1
|
Nell HJ, Castelli LM, Bertani D, Jipson AA, Meagher SF, Melo LT, Zabjek K, Reid WD. The effects of hypoxia on muscle deoxygenation and recruitment in the flexor digitorum superficialis during submaximal intermittent handgrip exercise. BMC Sports Sci Med Rehabil 2020; 12:16. [PMID: 32467763 PMCID: PMC7226965 DOI: 10.1186/s13102-020-00163-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/20/2020] [Indexed: 12/02/2022]
Abstract
Background Decreased oxygenation of muscle may be accentuated during exercise at high altitude. Monitoring the oxygen saturation of muscle (SmO2) during hand grip exercise using near infrared spectroscopy during acute exposure to hypoxia could provide a model for a test of muscle performance without the competing cardiovascular stresses that occur during a cycle ergometer or treadmill test. The purpose of this study was to examine and compare acute exposure to normobaric hypoxia versus normoxia on deoxygenation and recruitment of the flexor digitorum superficialis (FDS) during submaximal intermittent handgrip exercise (HGE) in healthy adults. Methods Twenty subjects (11 M/9 F) performed HGE at 50% of maximum voluntary contraction, with a duty cycle of 2 s:1 s until task failure on two occasions one week apart, randomly assigned to normobaric hypoxia (FiO2 = 12%) or normoxia (FiO2 = 21%). Near-infrared spectroscopy monitored SmO2, oxygenated (O2Hb), deoxygenated (HHb), and total hemoglobin (tHb) over the FDS. Surface electromyography derived root mean square and mean power frequency of the FDS. Results Hypoxic compared to normoxic HGE induced a lower FDS SmO2 (63.8 ± 2.2 vs. 69.0 ± 1.5, p = 0.001) and both protocols decreased FDS SmO2 from baseline to task failure. FDS mean power frequency was lower during hypoxic compared to normoxic HGE (64.0 ± 1.4 vs. 68.2 ± 2.0 Hz, p = 0.04) and both decreased mean power frequency from the first contractions to task failure (p = 0.000). Under both hypoxia and normoxia, HHb, tHb and root mean square increased from baseline to task failure whereas O2Hb decreased and then increased during HGE. Arterial oxygen saturation via pulse oximetry (SpO2) was lower during hypoxia compared to normoxia conditions (p = 0.000) and heart rate and diastolic blood pressure only demonstrated small increases. Task durations and the tension-time index of HGE did not differ between normoxic and hypoxic trials. Conclusion Hypoxic compared to normoxic HGE decreased SmO2 and induced lower mean power frequency in the FDS, during repetitive hand grip exercise however did not result in differences in task durations or tension-time indices. The fiber type composition of FDS, and high duty cycle and intensity may have contributed greater dependence on anaerobiosis.
Collapse
Affiliation(s)
- Hayley J Nell
- 1Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7 Canada
| | - Laura M Castelli
- 1Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7 Canada
| | - Dino Bertani
- 1Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7 Canada
| | - Aaron A Jipson
- 1Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7 Canada
| | - Sean F Meagher
- 1Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7 Canada
| | - Luana T Melo
- 1Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7 Canada
| | - Karl Zabjek
- 1Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7 Canada.,2KITE, Toronto Rehab-University Health Network, 550 University Ave, Toronto, ON M5G 2A2 Canada
| | - W Darlene Reid
- 1Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7 Canada.,2KITE, Toronto Rehab-University Health Network, 550 University Ave, Toronto, ON M5G 2A2 Canada.,3Interdepartmental Division of Critical Care Medicine, University of Toronto, Li Ka Shing Knowledge Institute, 209 Victoria Street, 4th Floor, Room 411, Toronto, ON M5B 1T8 Canada
| |
Collapse
|
2
|
Abstract
The optical method to determine oxygen saturation in blood is limited to only tissues that can be transilluminated. The status quo provides a single-point measurement and lacks 2D oxygenation mapping capability. We use organic printed optoelectronics in a flexible array configuration that senses reflected light from tissue. Our reflectance oximeter is used beyond conventional sensing locations and accurately measures oxygen saturation on the forehead. In a full system implementation, coupled with a mathematical model, we create 2D oxygenation maps of adult forearms under pressure-cuff–induced ischemia. Our skin-like flexible sensor system has the potential to transform oxygenation monitoring of tissues, wounds, skin grafts, and transplanted organs. Transmission-mode pulse oximetry, the optical method for determining oxygen saturation in blood, is limited to only tissues that can be transilluminated, such as the earlobes and the fingers. The existing sensor configuration provides only single-point measurements, lacking 2D oxygenation mapping capability. Here, we demonstrate a flexible and printed sensor array composed of organic light-emitting diodes and organic photodiodes, which senses reflected light from tissue to determine the oxygen saturation. We use the reflectance oximeter array beyond the conventional sensing locations. The sensor is implemented to measure oxygen saturation on the forehead with 1.1% mean error and to create 2D oxygenation maps of adult forearms under pressure-cuff–induced ischemia. In addition, we present mathematical models to determine oxygenation in the presence and absence of a pulsatile arterial blood signal. The mechanical flexibility, 2D oxygenation mapping capability, and the ability to place the sensor in various locations make the reflectance oximeter array promising for medical sensing applications such as monitoring of real-time chronic medical conditions as well as postsurgery recovery management of tissues, organs, and wounds.
Collapse
|
3
|
Abstract
BACKGROUND Fewer than half of individuals with peripheral artery disease (PAD) experience classic claudication, and the relationships between PAD typical or atypical symptom intensity, location, and description (classic or atypical) with ischemic changes have not previously been reported. OBJECTIVE The primary purpose of this study was to evaluate the relationship between self-reported PAD symptom intensity and calf tissue ischemia measured using the tissue saturation index (TSI) during treadmill exercise. The location and descriptors of atypical PAD symptoms in the presence of calf tissue ischemia were also identified. METHODS Adults with PAD with exercise-limiting ischemic symptoms were asked to (a) rate symptom intensity using a numerical rating scale (NRS) from 0 to 5 (0 = no pain, 1 = onset of pain, 5 = maximal pain), (b) provide symptom locations and descriptors, and (c) wear a near-infrared spectroscopy device to obtain calf TSI values during treadmill exercise. Multilevel models with TSI as the outcome variable were estimated during exercise and recovery. Covariates included were exercise time, recovery time, baseline TSI, exercise rating, recovery rating, ankle-brachial index (ABI), age, race, gender, body mass index, diabetes, neuropathy, and smoking. RESULTS During three successive bouts of treadmill exercise for 40 participants (80% Caucasian men; average age = 68 years, SD = 9.2), the most rapid decline in TSI occurred between the start of exercise and symptom onset (when NRS = 1). The TSI nadir was often reached prior to report of maximum discomfort (when NRS = 5), and changes in TSI were related to exercise time (p < .001), baseline TSI (p < .001), exercise ratings (p < .001), and ABI (p < .05). During recovery, TSI increased steadily for most participants as pain eased. In the recovery model, changes in TSI were associated with recovery ratings (p < .001) and ABI (p < .03). Of 120 treadmill exercise tests, 69.2% were stopped due to discomfort in the calf with classic descriptors reported only half the time (55.4%). DISCUSSION Exploratory analyses revealed ischemic symptoms extended beyond classic claudication locations and descriptors. Future research should evaluate changes in TSI relative to atypical locations and descriptors to improve understanding of the full range of ischemic symptoms experienced by individuals with PAD.
Collapse
|
4
|
Patients with myogenic temporomandibular disorders have reduced oxygen extraction in the masseter muscle. Clin Oral Investig 2016; 21:1509-1518. [DOI: 10.1007/s00784-016-1912-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
|
5
|
Duret J, Pottecher J, Bouzat P, Brun J, Harrois A, Payen JF, Duranteau J. Skeletal muscle oxygenation in severe trauma patients during haemorrhagic shock resuscitation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:141. [PMID: 25882441 PMCID: PMC4391580 DOI: 10.1186/s13054-015-0854-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 03/03/2015] [Indexed: 02/07/2023]
Abstract
Introduction Early alterations in tissue oxygenation may worsen patient outcome following traumatic haemorrhagic shock. We hypothesized that muscle oxygenation measured using near-infrared spectroscopy (NIRS) on admission could be associated with subsequent change in the SOFA score after resuscitation. Methods The study was conducted in two Level I trauma centres and included 54 consecutive trauma patients with haemorrhagic shock, presenting within 6 hours of injury. Baseline tissue haemoglobin oxygen saturation (StO2) in the thenar eminence muscle and StO2 changes during a vascular occlusion test (VOT) were determined at 6 hours (H6) and 72 hours (H72) after the admission to the emergency room. Patients showing an improved SOFA score at H72 (SOFA improvers) were compared to those for whom it was unchanged or worse (SOFA non-improvers). Results Of the 54 patients, 34 patients were SOFA improvers and 20 SOFA non-improvers. They had comparable injury severity scores on admission. SOFA improvers had higher baseline StO2 values and a steeper StO2 desaturation slope at H6 compared to the SOFA non-improvers. These StO2 variables similarly correlated with the intra-hospital mortality. The StO2 reperfusion slope at H6 was similar between the two groups of patients. Conclusions Differences in StO2 parameters on admission of traumatic haemorrhagic shock were found between patients who had an improvement in organ failure in the first 72 hours and those who had unchanged or worse conditions. The use of NIRS to guide the initial management of trauma patients with haemorrhagic shock warrants further investigations.
Collapse
Affiliation(s)
- Jerome Duret
- Pole Anesthésie-Réanimation, Hôpital Michallon, Boulevard de la Chantourne, Grenoble, F-38043, France.
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Pôle Anesthésie Réanimation Chirurgicale SAMU, Hôpital de Hautepierre, Service d'Anesthésie-Réanimation Chirurgicale, 1 avenue Molière, F-67098, Strasbourg, France. .,Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Institut de Physiologie, Equipe d'Accueil EA3072 "Mitochondrie, stress oxydant et protection musculaire", 11 rue Humann, F-67000, Strasbourg, France.
| | - Pierre Bouzat
- Pole Anesthésie-Réanimation, Hôpital Michallon, Boulevard de la Chantourne, Grenoble, F-38043, France. .,Université Joseph Fourier, Grenoble Institut des Neurosciences, 6 rue Jules Horowitz, Grenoble, F-38043, France. .,INSERM, U836, Chemin Fortuné Ferrini, Grenoble, F-38042, France.
| | - Julien Brun
- Pole Anesthésie-Réanimation, Hôpital Michallon, Boulevard de la Chantourne, Grenoble, F-38043, France.
| | - Anatole Harrois
- AP-HP, Service d' Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre, 78, rue du Général Leclerc, F-94275, Le Kremlin-Bicêtre, France. .,Laboratoire d'Etude de la Microcirculation, "Bio-CANVAS: Biomarqueurs in CardiaNeuroVascular Diseases" UMRS 942, 2 Rue Ambroise-Paré, 75010, Paris, France.
| | - Jean-Francois Payen
- Pole Anesthésie-Réanimation, Hôpital Michallon, Boulevard de la Chantourne, Grenoble, F-38043, France. .,Université Joseph Fourier, Grenoble Institut des Neurosciences, 6 rue Jules Horowitz, Grenoble, F-38043, France. .,INSERM, U836, Chemin Fortuné Ferrini, Grenoble, F-38042, France.
| | - Jacques Duranteau
- AP-HP, Service d' Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre, 78, rue du Général Leclerc, F-94275, Le Kremlin-Bicêtre, France. .,Laboratoire d'Etude de la Microcirculation, "Bio-CANVAS: Biomarqueurs in CardiaNeuroVascular Diseases" UMRS 942, 2 Rue Ambroise-Paré, 75010, Paris, France.
| |
Collapse
|
6
|
Abay TY, Kyriacou PA. Reflectance Photoplethysmography as Noninvasive Monitoring of Tissue Blood Perfusion. IEEE Trans Biomed Eng 2015; 62:2187-95. [PMID: 25838515 DOI: 10.1109/tbme.2015.2417863] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In the last decades, photoplethysmography (PPG) has been used as a noninvasive technique for monitoring arterial oxygen saturation by pulse oximetry (PO), whereas near-infrared spectroscopy (NIRS) has been employed for monitoring tissue blood perfusion. While NIRS offers more parameters to evaluate oxygen delivery and consumption in deep tissues, PO only assesses the state of oxygen delivery. For a broader assessment of blood perfusion, this paper explores the utilization of dual-wavelength PPG by using the pulsatile (ac) and continuous (dc) PPG for the estimation of arterial oxygen saturation (SpO2) by conventional PO. Additionally, the Beer-Lambert law is applied to the dc components only for the estimation of changes in deoxyhemoglobin (HHb), oxyhemoglobin (HbO2), and total hemoglobin (tHb) as in NIRS. The system was evaluated on the forearm of 21 healthy volunteers during induction of venous occlusion (VO) and total occlusion (TO). A reflectance PPG probe and NIRS sensor were applied above the brachioradialis, PO sensors were applied on the fingers, and all the signals were acquired simultaneously. While NIRS and forearm SpO2 indicated VO, SpO2 from the finger did not exhibit any significant drop from baseline. During TO, all the indexes indicated the change in blood perfusion. HHb, HbO2, and tHb changes estimated by PPG presented high correlation with the same parameters obtained by NIRS during VO (r(2) = 0.960, r(2) = 0.821, and r(2) = 0.974, respectively) and during TO (r(2) = 0.988, r(2) = 0.940, and r(2) = 0.938, respectively). The system demonstrated the ability to extract valuable information from PPG signals for a broader assessment of tissue blood perfusion.
Collapse
|
7
|
Prospective evaluation of regional oxygen saturation to estimate central venous saturation in sepsis. J Clin Monit Comput 2015; 29:443-53. [PMID: 25757404 DOI: 10.1007/s10877-015-9683-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/27/2015] [Indexed: 01/01/2023]
Abstract
Current treatment guidelines for sepsis claim an early goal-directed hemodynamic optimization including fluid resuscitation, use of vasopressors and inotropic agents. We investigated the correlation between the prominent treatment goal central venous saturation (ScvO2) and the frontal and the thenar regional oxygen saturation (rSO2) measured by near infrared spectroscopy. Secondary, we examined the value of ScvO2, lactate levels and rSO2 as surrogate markers of an impaired tissue oxygenation for outcome prediction in sepsis. This prospective, observational study was performed at the surgical intensive care unit of the University Hospital Giessen. A total of 50 patients with sepsis, severe sepsis or septic shock were included. ScvO2, rSO2 and lactate were measured at sepsis diagnosis (baseline), 24 and 48 h, thereafter. We investigated the predictive value of frontal and thenar rSO2 for a decreased SvcO2 under 70%. For survivor and non-survivors ScvO2, rSO2 and lactate were analysed. Patients with ScvO2 >70% showed a trend to higher levels of fontal rSO2 (62.81 ± 8.06 vs. 53.54 ± 15.48; p = 0.058). ROC-analysis revealed a minor prediction of a decreased ScvO2 by frontal rSO2 levels at baseline (AUC = 0.687; 95% CI 0.511-0.863; p = 0.047). Combined measurements of lactate and ScvO2 showed significantly elevated mortality for patients with ScvO2 ≥70% and lactate levels ≥2.5 mmol/l (log rank test p = 0.004). In the group with ScvO2 <70% and lactate levels <2.5 mmol/l no patients died during the observation period. Frontal rSO2 correlates with ScvO2 but both frontal and thenar rSO2 do not exactly discriminate between patients with high or low ScvO2 in sepsis. The combination of elevated lactate >2.5 mmol/l and ScvO2 >70 % is highly associated with poor outcome in ICU patients with sepsis, severe sepsis and septic shock.
Collapse
|
8
|
Morris G, Maes M. Mitochondrial dysfunctions in myalgic encephalomyelitis/chronic fatigue syndrome explained by activated immuno-inflammatory, oxidative and nitrosative stress pathways. Metab Brain Dis 2014; 29:19-36. [PMID: 24557875 DOI: 10.1007/s11011-013-9435-x] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 08/22/2013] [Indexed: 02/07/2023]
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/cfs) is classified by the World Health Organization as a disorder of the central nervous system. ME/cfs is an neuro-immune disorder accompanied by chronic low-grade inflammation, increased levels of oxidative and nitrosative stress (O&NS), O&NS-mediated damage to fatty acids, DNA and proteins, autoimmune reactions directed against neoantigens and brain disorders. Mitochondrial dysfunctions have been found in ME/cfs, e.g. lowered ATP production, impaired oxidative phosphorylation and mitochondrial damage. This paper reviews the pathways that may explain mitochondrial dysfunctions in ME/cfs. Increased levels of pro-inflammatory cytokines, such as interleukin-1 and tumor necrosis factor-α, and elastase, and increased O&NS may inhibit mitochondrial respiration, decrease the activities of the electron transport chain and mitochondrial membrane potential, increase mitochondrial membrane permeability, interfere with ATP production and cause mitochondrial shutdown. The activated O&NS pathways may additionally lead to damage of mitochondrial DNA and membranes thus decreasing membrane fluidity. Lowered levels of antioxidants, zinc and coenzyme Q10, and ω3 polyunsaturated fatty acids in ME/cfs may further aggravate the activated immuno-inflammatory and O&NS pathways. Therefore, it may be concluded that immuno-inflammatory and O&NS pathways may play a role in the mitochondrial dysfunctions and consequently the bioenergetic abnormalities seen in patients with ME/cfs. Defects in ATP production and the electron transport complex, in turn, are associated with an elevated production of superoxide and hydrogen peroxide in mitochondria creating adaptive and synergistic damage. It is argued that mitochondrial dysfunctions, e.g. lowered ATP production, may play a role in the onset of ME/cfs symptoms, e.g. fatigue and post exertional malaise, and may explain in part the central metabolic abnormalities observed in ME/cfs, e.g. glucose hypometabolism and cerebral hypoperfusion.
Collapse
|
9
|
Lipcsey M, Woinarski NC, Bellomo R. Near infrared spectroscopy (NIRS) of the thenar eminence in anesthesia and intensive care. Ann Intensive Care 2012; 2:11. [PMID: 22569165 PMCID: PMC3488540 DOI: 10.1186/2110-5820-2-11] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 03/26/2012] [Indexed: 01/20/2023] Open
Abstract
Near infrared spectroscopy of the thenar eminence (NIRSth) is a noninvasive bedside method for assessing tissue oxygenation. The NIRS probe emits light with several wavelengths in the 700- to 850-nm interval and measures the reflected light mainly from a predefined depth. Complex physical models then allow the measurement of the relative concentrations of oxy and deoxyhemoglobin, and thus tissue saturation (StO2), as well as an approximation of the tissue hemoglobin, given as tissue hemoglobin index. Here we review of current knowledge of the application of NIRSth in anesthesia and intensive care. We performed an analytical and descriptive review of the literature using the terms “near-infrared spectroscopy” combined with “anesthesia,” “anesthesiology,” “intensive care,” “critical care,” “sepsis,” “bleeding,” “hemorrhage,” “surgery,” and “trauma” with particular focus on all NIRS studies involving measurement at the thenar eminence. We found that NIRSth has been applied as clinical research tool to perform both static and dynamic assessment of StO2. Specifically, a vascular occlusion test (VOT) with a pressure cuff can be used to provide a dynamic assessment of the tissue oxygenation response to ischemia. StO2 changes during such induced ischemia-reperfusion yield information on oxygen consumption and microvasculatory reactivity. Some evidence suggests that StO2 during VOT can detect fluid responsiveness during surgery. In hypovolemic shock, StO2 can help to predict outcome, but not in septic shock. In contrast, NIRS parameters during VOT increase the diagnostic and prognostic accuracy in both hypovolemic and septic shock. Minimal data are available on static or dynamic StO2 used to guide therapy. Although the available data are promising, further studies are necessary before NIRSth can become part of routine clinical practice.
Collapse
Affiliation(s)
- Miklos Lipcsey
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
| | | | | |
Collapse
|
10
|
Heyer L, Mebazaa A, Gayat E, Resche-Rigon M, Rabuel C, Rezlan E, Lukascewicz AC, Madadaki C, Pirracchio R, Schurando P, Morel O, Fargeaudou Y, Payen D. Cardiac troponin and skeletal muscle oxygenation in severe post-partum haemorrhage. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13 Suppl 5:S8. [PMID: 19951392 PMCID: PMC2786110 DOI: 10.1186/cc8006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Cardiac troponin has been shown to be elevated in one-half of the parturients admitted for post-partum haemorrhage. The purpose of the study was to assess whether increased cardiac troponin was associated with a simultaneous alteration in haemoglobin tissue oxygen saturation in peripheral muscles in post-partum haemorrhage. METHODS Tissue haemoglobin oxygen saturation of thenar eminence muscle (StO2) was measured via near-infrared spectroscopy technology. Two sets of StO2 parameters (both isolated baseline and during forearm ischaemia-reperfusion tests) were collected at two time points: upon intensive care unit admission and prior to intensive care unit discharge. Comparisons were performed using Wilcoxon paired tests, and univariate associations were assessed using logistic regression model and Wald tests. RESULTS The 42 studied parturients, admitted for post-partum haemorrhage, had clinical and biological signs of severe blood loss. Initial cardiac troponin I was increased in 24/42 parturients (0.43 +/- 0.60 microrg/l). All measured parameters of muscular haemoglobin oxygen saturation, including Srecovery, were also altered at admission and improved together with improved haemodynamics, when bleeding was controlled. Multivariate analysis showed that muscular Srecovery <3%/second at admission was strongly associated with increased cardiac troponin. CONCLUSIONS Our study confirmed the high incidence of increased cardiac troponin, and demonstrated the simultaneous impairment in the reserve of oxygen delivery to peripheral muscles in parturients admitted for severe post-partum haemorrhage.
Collapse
Affiliation(s)
- Laurent Heyer
- AP-HP, Department of Anesthesiology and Critical Care Medicine, University Paris 7, Hôpital Lariboisière, 2 Rue Ambroise Pare, 75010 Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
A portable functional imaging instrument for psychology research based on near-infrared spectroscopy. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s12200-008-0057-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
12
|
Near-infrared spectroscopy to monitor peripheral blood flow perfusion. J Clin Monit Comput 2007; 22:37-43. [PMID: 18040873 DOI: 10.1007/s10877-007-9105-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 11/13/2007] [Indexed: 02/03/2023]
Abstract
BACKGROUND Non-invasive evaluation of peripheral perfusion may be useful in many contexts including peri-operative monitoring. We validated a novel non-invasive spectroscopy technique to assess peripheral perfusion. This method, which is based on the measurement of tissue saturation variations after an ischemic period, was compared to strain gauge plethysmography and radionuclide plethysmography. The technique uses near-infrared spectroscopy (NIRS) to determine the rate of change of forearm tissue saturation during reactive hyperemia. METHODS In a prospective crossover study, 25 subjects were simultaneously evaluated with NIRS and strain gauge plethysmography. Six baseline flow measurements were performed to assess the reproducibility of each method. Twenty-seven serial measurements were then made to evaluate flow variation during forearm reactive hyperemia. RESULTS Strain gauge and NIRS methods showed excellent reproducibility with intra-class correlation coefficients of 0.96 and 0.93, respectively. CONCLUSION The NIRS technique appears well suited for the non-invasive evaluation of limb perfusion.
Collapse
|
13
|
Kimura K, Watanabe Y, Umeda M, Arima Y, Watsuji T, Shinohara S. Quantitative analysis of the relation between soft tissue stiffness palpated from the body surface and tissue hemodynamics in the human forearm. Physiol Meas 2007; 28:1495-505. [PMID: 18057514 DOI: 10.1088/0967-3334/28/12/004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We investigated the quantitative relation between soft tissue stiffness palpated from the body surface and hemodynamics in the human forearm. We examined the relation between pressures and blood flow in both the main artery and vein measured by magnetic resonance imaging (MRI), the cross-sectional area of forearm measured by MRI and soft tissue stiffness. Six male volunteers participated. Two tourniquet pressures, 120 mmHg and 230 mmHg, were used to induce an occlusion of the proximal portion of the upper arm. Measurements were made at the mid-belly of the brachioradial muscle. The venous outflow ceased at tourniquet pressures of 120 and 230 mmHg. The arterial flow was interrupted at 230 mmHg. Larger increases of the cross-sectional area and soft tissue stiffness were found at 120 mmHg than at 230 mmHg. The increase of the cross-sectional area of muscle was larger than that of the surrounding connective tissue during occlusion. We propose that low-pressure compression occludes venous outflow without restricting arterial inflow and induces an increase of the cross-sectional area that reflects the intramuscular pressure; and changes in this pressure caused by fluid accumulation should be the major factor for change in stiffness.
Collapse
Affiliation(s)
- Keisaku Kimura
- Department of Health Promoting and Preventive Medicine, Meiji University of Oriental Medicine, Hiyoshi-cho, Nantan-city, Kyoto, 629-0392, Japan.
| | | | | | | | | | | |
Collapse
|
14
|
Creteur J, Carollo T, Soldati G, Buchele G, De Backer D, Vincent JL. The prognostic value of muscle StO2 in septic patients. Intensive Care Med 2007; 33:1549-56. [PMID: 17572876 DOI: 10.1007/s00134-007-0739-3] [Citation(s) in RCA: 223] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 05/11/2007] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To quantify sepsis-induced alterations in changes in muscle tissue oxygenation (StO(2)) after an ischemic challenge using near-infrared spectroscopy (NIRS), and to test the hypothesis that these alterations are related to outcome. DESIGN Prospective study. SETTING Thirty-one-bed, university hospital Department of Intensive Care. PATIENTS Seventy-two patients with severe sepsis or septic shock, 18 hemodynamically stable, acutely ill patients without infection, and 18 healthy volunteers. INTERVENTIONS Three-minute occlusion of the brachial artery using a cuff inflated 50[Symbol: see text]mmHg above systolic arterial pressure. MEASUREMENTS AND MAIN RESULTS Thenar eminence StO(2) was measured continuously by NIRS before (StO(2)baseline), during, and after the 3-min occlusion. Changes in StO(2) were assessed by the slope of increase in StO(2) during the first 14 s following the ischemic period and by the difference between the maximum StO(2) and StO(2)baseline (Delta). The slope was lower in septic patients than in controls and volunteers [2.3 (1.3-3.6), 4.8 (3.5-6.0), and 4.7 (3.2-6.3) %/s, p < 0.001]. Delta was also significantly lower in septic patients than in the other groups. Slopes were lower in septic patients with than without shock [2.0 (1.2-2.9) vs 3.2 (1.8-4.5) %/s, p < 0.05]. In 52 septic patients, in whom the slope was obtained every 24 h for 48 h, slopes were higher in survivors than in non-survivors and tended to increase in survivors but not in non-survivors. CONCLUSIONS Altered recovery in StO(2) after an ischemic challenge is frequent in septic patients and more pronounced in the presence of shock. The presence and persistence of these alterations in the first 24[Symbol: see text]h of sepsis are associated with worse outcome.
Collapse
Affiliation(s)
- Jacques Creteur
- Erasme University Hospital, Free University of Brussels, Department of Intensive Care, Route de Lennik 808, 1070 Brussels, Belgium
| | | | | | | | | | | |
Collapse
|
15
|
Fukunaga S, Miyazaki T, Yuji T, Fujimoto T, Higashi Y, Sekine N, Tamura T, Shiga T. Assessment of muscle blood flow volume in elderly poststroke hemiplegic patients using near-infrared spectroscopy. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2004:4815-7. [PMID: 17271388 DOI: 10.1109/iembs.2004.1404332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This study assessed the changes in blood flow volume in elderly hemiplegic patients before and after rehabilitation training. Total hemoglobin accumulation (blood flow volume) was measured using near-infrared spectroscopy (NIRS) in both the affected and unaffected gastrocnemius muscles before and after walking. In the gastrocnemius on the affected side, the blood flow volume was larger during the recovery period than during the rest period, and the blood flow volume did not decrease during the recovery period after the subjects walked a corridor. By contrast, the blood flow volume recovered faster on the unaffected side than on the affected side. After the subjects walked the stairs, the blood flow volume increased in the gastrocnemius muscles on both sides. These results suggested that the level of training involved in walking a corridor was too light for the unaffected side, although it was effective for the affected side. In our subjects, walking the stairs was effective rehabilitation training for both the unaffected and affected sides. Our results suggested that NIRS was an objective tool useful for planning rehabilitation training.
Collapse
Affiliation(s)
- S Fukunaga
- Fujimoto Hayasuzu Hospital, Miyazaki, Japan
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Grassi B, Marzorati M, Lanfranconi F, Ferri A, Longaretti M, Stucchi A, Vago P, Marconi C, Morandi L. Impaired oxygen extraction in metabolic myopathies: Detection and quantification by near-infrared spectroscopy. Muscle Nerve 2007; 35:510-20. [PMID: 17143893 DOI: 10.1002/mus.20708] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patients with mitochondrial myopathies (MM) or myophosphorylase deficiency (McArdle's disease, McA) show impaired capacity for O(2) extraction, low maximal aerobic power, and reduced exercise tolerance. Non-invasive tools are needed to quantify the metabolic impairment. Six patients with MM, 6 with McA, 25 with symptoms of metabolic myopathy but negative biopsy (patient-controls, P-CTRL) and 20 controls (CTRL) underwent an incremental cycloergometric test. Pulmonary O(2) uptake (VO(2)) and vastus lateralis oxygenation indices (by near-infrared spectroscopy, NIRS) were determined. Concentration changes of deoxygenated hemoglobin and myoglobin (Delta[deoxy(Hb + Mb)]) were considered an index of O(2) extraction. Delta[deoxy(Hb + Mb)] peak (percent limb ischemia) was lower in MM (25.3 +/- 12.0%) and McA (18.7 +/- 7.3) than in P-CTRL (62.4 +/- 3.9) and CTRL (71.3 +/- 3.9) subjects. VO(2) peak and Delta[deoxy(Hb + Mb)] peak were linearly related (r(2) = 0.83). In these patients, NIRS is a tool to detect and quantify non-invasively the metabolic impairment, which may be useful in the follow-up of patients and in the assessment of therapies and interventions.
Collapse
Affiliation(s)
- Bruno Grassi
- Department of Science and Biomedical Technologies, University of Milan, LITA-Via Fratelli Cervi 93, I-20090 Segrate, MI, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Wright CI, Kroner CI, Draijer R. Non-invasive methods and stimuli for evaluating the skin's microcirculation. J Pharmacol Toxicol Methods 2006; 54:1-25. [PMID: 16256378 DOI: 10.1016/j.vascn.2005.09.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 09/21/2005] [Indexed: 11/17/2022]
Abstract
Vessels in the skin are arranged into superficial and deep horizontal plexuses and they are involved in thermoregulation, oxygen and nutritional support. The skin has a large number of functions and broad appeal spanning basic mechanistic and clinical research. Indeed, the skin can be used as a marker of normal and impaired vascular control and, owing to its accessibility and frequent involvement, is easy to investigate non-invasively. A large number of non-invasive methods are available for investigating the skin, ranging from those that permit the visualisation of microvessels, to those that monitor blood flow or one of its derivatives (e.g., skin temperature and transcutaneous oxygen). Such methods can be combined with non-invasive, dynamic stimuli (e.g., the use of cold or warm stimuli, activation of the peripheral nervous system or local neuronal systems, and the topical application of vasoactive drugs) and this potentially enables the differentiation of underlying disorders (e.g., primary from secondary Raynaud's phenomenon) and also to quantify changes over time or following intervention. The present article outlines the non-invasive methods and dynamic tests that can be used to investigate the microcirculation of the skin.
Collapse
Affiliation(s)
- C I Wright
- Unilever Food and Health Research Institute, Unilever R&D Vlaardingen, Olivier van Noortlaan 120, PO Box 114, 3130 AC Vlaardingen, The Netherlands.
| | | | | |
Collapse
|
18
|
Johansson A, Johansson T, Thompson MS, Bendsoe N, Svanberg K, Svanberg S, Andersson-Engels S. In vivo measurement of parameters of dosimetric importance during interstitial photodynamic therapy of thick skin tumors. JOURNAL OF BIOMEDICAL OPTICS 2006; 11:34029. [PMID: 16822078 DOI: 10.1117/1.2204027] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A system for interstitial photodynamic therapy is used in the treatment of thick skin tumors. The system allows simultaneous measurements of light fluence rate, sensitizer fluorescence, and tissue oxygen saturation by using the same fibers as for therapeutic light delivery. Results from ten tumor treatments using delta-aminolevulinic acid (ALA)-induced protoporphyrin IX show a significant, treatment-induced increase in tissue absorption at the therapeutic wavelength, and rapid sensitizer photobleaching. The changes in oxy- and deoxyhemoglobin content are monitored by means of near-infrared spectroscopy, revealing a varying tissue oxygenation and significant changes in blood volume during treatment. These changes are consistent with the temporal profiles of the light fluence rate at the therapeutic wavelength actually measured. We therefore propose the observed absorption increase to be due to treatment-induced deoxygenation in combination with changes in blood concentration within the treated volume. A higher rate of initial photobleaching is found to correlate with a less pronounced increase in tissue absorption. Based on the measured signals, we propose how real-time treatment supervision and feedback can be implemented. Simultaneous study of the fluence rate, sensitizer fluorescence, and local tissue oxygen saturation level may contribute to the understanding of the threshold dose for photodynamic therapy.
Collapse
Affiliation(s)
- Ann Johansson
- Lund Institute of Technology, Department of Physics, Lund, Sweden.
| | | | | | | | | | | | | |
Collapse
|
19
|
Pham TH, Hornung R, Ha HP, Burney T, Serna D, Powell L, Brenner M, Tromberg BJ. Noninvasive monitoring of hemodynamic stress using quantitative near-infrared frequency-domain photon migration spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2002; 7:34-44. [PMID: 11818010 DOI: 10.1117/1.1427046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2001] [Revised: 08/07/2001] [Accepted: 08/20/2001] [Indexed: 05/23/2023]
Abstract
Hemorrhagic hypovolemia and inotropic agent administration were used to manipulate cardiac output (CO) and oxygen delivery in rabbits to investigate the correlation between noninvasive frequency domain photon migration (FDPM) spectroscopy and invasive hemodynamic monitoring parameters. Frequency-domain photon migration provides quantitative measurements of light absorption and reduced scattering (mu(a) and mu(s)(prime prime or minute), respectively) in tissue. Wavelength dependent mu(a) values were used to calculate in vivo tissue concentration of deoxyhemoglobin [Hb], oxyhemoglobin [HbO(2)], total hemoglobin [TotHb], and water [H(2)O] as well as mixed arterial-venous oxygen saturation (S(t)O(2)) in tissue. FDPM-derived physiologic properties were correlated with invasive measurements of CO and mean pulmonary artery pressure (mPAP), FDPM-derived [TotHb] and S(t) O(2) correlated significantly with hemorrhaged volume (HV), mPAP, and CO. Correlation coefficients for [TotHb] vs HV, mPAP, and CO were -0.77, 0.86, and 0.70, respectively. Correlation coefficients of S(t)O( 2) vs HV, mPAP, and CO were -0.71, 0.55, and 0.61, respectively. Dobutamine induced changes resulted in correlation coefficients between FDPM-derived and invasively measured physiologic parameters that are comparable to those induced by hypovolemia. FDPM spectroscopy is sensitive to changes in mPAP and CO of as little as 15%. These results suggest that FDPM spectroscopy may be used in clinical settings to noninvasively monitor central hemodynamic parameters and to directly assess oxygenation of tissues.
Collapse
Affiliation(s)
- Tuan H Pham
- University of California, Beckman Laser Institute and Medical Clinic, Irvine, California, USA
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Taivassalo T, Abbott A, Wyrick P, Haller RG. Venous oxygen levels during aerobic forearm exercise: An index of impaired oxidative metabolism in mitochondrial myopathy. Ann Neurol 2002; 51:38-44. [PMID: 11782982 DOI: 10.1002/ana.10027] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A cardinal feature of impaired skeletal muscle oxidative metabolism in mitochondrial myopathies is a limited ability to increase the extraction of O(2) from blood relative to the increase in O(2) delivery by the circulation during exercise. We investigated whether aerobic forearm exercise would result in an abnormal increase in venous effluent O(2) in patients with impaired skeletal muscle oxidative phosphorylation attributable to mitochondrial disease. We monitored the partial pressure of O(2) (PO(2)) in cubital venous blood at rest, during handgrip exercise, and during recovery in 13 patients with mitochondrial myopathy and exercise intolerance and in 13 healthy control and 11 patient control subjects. Resting and recovery venous effluent PO(2) were similar in all subjects, but during exercise venous PO(2) paradoxically rose in mitochondrial myopathy patients from 27.2 +/- 4.0mmHg to 38.2 +/- 13.3mmHg, whereas PO(2) fell from 27.2 +/- 4.2mmHg to 24.2 +/- 2.7mmHg in healthy subjects and from 27.4 +/- 9.5mmHg to 22.2 +/- 5.2mmHg in patient controls. The range of elevated venous PO(2) during forearm exercise in mitochondrial myopathy patients (32 to 82mmHg) correlated closely with the severity of oxidative impairment as assessed during cycle exercise. We conclude that measurement of venous PO(2) during aerobic forearm exercise provides an easily performed screening test that sensitively detects impaired O(2) use and accurately assesses the severity of oxidative impairment in patients with mitochondrial myopathy and exercise intolerance.
Collapse
Affiliation(s)
- Tanja Taivassalo
- Neuromuscular Center, Institute for Exercise and Environmental Medicine, Presbyterian Hospital, Dallas, TX 75231, USA
| | | | | | | |
Collapse
|
21
|
Nakayama M, Iwasaki S, Ichinose H, Yamamoto S, Kanaya N, Namiki A. Intraoperative acute lower extremity ischemia detected by near-infrared spectroscopy. J Cardiothorac Vasc Anesth 2001; 15:624-5. [PMID: 11688006 DOI: 10.1053/jcan.2001.26544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Nakayama
- Division of Anesthesia, Obihiro Kosei Hospital, Obihiro, Japan.
| | | | | | | | | | | |
Collapse
|
22
|
Stainsby JA, Wright GA. Monitoring blood oxygen state in muscle microcirculation with transverse relaxation. Magn Reson Med 2001; 45:662-72. [PMID: 11283995 DOI: 10.1002/mrm.1089] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Oxygen uptake from the microcirculation is a direct measure of tissue function. Magnetic resonance is capable of detecting differences between oxygenated and deoxygenated blood due to the paramagnetic properties of deoxyhemoglobin. At the level of the microcirculation, however, imaging methods cannot directly visualize the vessels. Instead, bulk MR parameters are investigated for their ability to monitor blood oxygen saturation (%O(2)) changes in the microcirculation of tissue, specifically skeletal muscle. Experiments in an in vitro model verified the feasibility of detecting changes in exponential decay signals, and also verified the prediction of only two distinct decay components. Experiments in a rabbit model demonstrate that T(2)' and monoexponential T(2) decay are not sensitive to blood oxygen changes, but that the long-T(2) component in a biexponential fit is correlated to the blood oxygen state. Assuming a two-pool model for water protons in muscle, and with knowledge of the T(2)-%O(2) relation, estimates of the microcirculation blood oxygen state can be made with some reasonable assumptions. Magn Reson Med 45:662-672, 2001.
Collapse
Affiliation(s)
- J A Stainsby
- Department of Medical Biophysics, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|