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Garcia Mancebo J, Sack K, Romfh P, Peng Y, Kheir J. Esophageal oxyhemoglobin saturation as a resuscitative metric in hemorrhagic shock. Trauma Surg Acute Care Open 2024; 9:e001480. [PMID: 39296600 PMCID: PMC11409389 DOI: 10.1136/tsaco-2024-001480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/09/2024] [Indexed: 09/21/2024] Open
Abstract
Background Mixed venous saturation (SvO2) is considered the gold standard to assess the adequacy of tissue oxygen delivery (DO2) in shock states. However, SvO2 monitoring is challenging as it requires an invasive catheter and frequent blood sampling. Non-invasive methods, including near-infrared spectroscopy, have demonstrated low sensitivity to tissue dysoxia. Methods We fabricated a new device that uses resonance Raman spectroscopy (RRS) to quantify oxyhemoglobin saturation (ShbO2) in the esophagus (eShbO2), tongue (tShbO2), and liver (hShbO2). In two rat models of hemorrhagic shock, we quantified (1) The correlation of RRS-measured ShbO2 to SvO2 during progressive hemorrhage (n=20) and (2) The value of these metrics to predict near-term mortality in fixed, severe hemorrhage (mean blood pressure =25 mm Hg; n=18). Results In model 1, eShbO2 (r=0.705, p<0.0001) and tShbO2 (r=0.724, p<0.0001) correlated well with SvO2 and with serum lactic acid (eShbO2-lactate r=0.708, p<0.0001; tShbO2-lactate r=0.830, p<0.0001). hShbO2 correlated poorly with both SvO2 and lactic acid. Using time-matched ShbO2-SvO2 pairs, the performance of ShbO2 to detect severe tissue hypoxia (SvO2<20%) was excellent (AUC 0.843 for eShbO2, 0.879 for tShbO2). In model 2, eShbO2 showed a maximized threshold of 40% with 83% of animals dying within 45 minutes of this cut-off, demonstrating accuracy as a monitoring device. This was similar for tShbO2, with a threshold of 50%, predicting death within 45 minutes in 76% of animals. ShbO2 showed superior sensitivity to invasive monitoring parameters, including MABP<30 mm Hg (sensitivity 59%), pulse pressure<15 mm Hg (sensitivity 50%), and heart rate>220 bpm (sensitivity 39%, p=0.004). Conclusions eShbO2 represents a new paradigm to assess the adequacy of DO2 to a tissue. It constitutes a promising monitoring method to evaluate tissue oxygen saturation in real time and non-invasively, correlating with SvO2 and time to death. Level of evidence Level III, therapeutic/care management.
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Affiliation(s)
- Julia Garcia Mancebo
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kristen Sack
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Yifeng Peng
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - John Kheir
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Kolnik SE, Marquard R, Brandon O, Puia-Dumitrescu M, Valentine G, Law JB, Natarajan N, Dighe M, Mourad PD, Wood TR, Mietzsch U. Preterm infants variability in cerebral near-infrared spectroscopy measurements in the first 72-h after birth. Pediatr Res 2023; 94:1408-1415. [PMID: 37138026 DOI: 10.1038/s41390-023-02618-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Cerebral near-infrared spectroscopy is a non-invasive tool used to measure regional cerebral tissue oxygenation (rScO2) initially validated in adult and pediatric populations. Preterm neonates, vulnerable to neurologic injury, are attractive candidates for NIRS monitoring; however, normative data and the brain regions measured by the current technology have not yet been established for this population. METHODS This study's aim was to analyze continuous rScO2 readings within the first 6-72 h after birth in 60 neonates without intracerebral hemorrhage born at ≤1250 g and/or ≤30 weeks' gestational age (GA) to better understand the role of head circumference (HC) and brain regions measured. RESULTS Using a standardized brain MRI atlas, we determined that rScO2 in infants with smaller HCs likely measures the ventricular spaces. GA is linearly correlated, and HC is non-linearly correlated, with rScO2 readings. For HC, we infer that rScO2 is lower in infants with smaller HCs due to measuring the ventricular spaces, with values increasing in the smallest HCs as the deep cerebral structures are reached. CONCLUSION Clinicians should be aware that in preterm infants with small HCs, rScO2 displayed may reflect readings from the ventricular spaces and deep cerebral tissue. IMPACT Clinicians should be aware that in preterm infants with small head circumferences, cerebral near-infrared spectroscopy readings of rScO2 displayed may reflect readings from the ventricular spaces and deep cerebral tissue. This highlights the importance of rigorously re-validating technologies before extrapolating them to different populations. Standard rScO2 trajectories should only be established after determining whether the mathematical models used in NIRS equipment are appropriate in premature infants and the brain region(s) NIRS sensors captures in this population, including the influence of both gestational age and head circumference.
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Affiliation(s)
- Sarah E Kolnik
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA.
| | | | - Olivia Brandon
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
| | - Mihai Puia-Dumitrescu
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
| | - Gregory Valentine
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
| | - Janessa B Law
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
| | - Niranjana Natarajan
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
- Department of Neurology, Division of Child Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Pierre D Mourad
- Division of Engineering and Mathematics, School of STEM, University of Washington, Bothell, WA, USA
- Department of Neurological Surgery, School of Medicine, University of Washington, Seattle, WA, USA
| | - Thomas R Wood
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ulrike Mietzsch
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
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Skrifvars MB, Ameloot K, Åneman A. Blood pressure targets and management during post-cardiac arrest care. Resuscitation 2023; 189:109886. [PMID: 37380065 DOI: 10.1016/j.resuscitation.2023.109886] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023]
Abstract
Blood pressure is one modifiable physiological target in patients treated in the intensive care unit after cardiac arrest. Current Guidelines recommend targeting a mean arterial pressure (MAP) of higher than 65-70 mmHg using fluid resuscitation and the use of vasopressors. Management strategies will vary based in the setting, i.e. the pre-hospital compared to the in-hospital phase. Epidemiological data suggest that some degree of hypotension requiring vasopressors occur in almost 50% of patients. A higher MAP could theoretically increase coronary blood flow but on the other hand the use of vasopressor may result in an increase in cardiac oxygen demand and arrhythmia. An adequate MAP is paramount for maintaining cerebral blood flow. In some cardiac arrest patients the cerebral autoregulation may be disturbed resulting in the need for higher MAP in order to avoid decreasing cerebral blood flow. Thus far, four studies including little more than 1000 patients have compared a lower and higher MAP target in cardiac arrest patients. The achieved mean difference of MAP between groups has varied from 10-15 mmHg. Based on these studies a Bayesian meta-analysis suggests that the posterior probability that a future study would find treatment effects higher than a 5% difference between groups to be less than 50%. On the other hand, this analysis also suggests, that the likelihood of harm with a higher MAP target is also low. Noteworthy is that all studies to date have focused mainly on patients with a cardiac cause of the arrest with the majority of patients being resuscitated from a shockable initial rhythm. Future studies should aim to include also non-cardiac causes and aim to target a wider separation in MAP between groups.
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Affiliation(s)
- Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Finland, Meilahden Sairaala, Haartmaninkatu 9, 00029 HUS, Finland.
| | - Koen Ameloot
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Anders Åneman
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Australia
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Vitt JR, Loper NE, Mainali S. Multimodal and autoregulation monitoring in the neurointensive care unit. Front Neurol 2023; 14:1155986. [PMID: 37153655 PMCID: PMC10157267 DOI: 10.3389/fneur.2023.1155986] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023] Open
Abstract
Given the complexity of cerebral pathology in patients with acute brain injury, various neuromonitoring strategies have been developed to better appreciate physiologic relationships and potentially harmful derangements. There is ample evidence that bundling several neuromonitoring devices, termed "multimodal monitoring," is more beneficial compared to monitoring individual parameters as each may capture different and complementary aspects of cerebral physiology to provide a comprehensive picture that can help guide management. Furthermore, each modality has specific strengths and limitations that depend largely on spatiotemporal characteristics and complexity of the signal acquired. In this review we focus on the common clinical neuromonitoring techniques including intracranial pressure, brain tissue oxygenation, transcranial doppler and near-infrared spectroscopy with a focus on how each modality can also provide useful information about cerebral autoregulation capacity. Finally, we discuss the current evidence in using these modalities to support clinical decision making as well as potential insights into the future of advanced cerebral homeostatic assessments including neurovascular coupling.
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Affiliation(s)
- Jeffrey R. Vitt
- Department of Neurological Surgery, UC Davis Medical Center, Sacramento, CA, United States
- Department of Neurology, UC Davis Medical Center, Sacramento, CA, United States
| | - Nicholas E. Loper
- Department of Neurological Surgery, UC Davis Medical Center, Sacramento, CA, United States
| | - Shraddha Mainali
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
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Son AY, Karim AS, Joung RHS, McGregor R, Wu T, Andrei AC, Pawale A, Ho KJ, Pham DT. Ankle-brachial index to monitor limb perfusion in patients with femoral venoarterial extracorporeal membrane oxygenation. J Card Surg 2021; 36:3119-3125. [PMID: 34155679 DOI: 10.1111/jocs.15757] [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: 04/02/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Limb ischemia is a major complication of femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO). Use of ankle-brachial index (ABI) to monitor limb perfusion in VA-ECMO has not been described. We report our experience monitoring femoral VA-ECMO patients with serial ABI and the relationships between ABI and near infrared spectroscopy (NIRS). METHODS This is a retrospective single-center review of consecutive adult patients placed on femoral VA-ECMO between January 2019 and October 2019. Data were collected on patients with paired ABI and NIRS values. Relationships between NIRS and ABI of the cannulated (E-NIRS and E-ABI) and non-cannulated legs (N-NIRS and N-ABI) along with the difference between legs (d-NIRS and d-ABI) were determined using Pearson correlation. RESULTS Overall, 22 patients (mean age 56.5 ± 14.0 years, 72.7% male) were assessed with 295 E-ABI and E-NIRS measurements, and 273 N-ABI and N-NIRS measurements. Mean duration of ECMO support was 129.8 ± 78.3 h. ECMO-mortality was 13.6% and in-hospital mortality was 45.5%. N-ABI and N-NIRS were significantly higher than their ECMO counterparts (ABI mean difference 0.16, 95% confidence interval [CI]: 0.13-0.19, p < .0001; NIRS mean difference 2.51, 95% CI: 1.48-3.54, p < .0001). There was no correlation between E-ABI versus E-NIRS (r = .032, p = .59), N-ABI versus N-NIRS (r = .097, p = .11), or d-NIRS versus d-ABI (r = .11, p = .069). CONCLUSION ABI is a quantitative metric that may be used to monitor limb perfusion and supplement clinical exams to identify limb ischemia in femorally cannulated VA-ECMO patients. More studies are needed to characterize the significance of ABI in femoral VA-ECMO and its value in identifying limb ischemia in this patient population.
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Affiliation(s)
- Andre Y Son
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Azad S Karim
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachel Hae-Soo Joung
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Randy McGregor
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tingqing Wu
- Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Adin-Cristian Andrei
- Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amit Pawale
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Karen J Ho
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Duc Thinh Pham
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Dar IA, Khan IR, Maddox RK, Selioutski O, Donohue KL, Marinescu MA, Prasad SM, Quazi NH, Donlon JS, Loose EA, Ramirez GA, Ren J, Majeski JB, Abramson K, Durduran T, Busch DR, Choe R. Towards detection of brain injury using multimodal non-invasive neuromonitoring in adults undergoing extracorporeal membrane oxygenation. BIOMEDICAL OPTICS EXPRESS 2020; 11:6551-6569. [PMID: 33282508 PMCID: PMC7687959 DOI: 10.1364/boe.401641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/16/2020] [Accepted: 10/02/2020] [Indexed: 05/27/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is a form of cardiopulmonary bypass that provides life-saving support to critically ill patients whose illness is progressing despite maximal conventional support. Use in adults is expanding, however neurological injuries are common. Currently, the existing brain imaging tools are a snapshot in time and require high-risk patient transport. Here we assess the feasibility of measuring diffuse correlation spectroscopy, transcranial Doppler ultrasound, electroencephalography, and auditory brainstem responses at the bedside, and developing a cerebral autoregulation metric. We report preliminary results from two patients, demonstrating feasibility and laying the foundation for future studies monitoring neurological health during ECMO.
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Affiliation(s)
- Irfaan A. Dar
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14620, USA
| | - Imad R. Khan
- Department of Neurology, Division of Neurocritical Care, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Ross K. Maddox
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14620, USA
- Department of Neuroscience, University of Rochester, Rochester, New York 14620, USA
| | - Olga Selioutski
- Department of Neurology, Division of Epilepsy, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Kelly L. Donohue
- Department of Neurology, Division of Neurocritical Care, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Mark A. Marinescu
- Department of Medicine, Division of Cardiology, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Sunil M. Prasad
- Department of Surgery, Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Nadim H. Quazi
- Department of Biology, University of Rochester, Rochester, New York 14620, USA
| | - Jack S. Donlon
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14620, USA
| | - Emily A. Loose
- Department of Biology, University of Rochester, Rochester, New York 14620, USA
| | - Gabriel A. Ramirez
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14620, USA
| | - Jingxuan Ren
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14620, USA
| | - Joseph B. Majeski
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14620, USA
| | - Kenneth Abramson
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), 08860, Spain
- Instituciò Catalana de Recerca i Estudis Avançats (ICREA), Castelldefels (Barcelona), 08015, Spain
| | - David R. Busch
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Regine Choe
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14620, USA
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York 14620, USA
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Transcutaneous carbon dioxide measurements in fruits, vegetables and humans: A prospective observational study. Eur J Anaesthesiol 2020; 36:904-910. [PMID: 31464713 DOI: 10.1097/eja.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transcutaneous carbon dioxide measurement (TcCO2) is frequently used as a surrogate for arterial blood gas sampling in adults and children with critical illness. Data from noninvasive TcCO2 monitoring assists with clinical decisions regarding mechanical ventilation settings, estimation of metabolic consumption and determination of adequate end-organ tissue perfusion. OBJECTIVES To report TcCO2 values obtained from various fruits, vegetables and elite critical care medicine specialists. DESIGN Prospective, observational, nonblinded cohort study. SETTINGS Single-centre, tertiary paediatric referral centre and organic farmers' market. PARTICIPANTS Vegetables and fruits included 10 samples of each of the following: red delicious apple (Malus domestica), manzano banana (Musa sapientum), key lime (Citrus aurantiifolia), miniature sweet bell pepper (Capsicum annuum), sweet potato (Ipomoea batatas) and avocado (Persea americana). Ten human controls were studied including a paediatric intensivist, a paediatric inpatient hospital physician, four paediatric resident physicians and four paediatric critical care nurses. INTERVENTIONS None. MAIN OUTCOME MEASURES TcCO2 values for each species and device response times. RESULTS TcCO2 readings were measurable in all study species except the sweet potato. Mean ± SD values of TcCO2 for human controls [4.34 ± 0.37 kPa (32.6 ± 2.8 mmHg)] were greater than apples [3.09 ± 0.19 kPa (23.2 ± 1.4 mmHg), P < 0.01], bananas [2.73 ± 0.28 kPa (20.5 ± 2.1 mmHg), P < 0.01] and limes [2.76 ± 0.52 kPa (20.7 ± 3.9 mmHg), P < 0.01] but no different to those of avocados [4.29 ± 0.44 kPa (32.2 ± 3.3 mmHg), P = 0.77] and bell peppers [4.19 ± 1.13 kPa (31.4 ± 8.5 mmHg), P = 0.68]. Transcutaneous response times did not differ between research cohorts and human controls. CONCLUSION We found nonroot, nontuberous vegetables to have TcCO2 values similar to that of healthy, human controls. Fruits yield TcCO2 readings, but substantially lower than human controls.
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Shaaban-Ali M, Momeni M, Denault A. Clinical and Technical Limitations of Cerebral and Somatic Near-Infrared Spectroscopy as an Oxygenation Monitor. J Cardiothorac Vasc Anesth 2020; 35:763-779. [PMID: 32709385 DOI: 10.1053/j.jvca.2020.04.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/12/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022]
Abstract
Cerebral and somatic near-infrared spectroscopy monitors are commonly used to detect tissue oxygenation in various circumstances. This form of monitoring is based on tissue infrared absorption and can be influenced by several physiological and non-physiological factors that can induce error in the interpretation. This narrative review explores those clinical and technical limitations and proposes solutions and alternatives in order to avoid some of those pitfalls.
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Affiliation(s)
- Mohamed Shaaban-Ali
- Department of Anesthesia, College of Medicine, Assiut University, Assiut, Egypt
| | - Mona Momeni
- Department of Acute Medicine, Section Cardiothoracic and Vascular Anesthesia, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
| | - André Denault
- Department of Anesthesia and Critical Care Medicine, Montreal Heart Institute, Université de Montréal, and Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
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10
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Donnelly P, Fine-Goulden MR. How to use near-infrared spectroscopy. Arch Dis Child Educ Pract Ed 2020; 105:58-63. [PMID: 31186270 DOI: 10.1136/archdischild-2018-315532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Peter Donnelly
- Paediatric Intensive Care Unit, Belfast Children's Hospital, Belfast, UK
| | - Miriam R Fine-Goulden
- Paediatric Intensive Care, Evelina Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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Skrifvars MB, Aneman A. How near is near infrared spectroscopy in pre-hospital care? Acta Anaesthesiol Scand 2020; 64:2-3. [PMID: 31502252 DOI: 10.1111/aas.13467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Anesthesiology, Intensive Care and Paine Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anders Aneman
- Intensive Care Unit, Liverpool Hospital, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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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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Reply to: foundation and clinical exigency of cerebral oximetry. Eur J Anaesthesiol 2019; 36:376-377. [PMID: 30946172 DOI: 10.1097/eja.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Argüelles-Delgado PM, Dworschak M. Near-infrared spectroscopy: A measurement tool for 'vegetables'? Eur J Anaesthesiol 2019; 36:469. [PMID: 31045703 DOI: 10.1097/eja.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Placido M Argüelles-Delgado
- From the Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz and Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
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Heschl S, Bruchelt W, Binder-Heschl C, Urlesberger B. Near-infrared spectroscopy measures extinction of light by chromophores. Eur J Anaesthesiol 2019; 36:468-469. [PMID: 31045702 DOI: 10.1097/eja.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Stefan Heschl
- From the Section for Paediatric Anaesthesia, Department of Anaesthesiology and Intensive Care Medicine (SH, WB) and Division of Neonatology, Department of Paediatrics, Medical University of Graz, Graz, Austria (CB-H, BU)
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Kornilov E, Orbach-Zinger S, Hoshen M, Weiniger C, Fein S, Fireman S, Firman S, Aviram A, Eidelman L. A prospective observational study of the change in regional cerebral oxygen saturation during cesarean delivery in women receiving phenylephrine prophylaxis for spinal hypotension. Int J Obstet Anesth 2019; 37:29-35. [DOI: 10.1016/j.ijoa.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/02/2018] [Accepted: 09/12/2018] [Indexed: 11/28/2022]
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Rao R, Karamlou T. Smart food…vegetables may be smarter than we think: A word about multisite near-infrared spectroscopy. J Thorac Cardiovasc Surg 2018; 156:2258-2259. [PMID: 30266392 DOI: 10.1016/j.jtcvs.2018.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Rohit Rao
- Division of Cardiology, Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, Calif.
| | - Tara Karamlou
- Division of Pediatric Cardiac Surgery, Department of Surgery, Western Regional Medical Center and Rady Children's Hospital, San Diego, Calif
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