO2 regional oxygen saturation Fig. 2 Fragility of tissue perfusion during thoracoscopic lung lobectomy in a neonate. Pathological desaturation occurred frequently during neonatal thoracoscopic surgery rSO2 regional oxygen saturation Fig. 3 Changes in cerebral and renal rSO2 according to operative time. Cerebral and renal rSO2 did not appear to change according to operative time during major open and major minimally invasive surgery in children. rSO2 regional oxygen saturation CONCLUSIONS: NIRS is a non-invasive technique for monitoring rSO2 as an indicator of intraoperative stress and vascular perfusion. PD was so significant in neonates that intraoperative NIRS is highly recommended during thoracoscopy and procedures requiring visceral manipulation.
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Affiliation(s)
- Yuichiro Miyake
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Shogo Seo
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kumi Kataoka
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku Tokyo, Tokyo, 113-8421, Japan
| | - Takanori Ochi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Go Miyano
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kinya Nishimura
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku Tokyo, Tokyo, 113-8421, Japan
| | - Eiichi Inada
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku Tokyo, Tokyo, 113-8421, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
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Ong J, Tavakkoli A, Strangman G, Zaman N, Kamran SA, Zhang Q, Ivkovic V, Lee AG. Neuro-ophthalmic Imaging and Visual Assessment Technology for Spaceflight Associated Neuro-ocular Syndrome (SANS). Surv Ophthalmol 2022; 67:1443-1466. [DOI: 10.1016/j.survophthal.2022.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 12/11/2022]
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Moosaeifar S, Mousavizadeh M, Najafi Ghezeljeh T, Hosseinian A, Babaee T, Hosseini S, Mestres CA. The effect of pulsatile versus non-pulsatile flow during cardiopulmonary bypass on cerebral oxygenation: A randomized trial. Asian Cardiovasc Thorac Ann 2021; 30:441-448. [PMID: 34904903 DOI: 10.1177/02184923211045915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The present study aims to compare regional oxygen supply determined by Near-Infrared Spectroscopy in the course of pulsatile perfusion with non-pulsatile perfusion during cardiopulmonary bypass in patients undergoing valvular heart surgery. METHODS In this prospective randomized single-blinded trial, we enrolled adult subjects aged 18-65 years scheduled for elective valvular heart repair/replacement surgery with non-stenotic carotid arteries, employing a consecutive sampling method. Eligible patients were then randomly assigned in a 1:1 ratio to pulsatile or non-pulsatile perfusion during aortic cross-clamp. The primary outcome was regional cerebral oxygenation monitored by Near-Infrared Spectroscopy in each group. RESULTS Seventy patients were randomly assigned, and each group comprised 35 patients. Mean age was 46.8 and 46.5 years in pulsatile and non-pulsatile groups, respectively. There were no significant between-group differences in regional cerebral oxygen saturation at different time points of cardiopulmonary bypass (p-value for analysis of variance repeated measures: 0.923 and 0.223 for left and right hemispheres, respectively). Moreover, no significant differences in regional cerebral oxygen saturation levels from baseline between pulsatile and non-pulsatile groups at all desired time points for the left (p = 0.51) and right (p = 0.22) hemispheres of the brain were detected. CONCLUSION Pulsatile perfusion during cardiopulmonary bypass does not offer superior regional cerebral oxygenation measured by Near-Infrared Spectroscopy than non-pulsatile perfusion during cardiopulmonary bypass. Nonetheless, the efficacy of pulsatile flow in the subgroup of patients in whom cerebral blood flow is impaired due to carotid artery stenosis needs to be explored and evaluated by this method in future studies.
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Affiliation(s)
- Samira Moosaeifar
- Department of Critical Care Nursing and Midwifery, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Mousavizadeh
- Heart Valve disease Research Center, Rajaie Cardiovascular, Medical and Research Center, 158776Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh
- Center for Nursing Care Research, Department of Critical Care Nursing and Midwifery, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Afshin Hosseinian
- Heart Valve disease Research Center, Rajaie Cardiovascular, Medical and Research Center, 158776Iran University of Medical Sciences, Tehran, Iran
| | - Touraj Babaee
- Heart Valve disease Research Center, Rajaie Cardiovascular, Medical and Research Center, 158776Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Hosseini
- Heart Valve disease Research Center, Rajaie Cardiovascular, Medical and Research Center, 158776Iran University of Medical Sciences, Tehran, Iran
| | - Carlos-A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
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Uzianbaeva L, Yan Y, Joshi T, Yin N, Hsu CD, Hernandez-Andrade E, Mehrmohammadi M. Methods for Monitoring Risk of Hypoxic Damage in Fetal and Neonatal Brains: A Review. Fetal Diagn Ther 2021; 49:1-24. [PMID: 34872080 PMCID: PMC8983560 DOI: 10.1159/000520987] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
Fetal, perinatal, and neonatal asphyxia are vital health issues for the most vulnerable groups in human beings, including fetuses, newborns, and infants. Severe reduction in oxygen and blood supply to the fetal brain can cause hypoxic-ischemic encephalopathy (HIE), leading to long-term neurological disorders, including mental impairment and cerebral palsy. Such neurological disorders are major healthcare concerns. Therefore, there has been a continuous effort to develop clinically useful diagnostic tools for accurately and quantitatively measuring and monitoring blood and oxygen supply to the fetal and neonatal brain to avoid severe consequences of asphyxia HIE and neonatal encephalopathy. Major diagnostic technologies used for this purpose include fetal heart rate monitoring, fetus scalp blood sampling, ultrasound imaging, magnetic resonance imaging, X-ray computed tomography, and nuclear medicine. In addition, given the limitations and shortcomings of traditional diagnostic methods, emerging technologies such as near-infrared spectroscopy and photoacoustic imaging have also been introduced as stand-alone or complementary solutions to address this critical gap in fetal and neonatal care. This review provides a thorough overview of the traditional and emerging technologies for monitoring fetal and neonatal brain oxygenation status and describes their clinical utility, performance, advantages, and disadvantages.
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Affiliation(s)
- Liaisan Uzianbaeva
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Yan Yan
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Tanaya Joshi
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Nina Yin
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
- Department of Anatomy, School of Basic Medical Science, Hubei University of Chinese Medicine, Wuhan, China
| | - Chaur-Dong Hsu
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Arizona, College of Medicine, Tucson, Arizona, USA
| | - Edgar Hernandez-Andrade
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center, Houston, Texas, USA
| | - Mohammad Mehrmohammadi
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
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Renal Oxygenation (rSO2) Population Parameter Estimates in Premature Infants Routinely Monitored With Near-Infrared Spectroscopy. Adv Neonatal Care 2021; 22:370-377. [PMID: 34417355 DOI: 10.1097/anc.0000000000000927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Currently, reference ranges for renal oxygenation measured by near-infrared spectroscopy (NIRS) in preterm infants beyond the first days of life are lacking, especially those born prior to 29 weeks' gestation. Population estimates of renal oxygenation (rSO2) levels among preterm infants over time have yet to be established, leading to reluctance in clinical application. PURPOSE To characterize the distribution and estimate population parameters for renal oxygenation measured by NIRS during the first 14 days of life among preterm infants. METHODS We prospectively observed rSO2 trends of 37 infants before 34 weeks' gestation and 1800-g or less birth weight for the first 14 days of life. Analyses included distribution fit tests, ordinary least squares (OLS) regression, and t tests. RESULTS Average daily rSO2 variation steadily increased with 42% difference through the first 14 days of life. For all infants, renal rSO2 means peaked during the first 3 days of life and plateaued around 7 days. Daily rSO2 slopes were significantly lower among males and infants 29 weeks' or less gestation. IMPLICATIONS FOR PRACTICE Renal rSO2 during the first 14 days of life reflects normal extrauterine transition reaching stabilization around 7 days of life. Gestational age, birth weight, and gender may predict the early trajectory of rSO2 patterns. Population estimates provide parameters for renal rSO2 that may indicate early-onset tissue hypoxia when acute or significant drops from baseline occur. IMPLICATIONS FOR RESEARCH We present a framework to guide future research using renal NIRS technology in preterm infants to determine deviations from expected trends that may precede renal injury.
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Abstract
BACKGROUND Acute kidney injury (AKI) affects approximately 30% of infants admitted to the neonatal intensive care unit (NICU), and increases mortality risk by 50%. Current diagnostic criteria (serum creatinine rise with oliguria) cannot detect early-onset AKI, as up to 50% of nephron damage may occur by the time these abnormalities present. Once AKI is established, clinical management is often ineffective; therefore, prevention is key. Near-infrared spectroscopy (NIRS) offers a feasible, noninvasive approach to continuously monitor renal oxygenation trends over time, serving as a surrogate marker for renal perfusion. PURPOSE To provide an overview of NIRS principles for measuring renal oxygenation, and to describe current evidence of how this technology is being used among infants admitted to the NICU relative to the prediction and identification of AKI. METHODS A comprehensive search of PubMed and CINHAL focused on renal NIRS studies in NICU preterm and term infants was conducted. RESULTS Findings from 34 studies were included. In term infants, reduced renal oxygenation correlated to invasive SvO2 monitoring, predicted survivability and AKI. In preterm infants, reduced renal oxygenation was associated with AKI in one study, yet contrasting findings were reported in those with patent ductus arteriosus, including those who received prostaglandin inhibitors. Normative data in all infants were sparse. IMPLICATIONS FOR PRACTICE Renal NIRS may offer a noninvasive measurement of kidney hypoperfusion that may precede conventional diagnostic measures. IMPLICATIONS FOR RESEARCH Normative data are lacking, the threshold for renal ischemia is not defined, and consensus guiding clinical treatment based on NIRS data is nonexistent.
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Wood MD, Boyd JG, Wood N, Frank J, Girard TD, Ross-White A, Chopra A, Foster D, Griesdale DEG. The Use of Near-Infrared Spectroscopy and/or Transcranial Doppler as Non-Invasive Markers of Cerebral Perfusion in Adult Sepsis Patients With Delirium: A Systematic Review. J Intensive Care Med 2021; 37:408-422. [PMID: 33685273 PMCID: PMC8772019 DOI: 10.1177/0885066621997090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Several studies have previously reported the presence of altered cerebral perfusion during sepsis. However, the role of non-invasive neuromonitoring, and the impact of altered cerebral perfusion, in sepsis patients with delirium remains unclear. Methods: We performed a systematic review of studies that used near-infrared spectroscopy (NIRS) and/or transcranial Doppler (TCD) to assess adults (≥18 years) with sepsis and delirium. From study inception to July 28, 2020, we searched the following databases: Ovid MedLine, Embase, Cochrane Library, and Web of Science. Results: Of 1546 articles identified, 10 met our inclusion criteria. Although NIRS-derived regional cerebral oxygenation was consistently lower, this difference was only statistically significant in one study. TCD-derived cerebral blood flow velocity was inconsistent across studies. Importantly, both impaired cerebral autoregulation during sepsis and increased cerebrovascular resistance were associated with delirium during sepsis. However, the heterogeneity in NIRS and TCD devices, duration of recording (from 10 seconds to 72 hours), and delirium assessment methods (e.g., electronic medical records, confusion assessment method for the intensive care unit), precluded meta-analysis. Conclusion: The available literature demonstrates that cerebral perfusion disturbances may be associated with delirium in sepsis. However, future investigations will require consistent definitions of delirium, delirium assessment training, harmonized NIRS and TCD assessments (e.g., consistent measurement site and length of recording), as well as the quantification of secondary and tertiary variables (i.e., Cox, Mxa, MAPOPT), in order to fully assess the relationship between cerebral perfusion and delirium in patients with sepsis.
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Affiliation(s)
- Michael D Wood
- Department of Anesthesiology, Pharmacology and Therapeutics, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - J Gordon Boyd
- Department of Critical Care Medicine, 4257Queen's University, Kingston, Ontario, Canada
| | - Nicole Wood
- Department of Physics, 8430University of Waterloo, Waterloo, Ontario, Canada
| | - James Frank
- Department of Physics, 7497Brock University, St. Catharines, Ontario, Canada
| | - Timothy D Girard
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Akash Chopra
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Denise Foster
- Division of Critical Care Medicine, Department of Medicine, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald E G Griesdale
- Department of Anesthesiology, Pharmacology and Therapeutics, 8166University of British Columbia, Vancouver, British Columbia, Canada.,Division of Critical Care Medicine, Department of Medicine, 8166University of British Columbia, Vancouver, British Columbia, Canada.,Center for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Dorum BA, Ozkan H, Cetinkaya M, Koksal N. Regional oxygen saturation and acute kidney injury in premature infants. Pediatr Int 2021; 63:290-294. [PMID: 32634851 DOI: 10.1111/ped.14377] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Decreased renal blood flow plays a vital role in the etiology of acute kidney injury (AKI). In this study, we aim to investigate the role of renal regional oxygen saturation (rSO2 ) reductions in predicting AKI in the first 24 h of life. METHODS One hundred premature babies with a gestational age of ≤32 weeks were included. Renal and cerebral rSO2 s were monitored for 24 h by near-infrared spectroscopy. Infants were followed up for the first 7 days for the diagnosis of AKI. RESULTS Infants' median gestational age was 29 (23-32) weeks, and their birthweight was 1,192 ± 355 g. It was found that the renal rSO2 values were lower in the first 24 h of life in patients who developed AKI, and this decrease was statistically significant in the first 6 h of life. CONCLUSIONS The low renal rSO2 values in the early hours of life in premature babies may have a role in predicting AKI.
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Affiliation(s)
- Bayram Ali Dorum
- Department of Neonatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Hilal Ozkan
- Department of Neonatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Merih Cetinkaya
- Department of Neonatology, Ministry of Health University of Health Science Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Nilgun Koksal
- Department of Neonatology, Faculty of Medicine, Uludag University, Bursa, Turkey
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Stienstra RM, McHoney M. Near-infrared spectroscopy (NIRS) measured tissue oxygenation in neonates with gastroschisis: a pilot study. J Matern Fetal Neonatal Med 2021; 35:5099-5107. [PMID: 33602021 DOI: 10.1080/14767058.2021.1875429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Management of gastroschisis involves either primary or staged closure. Bowel ischemia and abdominal compartment syndrome (ACS) are possible complications that can be related to a method of treatment. NIRS monitoring has never been applied in this group of patients and may allow for earlier detection of complications. OBJECTIVE To assess near-infrared spectroscopy (NIRS) monitoring in neonates with gastroschisis for detecting changes in tissue oxygenation (rSO2) related to bowel reductions or height of bowel in the silo and for detecting tissue ischemia. METHODS Patients with gastroschisis and controls underwent continuous multi-channel assessment of oxygenation of the brain (CrSO2), kidney (RrSO2) and bowel (GrSO2) in a prospective pilot study. RESULTS Fifteen neonates were treated with primary closure (n = 3) or staged closure (n = 12); two had confirmed bowel ischemia, none developed ACS.There was no significant correlation between height of the bowel and GrSO2 at apex (p = .72) or base (p = .54) within the silo. During staged reductions there was a clinically non-significant change in RrSO2 (Δ-2.5%, p = .04), but no significant changes in CrSO2 (p = .11), and GrSO2 of apex (p = .97) and base (p = .31). Patients with confirmed ischemia had GrSO2 that were lower than controls. CONCLUSIONS Measuring GrSO2 through a silo is feasible. Staged reduction seems safe based on NIRS measurements, with minimal effect of hydrostatic pressure on bowel oxygenation. NIRS was able to detect subtle changes in intra-abdominal renal perfusion during reduction and could differentiate healthy and ischemic bowel.
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Affiliation(s)
- Roxane M Stienstra
- University of Groningen, Groningen, the Netherlands.,Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Merrill McHoney
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, Scotland
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Neonatal NIRS monitoring: recommendations for data capture and review of analytics. J Perinatol 2021; 41:675-688. [PMID: 33589724 PMCID: PMC7883881 DOI: 10.1038/s41372-021-00946-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/20/2020] [Accepted: 01/19/2021] [Indexed: 01/29/2023]
Abstract
Brain injury is one of the most consequential problems facing neonates, with many preterm and term infants at risk for cerebral hypoxia and ischemia. To develop effective neuroprotective strategies, the mechanistic basis for brain injury must be understood. The fragile state of neonates presents unique research challenges; invasive measures of cerebral blood flow and oxygenation assessment exceed tolerable risk profiles. Near-infrared spectroscopy (NIRS) can safely and non-invasively estimate cerebral oxygenation, a correlate of cerebral perfusion, offering insight into brain injury-related mechanisms. Unfortunately, lack of standardization in device application, recording methods, and error/artifact correction have left the field fractured. In this article, we provide a framework for neonatal NIRS research. Our goal is to provide a rational basis for NIRS data capture and processing that may result in better comparability between studies. It is also intended to serve as a primer for new NIRS researchers and assist with investigation initiation.
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Leon RL, Ortigoza EB, Ali N, Angelis D, Wolovits JS, Chalak LF. Cerebral Blood Flow Monitoring in High-Risk Fetal and Neonatal Populations. Front Pediatr 2021; 9:748345. [PMID: 35087771 PMCID: PMC8787287 DOI: 10.3389/fped.2021.748345] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/15/2021] [Indexed: 12/18/2022] Open
Abstract
Cerebrovascular pressure autoregulation promotes stable cerebral blood flow (CBF) across a range of arterial blood pressures. Cerebral autoregulation (CA) is a developmental process that reaches maturity around term gestation and can be monitored prenatally with both Doppler ultrasound and magnetic resonance imaging (MRI) techniques. Postnatally, there are key advantages and limitations to assessing CA with Doppler ultrasound, MRI, and near-infrared spectroscopy. Here we review these CBF monitoring techniques as well as their application to both fetal and neonatal populations at risk of perturbations in CBF. Specifically, we discuss CBF monitoring in fetuses with intrauterine growth restriction, anemia, congenital heart disease, neonates born preterm and those with hypoxic-ischemic encephalopathy. We conclude the review with insights into the future directions in this field with an emphasis on collaborative science and precision medicine approaches.
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Affiliation(s)
- Rachel L Leon
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Eric B Ortigoza
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Noorjahan Ali
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Dimitrios Angelis
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Joshua S Wolovits
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Lina F Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Li R, Ye X, Li G, Cao X, Zou Y, Yao S, Luo F, Zhang L, Dong W. Effects of Different Body Positions and Head Elevation Angles on Regional Cerebral Oxygen Saturation in Premature Infants of China. J Pediatr Nurs 2020; 55:1-5. [PMID: 32570090 DOI: 10.1016/j.pedn.2020.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND To investigate the effects of different body positions and head elevation angles on regional cerebral oxygen saturation in premature infants using near-infrared spectroscopy (NIRS). METHODS This was a prospective study of premature infants hospitalized. The position was changed each feeding cycle (2-3 h), in order: 15° prone, 15° supine, 0° prone, and 0° supine position. Regional cerebral oxygen saturation (rSO2) was measured after each position period using NIRS, over 7 days. FINDINGS Thirty-three premature infants were included in the analysis. Among them, 22 (66.7%) were male, and 11 (33.3%) were female. When placing the premature infants in the prone position, the regional cerebral oxygen saturation (rSO2) values were higher at head elevation 15° compared with 0° (main effect P < 0.001). When placing the premature infants in the supine position, rSO2 was higher at a head elevation of 15° compared with that at 0° (main effect P < 0.001). When placing the premature infants with a head elevation of 15°, rSO2 in the prone position was higher than that of the supine position (main effect P < 0.001). There was no difference between the prone and supine positions when placing the premature infants with the head elevation at 0° (P > 0.05). DISCUSSION Higher cerebral rSO2 can be achieved when placing premature infants in the prone or supine position, with a 15° head elevation angle. APPLICATION TO PRACTICE Using a specific body position and head angle could improve the regional cerebral oxygen saturation of premature infants.
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Affiliation(s)
- Run Li
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Xiaoxiu Ye
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Guiping Li
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Xiaokuan Cao
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Yuanxia Zou
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Shihan Yao
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Feng Luo
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Lin Zhang
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Wenbin Dong
- Department of Newborn Medicine, Affiliated Hospital of Southwest Medical University, Sichuan, China.
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Abstract
PURPOSE OF REVIEW The last decades, anesthesia has become safer, partly due to developments in monitoring. Advanced monitoring of children under anesthesia is challenging, due to lack of evidence, validity and size constraints. Most measured parameters are proxies for end organ function, in which an anesthesiologist is actually interested. Ideally, monitoring should be continuous, noninvasive and accurate. This present review summarizes the current literature on noninvasive monitoring in noncardiac pediatric anesthesia. RECENT FINDINGS For cardiac output (CO) monitoring, bolus thermodilution is still considered the gold standard. New noninvasive techniques based on bioimpedance and pulse contour analysis are promising, but require more refining in accuracy of CO values in children. Near-infrared spectroscopy is most commonly used in cardiac surgery despite there being no consensus on safety margins. Its place in noncardiac anesthesia has yet to be determined. Transcutaneous measurements of blood gases are used mainly in the neonatal intensive care unit, and is finding its way to the pediatric operation theatre. Especially CO2 measurements are accurate and useful. SUMMARY New techniques are available to assess a child's hemodynamic and respiratory status while under anesthesia. These new monitors can be used as complementary tools together with standard monitoring in children, to further improve perioperative safety.
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Abstract
Abnormal brain perfusion is a key mechanism underlying neonatal brain injury. Understanding the mechanisms leading to brain perfusion changes in high-risk neonates and how these alterations may influence brain development is key to improve therapeutic strategies preventing brain injury and the neurodevelopmental outcome of these infants. To date, several studies demonstrated that Arterial Spin Labeling is a reliable tool to accurately and non-invasively analyze brain perfusion, facilitating the understanding of normal and pathological mechanisms underlying neonatal brain maturation and injury. This paper provides an overview of the normal pattern of brain perfusion on Arterial Spin Labeling in term and preterm neonates, and reviews perfusion abnormalities associated with common neonatal neurological disorders.
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Affiliation(s)
- Domenico Tortora
- Neuroradiology Unit IRCCS, Istituto Giannina Gaslini, Genoa, Italy.
| | | | - Andrea Rossi
- Neuroradiology Unit IRCCS, Istituto Giannina Gaslini, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
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Near-Infrared Spectroscopy to Assess Cerebral Autoregulation and Optimal Mean Arterial Pressure in Patients With Hypoxic-Ischemic Brain Injury: A Prospective Multicenter Feasibility Study. Crit Care Explor 2020; 2:e0217. [PMID: 33063026 PMCID: PMC7523861 DOI: 10.1097/cce.0000000000000217] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. We provide preliminary multicenter data to suggest that recruitment and collection of physiologic data necessary to quantify cerebral autoregulation and individualized blood pressure targets are feasible in postcardiac arrest patients. We evaluated the feasibility of a multicenter protocol to enroll patients across centers, as well as collect continuous recording (≥ 80% of monitoring time) of regional cerebral oxygenation and mean arterial pressure, which is required to quantify cerebral autoregulation, using the cerebral oximetry index, and individualized optimal mean arterial pressure thresholds. Additionally, we conducted an exploratory analysis to assess if an increased percentage of monitoring time where mean arterial pressure was greater than or equal to 5 mm Hg below optimal mean arterial pressure, percentage of monitoring time with dysfunctional cerebral autoregulation (i.e., cerebral oximetry index ≥ 0.3), and time to return of spontaneous circulation were associated with an unfavorable neurologic outcome (i.e., 6-mo Cerebral Performance Category score ≥ 3).
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Tortora D, Lo Russo FM, Severino M, Parodi A, Massirio P, Ramenghi LA, Rossi A. Regional impairment of cortical and deep gray matter perfusion in preterm neonates with low-grade germinal matrix-intraventricular hemorrhage: an ASL study. Neuroradiology 2020; 62:1689-1699. [DOI: 10.1007/s00234-020-02514-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022]
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Intestinal Oxygenation and Survival After Surgery for Necrotizing Enterocolitis: An Observational Cohort Study. Ann Surg 2020; 275:e503-e510. [PMID: 32324690 DOI: 10.1097/sla.0000000000003913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether regional intestinal oxygen saturation (rintSO2) and regional cerebral oxygen saturation (rcSO2) measurements aid in estimating survival of preterm infants after surgery for NEC. SUMMARY OF BACKGROUND DATA Predicting survival after surgery for NEC is difficult yet of the utmost importance for counseling parents. METHODS We retrospectively studied prospectively collected data of preterm infants with surgical NEC who had available rintSO2 and rcSO2 values measured via near-infrared spectroscopy 0-24 hours preoperatively. We calculated mean rintSO2 and rcSO2 for 60-120 minutes for each infant. We analyzed whether preoperative rintSO2 and rcSO2 differed between survivors and non-survivors, determined cut-off points, and assessed the added value to clinical variables. RESULTS We included 22 infants, median gestational age 26.9 weeks [interquartile range (IQR): 26.3-28.4], median birth weight 1088 g [IQR: 730-1178]. Eleven infants died postoperatively. Preoperative rintSO2, but not rcSO2, was higher in survivors than in non-survivors [median: 63% (IQR: 42-68) vs 29% (IQR: 21-43), P < 0.01), with odds ratio for survival 4.1 (95% confidence interval, 1.2-13.9, P = 0.02) per 10% higher rintSO2. All infants with rintSO2 values of >53% survived, whereas all infants with rintSO2 <35% died. Median C-reactive protein [138 mg/L (IQR: 83-179) vs 73 mg/L (IQR: 12-98), P < 0.01), lactate [1.1 mmol/L (IQR: 1.0-1.6) vs 4.6 mmol/L (IQR: 2.8-8.0), P < 0.01], and fraction of inspired oxygen [25% (IQR: 21-31) vs 42% (IQR: 30-80), P < 0.01] differed between survivors and non-survivors. Only rintSO2 remained significant in the multiple regression model. CONCLUSIONS Measuring rintSO2, but not rcSO2, seems of added value to clinical variables in estimating survival of preterm infants after surgery for NEC. This may help clinicians in deciding whether surgery is feasible and to better counsel parents about their infants' chances of survival.
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Predicting intestinal recovery after necrotizing enterocolitis in preterm infants. Pediatr Res 2020; 87:903-909. [PMID: 31649338 DOI: 10.1038/s41390-019-0634-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Intestinal recovery after NEC is difficult to predict in individuals. We evaluated whether several biomarkers predict intestinal recovery after NEC in preterm infants. METHODS We measured intestinal tissue oxygen saturation (rintSO2) and collected urinary intestinal-fatty acid binding protein (I-FABPu) levels 0-24 h and 24-48 h after NEC onset, and before and after the first re-feed. We assessed intestinal recovery in two ways: time to full enteral feeding (FEFt; below or equal/above group's median) and development of post-NEC complications (recurrent NEC/post-NEC stricture). We determined whether the rintSO2, its range, and I-FABPu differed between groups. RESULTS We included 27 preterm infants who survived NEC (Bell's stage ≥ 2). Median FEFt was 14 [IQR: 12-23] days. Biomarkers only predicted intestinal recovery after the first re-feed. Mean rintSO2 ≥ 53% combined with mean rintSO2range ≥ 50% predicted FEFt < 14 days with OR 16.7 (CI: 2.3-122.2). The rintSO2range was smaller (33% vs. 51%, p < 0.01) and I-FABPu was higher (92.4 vs. 25.5 ng/mL, p = 0.03) in case of post-NEC stricture, but not different in case of recurrent NEC, compared with infants without complications. CONCLUSION The rintSO2, its range, and I-FABPu after the first re-feed after NEC predicted intestinal recovery. These biomarkers have potential value in individualizing feeding regimens after NEC.
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Claffey P, Pérez-Denia L, Rivasi G, Finucane C, Kenny RA. Near-infrared spectroscopy in evaluating psychogenic pseudosyncope-a novel diagnostic approach. QJM 2020; 113:239-244. [PMID: 31596496 DOI: 10.1093/qjmed/hcz257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/11/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Psychogenic pseudosyncope (PPS), a conversion disorder and syncope mimic, accounts for a large proportion of 'unexplained syncope'. PPS is diagnosed by reproduction of patients' symptoms during head-up tilt (HUT). Electroencephalogram (EEG), a time consuming and resource intensive technology, is used during HUT to demonstrate absence of cerebral hypoperfusion during transient loss of consciousness (TLOC). Near-infrared spectroscopy (NIRS) is a simple, non-invasive technology for continuous monitoring of cerebral perfusion. We present a series of patients for whom PPS diagnosis was supported by NIRS during HUT. METHODS Eight consecutive patients with suspected PPS referred to a syncope unit underwent evaluation. During HUT, continuous beat-to-beat blood pressure (BP), heart rate (HR) and NIRS-derived tissue saturation index (TSI) were measured. BP, HR and TSI at baseline, time of first symptom, presyncope and apparent TLOC were measured. Patients were given feedback and followed for symptom recurrence. RESULTS Eight predominantly female patients (6/8, 75%) aged 31 years (16-54) were studied with (5/8, 63%) having comorbid psychiatric diagnoses, and (5/8, 63%) presenting with frequent episodes of prolonged TLOC with eyes closed (6/8, 75%). All patients experienced reproduction of typical events during HUT. Systolic BP (mmHg) increased from baseline (129.7 (interquartile range [IQR] 124.9-133.4)) at TLOC (153.0 (IQR 146.7-159.0)) (P-value = 0.012). HR (bpm) increased from baseline 78 (IQR 68.6-90.0) to 115.7 (IQR 93.5-127.9) (P-value = 0.012). TSI (%) remained stable throughout, 71.4 (IQR 67.5-72.9) at baseline vs. 71.0 (IQR 68.2-73.0) at TLOC (P-value = 0.484). CONCLUSIONS NIRS provides a non-invasive surrogate of cerebral perfusion during HUT. We propose HUT incorporating NIRS monitoring in the diagnostic algorithm for patients with suspected PPS.
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Affiliation(s)
- P Claffey
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- Falls and Syncope Unit, Dublin, Ireland
| | - L Pérez-Denia
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- Falls and Syncope Unit, Dublin, Ireland
- Department of Medical Physics and Bioengineering, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - G Rivasi
- Syncope Unit, Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - C Finucane
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- Falls and Syncope Unit, Dublin, Ireland
- Department of Medical Physics and Bioengineering, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - R A Kenny
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- Falls and Syncope Unit, Dublin, Ireland
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Semrau JS, Scott SH, Hamilton AG, Petsikas D, Payne DM, Bisleri G, Saha T, Boyd JG. Quantified pre-operative neurological dysfunction predicts outcome after coronary artery bypass surgery. Aging Clin Exp Res 2020; 32:289-297. [PMID: 30963519 DOI: 10.1007/s40520-019-01184-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/26/2019] [Indexed: 11/29/2022]
Abstract
AIMS Patients undergoing coronary artery bypass grafting (CABG) surgery may experience neurological impairment. We examined whether intraoperative regional cerebral oxygen saturation (rSO2) and neurological dysfunction prior to surgery, measured by robotic technology, are important predictors of post-operative performance following CABG surgery. METHODS Adult patients undergoing CABG surgery were recruited for this single-center prospective observational study. Intraoperative rSO2 was captured using the FORESIGHT cerebral oximeter. Neurological assessment was performed pre-operatively and 3 months following surgery using robotic technology and a standardized pen-and-paper assessment. Linear regression models were generated to determine the predictive ability of both intraoperative rSO2 and pre-operative performance on post-operative neurological outcome. RESULTS Forty patients had complete data available for analysis. Quantified pre-operative performance accounted for a significantly larger amount of variance in post-operative outcome compared to intraoperative rSO2. In particular, pre-operative scoring on a cognitive visuospatial task accounted for 82.2% of variance in post-operative performance (b = 0.937, t(37) = 12.98, p = 1.28e-5). DISCUSSION Our results suggest that pre-operative performance is a stronger indicator of post-operative neurological outcome than intraoperative rSO2, and should be included as an important variable when elucidating the relationship between cerebral oxygen levels and post-operative neurological impairment. Rigorous neurological assessment prior to surgery can provide valuable information about each individual patient's path to recovery. CONCLUSION Using robotic technology, quantified neurological impairment prior to CABG surgery may better predict post-operative neurological outcomes, compared to intraoperative rSO2 values.
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Affiliation(s)
- Joanna S Semrau
- Centre for Neuroscience Studies, Queen's University, 99 University Ave, Kingston, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, 99 University Ave, Kingston, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, 99 University Ave, Kingston, Canada
| | - Andrew G Hamilton
- Department of Surgery, Queen's University, 99 University Ave, Kingston, Canada
| | - Dimitri Petsikas
- Department of Surgery, Queen's University, 99 University Ave, Kingston, Canada
| | - Darrin M Payne
- Department of Surgery, Queen's University, 99 University Ave, Kingston, Canada
| | - Gianluigi Bisleri
- Department of Surgery, Queen's University, 99 University Ave, Kingston, Canada
| | - Tarit Saha
- Department of Anesthesiology and Perioperative Medicine, Queen's University, 99 University Ave, Kingston, Canada
| | - J Gordon Boyd
- Centre for Neuroscience Studies, Queen's University, 99 University Ave, Kingston, Canada.
- Department of Medicine (Neurology), Queen's University, 99 University Ave, Kingston, Canada.
- Department of Critical Care Medicine, Kingston Health Sciences Centre, Davies 2, 76 Stuart St., Kingston, ON, K7L 3C9, Canada.
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Harer MW, Chock VY. Renal Tissue Oxygenation Monitoring-An Opportunity to Improve Kidney Outcomes in the Vulnerable Neonatal Population. Front Pediatr 2020; 8:241. [PMID: 32528917 PMCID: PMC7247835 DOI: 10.3389/fped.2020.00241] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022] Open
Abstract
Adequate oxygenation of the kidney is of critical importance in the neonate. Non-invasive monitoring of renal tissue oxygenation using near-infrared spectroscopy (NIRS) is a promising bedside strategy for early detection of circulatory impairment as well as recognition of specific renal injury. As a diagnostic tool, renal NIRS monitoring may allow for earlier interventions to prevent or reduce injury in various clinical scenarios in the neonatal intensive care unit. Multiple studies utilizing NIRS monitoring in preterm and term infants have provided renal tissue oxygenation values at different time points during neonatal hospitalization, and have correlated measures with ultrasound and Doppler flow data. With the establishment of normal values, studies have utilized renal tissue oxygenation monitoring in preterm neonates to predict a hemodynamically significant patent ductus arteriosus, to assess response to potentially nephrotoxic medications, to identify infants with sepsis, and to describe changes after red blood cell transfusions. Other neonatal populations being investigated with renal NIRS monitoring include growth restricted infants, those requiring delivery room resuscitation, infants with congenital heart disease, and neonates undergoing extracorporeal membrane oxygenation. Furthermore, as the recognition of acute kidney injury (AKI) and its associated morbidity and mortality in neonates has increased over the last decade, alternative methods are being investigated to diagnose AKI before changes in serum creatinine or urine output occur. Studies have utilized renal NIRS monitoring to diagnose AKI in specific populations, including neonates with hypoxic ischemic encephalopathy after birth asphyxia and in infants after cardiac bypass surgery. The use of renal tissue oxygenation monitoring to improve renal outcomes has yet to be established, but results of studies published to date suggest that it holds significant promise to function as a real time, early indicator of poor renal perfusion that may help with development of specific treatment protocols to prevent or decrease the severity of AKI.
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Affiliation(s)
- Matthew W Harer
- Division of Neonatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Valerie Y Chock
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
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Kuik SJ, van Zoonen AGJF, Bos AF, Van Braeckel KNJA, Hulscher JBF, Kooi EMW. The effect of enteral bolus feeding on regional intestinal oxygen saturation in preterm infants is age-dependent: a longitudinal observational study. BMC Pediatr 2019; 19:404. [PMID: 31684920 PMCID: PMC6827212 DOI: 10.1186/s12887-019-1805-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/28/2019] [Indexed: 11/23/2022] Open
Abstract
Background The factors that determine the effect of enteral feeding on intestinal perfusion after preterm birth remain largely unknown. We aimed to determine the effect of enteral feeding on intestinal oxygen saturation (rintSO2) in preterm infants and evaluated whether this effect depended on postnatal age (PNA), postmenstrual age (PMA), and/or feeding volumes. We also evaluated whether changes in postprandial rintSO2 affected cerebral oxygen saturation (rcSO2). Methods In a longitudinal observational pilot study using near-infrared spectroscopy we measured rintSO2 and rcSO2 continuously for two hours on postnatal Days 2 to 5, 8, 15, 22, 29, and 36. We compared preprandial with postprandial values over time using multi-level analyses. To assess the effect of PNA, PMA, and feeding volumes, we performed Wilcoxon signed-rank tests or logistic regression analyses. To evaluate the effect on rcSO2, we also used logistic regression analyses. Results We included 29 infants: median (range) gestational age 28.1 weeks (25.1–30.7) and birth weight 1025 g (580–1495). On Day 5, rintSO2 values decreased postprandially: mean (SE) 44% (10) versus 35% (7), P = .01. On Day 29, rintSO2 values increased: 44% (11) versus 54% (7), P = .01. Infants with a PMA ≥ 32 weeks showed a rintSO2 increase after feeding (37% versus 51%, P = .04) whereas infants with a PMA < 32 weeks did not. Feeding volumes were associated with an increased postprandial rintSO2 (per 10 mL/kg: OR 1.63, 95% CI, 1.02–2.59). We did not find an effect on rcSO2 when rintSO2 increased postprandially. Conclusions Our study suggests that postprandial rintSO2 increases in preterm infants only from the fifth week after birth, particularly at PMA ≥ 32 weeks when greater volumes of enteral feeding are tolerated. We speculate that at young gestational and postmenstrual ages preterm infants are still unable to increase intestinal oxygen saturation after feeding, which might be essential to meet metabolic demands. Trial registration For this prospective longitudinal pilot study we derived patients from a larger observational cohort study: CALIFORNIA-Trial, Dutch Trial Registry NTR4153.
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Affiliation(s)
- Sara J Kuik
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands.
| | - Anne G J F van Zoonen
- University of Groningen, University Medical Center Groningen, Department of Surgery, Division of Pediatric Surgery, Groningen, the Netherlands
| | - Arend F Bos
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands
| | - Koenraad N J A Van Braeckel
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands
| | - Jan B F Hulscher
- University of Groningen, University Medical Center Groningen, Department of Surgery, Division of Pediatric Surgery, Groningen, the Netherlands
| | - Elisabeth M W Kooi
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands
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Wang L, Ayaz H, Izzetoglu M. Investigation of the source-detector separation in near infrared spectroscopy for healthy and clinical applications. JOURNAL OF BIOPHOTONICS 2019; 12:e201900175. [PMID: 31291506 DOI: 10.1002/jbio.201900175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 05/20/2023]
Abstract
Understanding near infrared light propagation in tissue is vital for designing next generation optical brain imaging devices. Monte Carlo (MC) simulations provide a controlled mechanism to characterize and evaluate contributions of diverse near infrared spectroscopy (NIRS) sensor configurations and parameters. In this study, we developed a multilayer adult digital head model under both healthy and clinical settings and assessed light-tissue interaction through MC simulations in terms of partial differential pathlength, mean total optical pathlength, diffuse reflectance, detector light intensity and spatial sensitivity profile of optical measurements. The model incorporated four layers: scalp, skull, cerebrospinal-fluid and cerebral cortex with and without a customizable lesion for modeling hematoma of different sizes and depths. The effect of source-detector separation (SDS) on optical measurements' sensitivity to brain tissue was investigated. Results from 1330 separate simulations [(4 lesion volumes × 4 lesion depths for clinical +3 healthy settings) × 7 SDS × 10 simulation = 1330)] each with 100 million photons indicated that selection of SDS is critical to acquire optimal measurements from the brain and recommended SDS to be 25 to 35 mm depending on the wavelengths to obtain optical monitoring of the adult brain function. The findings here can guide the design of future NIRS probes for functional neuroimaging and clinical diagnostic systems.
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Affiliation(s)
- Lei Wang
- Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, Pennsylvania
| | - Hasan Ayaz
- Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, Pennsylvania
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
- Children's Hospital of Philadelphia, Center for Injury Research and Prevention, Philadelphia, Pennsylvania
| | - Meltem Izzetoglu
- Villanova University, Electrical and Computer Engineering, Villanova, Pennsylvania
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Aktas S, Ergenekon E, Ozcan E, Aksu M, Unal S, Hirfanoglu IM, Turkyilmaz C, Onal E, Koc E, Atalay Y. Effects of blood transfusion on regional tissue oxygenation in preterm newborns are dependent on the degree of anaemia. J Paediatr Child Health 2019; 55:1209-1213. [PMID: 30632233 DOI: 10.1111/jpc.14378] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/30/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
Abstract
AIM Most of the preterm infants are transfused at least once during their stay in the neonatal intensive care unit (NICU). The aims of this study were to demonstrate if packed red blood cell (pRBC) transfusion modulates regional (cerebral, abdominal, renal) tissue oxygen saturation measured by near-infrared spectroscopy (NIRS) and to demonstrate if we can use NIRS to guide transfusion decisions in neonates. METHODS A multi-probe NIRS device was applied to anaemic preterm infants of gestational age <33 weeks for 30-60 min before and 24 h after pRBC transfusion. We evaluated the results separately in the subgroup with a pre-transfusion haemoglobin (Hb) < 8 g/dL. Cerebral, abdominal and renal tissue oxygen saturation (rSO2 ) and abdominal/cerebral, abdominal/renal and renal/cerebral rSO2 ratios before and 24 h after transfusion were compared. RESULTS There was no significant difference in cerebral rSO2 and abdominal/renal rSO2 ratios before and 24 h after transfusion, but abdominal and renal rSO2 and abdominal/cerebral and renal/cerebral rSO2 ratios at the 24th h following transfusion increased significantly. This increase was observed in the subgroup with pre-transfusion Hb < 8 g/dL. Although statistically significant, the increase in renal oxygenation was within the limits of variability. CONCLUSIONS The increase in tissue oxygenation in abdominal region after pRBC transfusion suggests decreased tissue oxygenation of intestines during severe anaemia despite cerebral oxygenation being maintained at that particular Hb level. The impact of the increase on renal oxygenation with pRBC transfusion is unclear and might need further investigation. Increase in abdominal rSO2 may cause reperfusion injury, oxidative damage and trigger necrotising enterocolitis.
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Affiliation(s)
- Selma Aktas
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Ebru Ergenekon
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Ebru Ozcan
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Meltem Aksu
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Sezin Unal
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Ibrahim M Hirfanoglu
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Canan Turkyilmaz
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Esra Onal
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Esin Koc
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Yildiz Atalay
- Department of Pediatrics, Division of Neonatology, Gazi University Hospital, Ankara, Turkey
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Weber F, Scoones GP. A practical approach to cerebral near-infrared spectroscopy (NIRS) directed hemodynamic management in noncardiac pediatric anesthesia. Paediatr Anaesth 2019; 29:993-1001. [PMID: 31437328 DOI: 10.1111/pan.13726] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/10/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
Abstract
Safeguarding cerebral function is of major importance during pediatric anesthesia. Premature, ex-premature, and full-term neonates can be vulnerable to physiological changes that occur during anesthesia and surgery. Data from studies performed during pediatric cardiac surgery and in neonatal/pediatric intensive care units have shown the benefits of near-infrared spectroscopy (NIRS) monitoring of regional cerebral oxygenation (c-rSO2 ). However, NIRS monitoring is seldom used during noncardiac pediatric anesthesia. Despite compelling evidence that blood pressure does not reflect end-organ perfusion, it is still regarded as the most important determinant of cerebral perfusion and the most relevant hemodynamic management target parameter by most (pediatric) anesthetists. The principle of NIRS monitoring is not self-explanatory and sometimes seems even counterintuitive, which may explain why many anesthesiologists are reserved regarding its use. The first part of this paper is dedicated to a clinical introduction to NIRS monitoring. Despite scientific efforts, it has not yet been possible to define individual lower limit c-rSO2 values and it is unlikely this will succeed in the near future. Nonetheless, published treatment algorithms usually specify c-rSO2 values which may be associated with cerebral hypoxia. Our treatment guideline for maintaining sufficient cerebral oxygenation differs fundamentally from all previously published approaches. We define a baseline c-rSO2 value, registered in the awake child prior to anesthesia induction, as the lowest acceptable limit during anesthesia and surgery. The cerebral rSO2 is the single target parameter, while blood pressure, heart rate, Pa CO2 , and SaO2 are major parameters that determine the c-rSO2. Cerebral NIRS monitoring, interpreted together with its continuously available contributing parameters, may help avoid potentially harmful episodes of cerebral desaturation in anesthetized pediatric patients.
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Affiliation(s)
- Frank Weber
- Department of Anesthesia, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Gail P Scoones
- Department of Anesthesia, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
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Regional tissue oxygenation monitoring in the neonatal intensive care unit: evidence for clinical strategies and future directions. Pediatr Res 2019; 86:296-304. [PMID: 31247635 DOI: 10.1038/s41390-019-0466-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/24/2019] [Accepted: 06/08/2019] [Indexed: 12/19/2022]
Abstract
Near-infrared spectroscopy (NIRS)-based monitoring of regional tissue oxygenation (rSO2) is becoming more commonplace in the neonatal intensive care unit (NICU). While increasing evidence supports rSO2 monitoring, actual standards for applying this noninvasive bedside technique continue to evolve. This review highlights the current strengths and pitfalls surrounding practical NIRS-based monitoring in the neonatal population. The physiologic background of rSO2 monitoring is discussed, with attention to understanding oxygen delivery/consumption mismatch and its effects on tissue oxygen extraction. The bedside utility of both cerebral and peripheral rSO2 monitoring in the NICU is then explored from two perspectives: (1) disease/event-specific "responsive" monitoring and (2) "routine," continuous monitoring. Recent evidence incorporating both monitoring approaches is summarized with emphasis on practical applicability in the NICU. Finally, a future paradigm for a broad-based NIRS monitoring strategy is presented, with attention towards improving personalization of neonatal care and ultimately enhancing long-term outcomes.
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