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Fotakopoulos G, Siasios I, Gatos C, Georgakopoulou VE, Trakas N, Sklapani P, Fountas KN. Acute intracranial hemorrhage during the installation of the LICOX microdialysis system: A case report. MEDICINE INTERNATIONAL 2024; 4:39. [PMID: 38827950 PMCID: PMC11140294 DOI: 10.3892/mi.2024.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/02/2024] [Indexed: 06/05/2024]
Abstract
Neuro-monitoring is widely employed for the evaluation of intubated patients in the intensive care unit with stroke, severe head trauma, subarachnoid hemorrhage and/or hepatic encephalopathy. The present study reports the case of a patient with acute intracranial hemorrhage following the insertion of neuromonitoring catheters, which required surgical management. The patient was a 14-year-old male who sustained a severe traumatic brain injury and underwent a right-sided hemicraniectomy. During the installation of the neuromonitoring catheters, an acute hemorrhage was noted with a rapidly elevating intracranial pressure. A craniotomy was performed to identify and coagulate the injured cortical vessel. As demonstrated herein, the thorough evaluation of the clotting profile of the patient, a meticulous surgical technique and obtaining a post-insertion computed tomography scan may minimize the risk of any neuromonitoring-associated hemorrhagic complications.
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Affiliation(s)
- George Fotakopoulos
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
| | - Ioannis Siasios
- Department of Neurosurgery, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Charalampos Gatos
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
| | | | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Pagona Sklapani
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
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Willms JF, Boss JM, Huo S, Wolf S, Westphal LP, Bögli SY, Inauen C, Baumann D, Fröhlich J, Keller E. Intraparenchymal near-infrared spectroscopy for detection of delayed cerebral ischemia in poor-grade aneurysmal subarachnoid hemorrhage. J Neurosci Methods 2024; 406:110113. [PMID: 38537749 DOI: 10.1016/j.jneumeth.2024.110113] [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: 12/01/2023] [Revised: 02/27/2024] [Accepted: 03/20/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVE Detection of delayed cerebral ischemia (DCI) is challenging in comatose patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). Brain tissue oxygen pressure (PbtO2) monitoring may allow early detection of its occurrence. Recently, a probe for combined measurement of intracranial pressure (ICP) and intraparenchymal near-infrared spectroscopy (NIRS) has become available. In this pilot study, the parameters PbtO2, Hboxy, Hbdeoxy, Hbtotal and rSO2 were measured in parallel and evaluated for their potential to detect perfusion deficits or cerebral infarction. METHODS In patients undergoing multimodal neuromonitoring due to poor neurological condition after aSAH, Clark oxygen probes, microdialysis and NIRS-ICP probes were applied. DCI was suspected when the measured parameters in neuromonitoring deteriorated. Thus, perfusion CT scan was performed as follow up, and DCI was confirmed as perfusion deficit. Median values for PbtO2, Hboxy, Hbdeoxy, Hbtotal and rSO2 in patients with perfusion deficit (Tmax > 6 s in at least 1 vascular territory) and/or already demarked infarcts were compared in 24- and 48-hour time frames before imaging. RESULTS Data from 19 patients (14 University Hospital Zurich, 5 Charité Universitätsmedizin Berlin) were prospectively collected and analyzed. In patients with perfusion deficits, the median values for Hbtotal and Hboxy in both time frames were significantly lower. With perfusion deficits, the median values for Hboxy and Hbtotal in the 24 h time frame were 46,3 [39.6, 51.8] µmol/l (no perfusion deficits 53 [45.9, 55.4] µmol/l, p = 0.019) and 69,3 [61.9, 73.6] µmol/l (no perfusion deficits 74,6 [70.1, 79.6] µmol/l, p = 0.010), in the 48 h time frame 45,9 [39.4, 51.5] µmol/l (no perfusion deficits 52,9 [48.1, 55.1] µmol/l, p = 0.011) and 69,5 [62.4, 74.3] µmol/l (no perfusion deficits 75 [70,80] µmol/l, p = 0.008), respectively. In patients with perfusion deficits, PbtO2 showed no differences in both time frames. PbtO2 was significantly lower in patients with infarctions in both time frames. The median PbtO2 was 17,3 [8,25] mmHg (with no infarctions 29 [22.5, 36] mmHg, p = 0.006) in the 24 h time frame and 21,6 [11.1, 26.4] mmHg (with no infarctions 31 [22,35] mmHg, p = 0.042) in the 48 h time frame. In patients with infarctions, the median values of parameters measured by NIRS showed no significant differences. CONCLUSIONS The combined NIRS-ICP probe may be useful for early detection of cerebral perfusion deficits and impending DCI. Validation in larger patient collectives is needed.
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Affiliation(s)
- Jan F Willms
- Neurocritical Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
| | - Jens M Boss
- Neurocritical Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Shufan Huo
- Neurocritical Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Wolf
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Laura P Westphal
- Neurocritical Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stefan Y Bögli
- Neurocritical Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Corinne Inauen
- Neurocritical Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | | | - Emanuela Keller
- Neurocritical Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Gomez A, Sainbhi AS, Stein KY, Vakitbilir N, Froese L, Zeiler FA. Statistical properties of cerebral near infrared and intracranial pressure-based cerebrovascular reactivity metrics in moderate and severe neural injury: a machine learning and time-series analysis. Intensive Care Med Exp 2023; 11:57. [PMID: 37635181 PMCID: PMC10460757 DOI: 10.1186/s40635-023-00541-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Cerebrovascular reactivity has been identified as a key contributor to secondary injury following traumatic brain injury (TBI). Prevalent intracranial pressure (ICP) based indices of cerebrovascular reactivity are limited by their invasive nature and poor spatial resolution. Fortunately, interest has been building around near infrared spectroscopy (NIRS) based measures of cerebrovascular reactivity that utilize regional cerebral oxygen saturation (rSO2) as a surrogate for pulsatile cerebral blood volume (CBV). In this study, the relationship between ICP- and rSO2-based indices of cerebrovascular reactivity, in a cohort of critically ill TBI patients, is explored using classical machine learning clustering techniques and multivariate time-series analysis. METHODS High-resolution physiologic data were collected in a cohort of adult moderate to severe TBI patients at a single quaternary care site. From this data both ICP- and rSO2-based indices of cerebrovascular reactivity were derived. Utilizing agglomerative hierarchical clustering and principal component analysis, the relationship between these indices in higher dimensional physiologic space was examined. Additionally, using vector autoregressive modeling, the response of change in ICP and rSO2 (ΔICP and ΔrSO2, respectively) to an impulse in change in arterial blood pressure (ΔABP) was also examined for similarities. RESULTS A total of 83 patients with 428,775 min of unique and complete physiologic data were obtained. Through agglomerative hierarchical clustering and principal component analysis, there was higher order clustering between rSO2- and ICP-based indices, separate from other physiologic parameters. Additionally, modeled responses of ΔICP and ΔrSO2 to impulses in ΔABP were similar, indicating that ΔrSO2 may be a valid surrogate for pulsatile CBV. CONCLUSIONS rSO2- and ICP-based indices of cerebrovascular reactivity relate to one another in higher dimensional physiologic space. ΔICP and ΔrSO2 behave similar in modeled responses to impulses in ΔABP. This work strengthens the body of evidence supporting the similarities between ICP-based and rSO2-based indices of cerebrovascular reactivity and opens the door to cerebrovascular reactivity monitoring in settings where invasive ICP monitoring is not feasible.
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Affiliation(s)
- Alwyn Gomez
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Amanjyot Singh Sainbhi
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Kevin Y Stein
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Nuray Vakitbilir
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Logan Froese
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Frederick A Zeiler
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
- Centre on Aging, University of Manitoba, Winnipeg, Canada
- Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, Karolinksa Institutet, Stockholm, Sweden
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Wang C, Xing D, Zhou S, Fang F, Fu Y, Xu F. Electrical bioimpedance measurement and near-infrared spectroscopy in pediatric postoperative neurocritical care: a prospective observational study. Front Neurol 2023; 14:1190140. [PMID: 37416310 PMCID: PMC10322191 DOI: 10.3389/fneur.2023.1190140] [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: 03/20/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
Background To investigate the clinical significance of the disturbance coefficient (DC) and regional cerebral oxygen saturation (rSO2) as obtained through the use of electrical bioimpedance and near-infrared spectroscopy (NIRS) in pediatric neurocritical care. Participants and methods We enrolled 45 pediatric patients as the injury group and 70 healthy children as the control group. DC was derived from impedance analysis of 0.1 mA-50 kHz current via temporal electrodes. rSO2 was the percentage of oxyhemoglobin measured from reflected NIR light on the forehead. DC and rSO2 were obtained at 6, 12, 24, 48 and 72 h after surgery for the injury group and during the health screening clinic visit for the control group. We compared DC and rSO2 between the groups, their changes over time within the injury group and their correlation with intracranial pressure (ICP), cerebral perfusion pressure (CPP), Glasgow coma scale (GCS) score, Glasgow outcome scale (GOS) score, and their ability to diagnose postoperative cerebral edema and predict poor prognosis. Results DC and rSO2 were significantly lower in the injury group than in the control group. In the injury group, ICP increased over the monitoring period, while DC, CPP and rSO2 decreased. DC was negatively correlated with ICP and positively correlated with GCS score and GOS score. Additionally, lower DC values were observed in patients with signs of cerebral edema, with a DC value of 86.5 or below suggesting the presence of brain edema in patients aged 6-16 years. On the other hand, rSO2 was positively correlated with CPP, GCS score, and GOS score, with a value of 64.4% or below indicating a poor prognosis. Decreased CPP is an independent risk factor for decreased rSO2. Conclusion DC and rSO2 monitoring based on electrical bioimpedance and near-infrared spectroscopy not only reflect the degree of brain edema and oxygenation, but also reflect the severity of the disease and predict the prognosis of the patients. This approach offers a real-time, bedside, and accurate method for assessing brain function and detecting postoperative cerebral edema and poor prognosis.
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Affiliation(s)
- Chenhao Wang
- Department of Critical Care Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Dianwei Xing
- Department of Critical Care Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Shuoyan Zhou
- Department of Critical Care Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Fang Fang
- Department of Critical Care Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yueqiang Fu
- Department of Critical Care Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Feng Xu
- Department of Critical Care Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
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de Courson H, Proust-Lima C, Tuaz E, Georges D, Verchère E, Biais M. Relationship Between Brain Tissue Oxygen and Near-Infrared Spectroscopy in Patients with Nontraumatic Subarachnoid Hemorrhage. Neurocrit Care 2022; 37:620-628. [PMID: 35876962 DOI: 10.1007/s12028-022-01563-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Continuous monitoring of cerebral oxygenation is one of the diagnostic tools used in patients with brain injury. Direct and invasive measurement of cerebral oxygenation with a partial brain oxygen pressure (PbtO2) probe is promising but invasive. Noninvasive assessment of regional transcranial oxygen saturation using near-infrared spectroscopy (NIRS) may be feasible. The aim of this study was to evaluate the interchangeability between PbtO2 and NIRS over time in patients with nontraumatic subarachnoid hemorrhage. METHODS This retrospective study was performed in a neurocritical care unit. Study participants underwent hourly PbtO2 and NIRS measurements over 72 h. Temporal agreement between markers was described by their pointwise correlation. A secondary analysis assessed the structure of covariation between marker trajectories using a bivariate linear mixed model. RESULTS Fifty-one patients with subarachnoid hemorrhage were included. A total of 3362 simultaneous NIRS and PbtO2 measurements were obtained. The correlation at each measurement time ranged from - 0.25 to 0.25. The global correlation over time was - 0.026 (p = 0.130). The bivariate linear mixed model confirmed the lack of significant correlation between the PbtO2 and NIRS measurements at follow-up. NIRS was unable to detect PbtO2 values below 20 mm Hg (area under the receiver operating characteristic curve 0.539 [95% confidence interval 0.536-0.542]; p = 0.928), and percentage changes in NIRS were unable to detect a decrease in PbtO2 ≥ 10% (area under the receiver operating characteristic curve 0.615 [95% confidence interval 0.614-0.616]; p < 0.001). CONCLUSIONS PbtO2 and NIRS measurements were not correlated. There is no evidence that NIRS could be a substitute for PbtO2 monitoring in patients with nontraumatic subarachnoid hemorrhage.
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Affiliation(s)
- Hugues de Courson
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France.,U1219, Bordeaux Population Health, Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, Bordeaux, France
| | - C Proust-Lima
- U1219, Bordeaux Population Health, Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, Bordeaux, France
| | - Estelle Tuaz
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Delphine Georges
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Eric Verchère
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Matthieu Biais
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France. .,U1034, Biology of Cardiovascular Diseases, Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, Bordeaux, France.
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Francoeur CL, Lauzier F, Brassard P, Turgeon AF. Near Infrared Spectroscopy for Poor Grade Aneurysmal Subarachnoid Hemorrhage-A Concise Review. Front Neurol 2022; 13:874393. [PMID: 35518206 PMCID: PMC9062216 DOI: 10.3389/fneur.2022.874393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Delayed cerebral ischemia (DCI) disproportionately affects poor grade aneurysmal subarachnoid hemorrhage (aSAH) patients. An unreliable neurological exam and the lack of appropriate monitoring leads to unrecognized DCI, which in turn is associated with severe long-term deficits and higher mortality. Near Infrared Spectroscopy (NIRS) offers simple, continuous, real time, non-invasive cerebral monitoring. It provides regional cerebral oxygen saturation (c-rSO2), which reflects the balance between cerebral oxygen consumption and supply. Reports have demonstrated a good correlation with other cerebral oxygen and blood flow monitoring, and credible cerebrovascular reactivity indices were also derived from NIRS signals. Multiple critical c-rSO2 values have been reported in aSAH patients, based on various thresholds, duration, variation from baseline or cerebrovascular reactivity indices. Some were associated with vasospasm, some with DCI and others with clinical outcomes. However, the poor grade aSAH population has not been specifically studied and no randomized clinical trial has been published. The available literature does not support a specific NIRS-based intervention threshold to guide diagnostic or treatment in aSAH patients. We review herein the fundamental basic concepts behind NIRS technology, relationship of c-rSO2 to other brain monitoring values and their potential clinical interpretation. We follow with a critical evaluation of the use of NIRS in the aSAH population, more specifically its ability to diagnose vasospasm, to predict DCI and its association to outcome. In summary, NIRS might offer significant potential for poor grade aSAH in the future. However, current evidence does not support its use in clinical decision-making, and proper technology evaluation is required.
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Affiliation(s)
- Charles L. Francoeur
- Population Health and Optimal Health Practices Research Unit (Trauma—Emergency—Critical Care Medicine), Centre Hospitalier Universitaire (CHU) de Québec—Université Laval Research Centre, Université Laval, Québec City, QC, Canada
- Department of Anesthesiology and Critical Care, CHU de Québec—Université Laval, Critical Care Division, Québec City, QC, Canada
- Critical Care Medicine Service, CHU de Québec—Université Laval, Québec City, QC, Canada
| | - François Lauzier
- Population Health and Optimal Health Practices Research Unit (Trauma—Emergency—Critical Care Medicine), Centre Hospitalier Universitaire (CHU) de Québec—Université Laval Research Centre, Université Laval, Québec City, QC, Canada
- Department of Anesthesiology and Critical Care, CHU de Québec—Université Laval, Critical Care Division, Québec City, QC, Canada
- Critical Care Medicine Service, CHU de Québec—Université Laval, Québec City, QC, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec City, QC, Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, QC, Canada
| | - Alexis F. Turgeon
- Population Health and Optimal Health Practices Research Unit (Trauma—Emergency—Critical Care Medicine), Centre Hospitalier Universitaire (CHU) de Québec—Université Laval Research Centre, Université Laval, Québec City, QC, Canada
- Department of Anesthesiology and Critical Care, CHU de Québec—Université Laval, Critical Care Division, Québec City, QC, Canada
- Critical Care Medicine Service, CHU de Québec—Université Laval, Québec City, QC, Canada
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Mokhtari M, Amirdosara M, Goharani R, Zangi M, Tafrishinejad A, Nashibi M, Dabbagh A, Sadeghi H, Nateghinia S, Hajiesmaeili M, Yousefi-Banaem H, Sayehmiri F. The Predictive Power of Near-Infrared Spectroscopy in Improving Cognitive Problems in Patients Undergoing Brain Surgeries: A Systematic Review. Anesth Pain Med 2022; 12:e116637. [PMID: 35433374 PMCID: PMC8995777 DOI: 10.5812/aapm.116637] [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: 06/12/2021] [Revised: 12/17/2021] [Accepted: 01/07/2022] [Indexed: 12/03/2022] Open
Abstract
One of the main objectives in neurosurgical procedures is the prevention of cerebral ischemia and hypoxia leading to secondary brain injury. Different methods for early detection of intraoperative cerebral ischemia and hypoxia have been used. Near-infrared spectroscopy (NIRS) is a simple, non-invasive method for monitoring cerebral oxygenation increasingly used today. The aim of this study was to systematically review the brain monitoring with NIRS in neurosurgery. The search process resulted in the detection of 324 articles using valid keywords on the electronic databases, including Embase, PubMed, Scopus, Web of Science, and Cochrane Library. Subsequently, the full texts of 34 studies were reviewed, and finally 11 articles (seven prospective studies, three retrospective studies, and one randomized controlled trial) published from 2005 to 2020 were identified as eligible for systematic review. Meta-analysis was not possible due to high heterogeneity in neurological and neurosurgical conditions of patients, expression of different clinical outcomes, and different standard reference tests in the studies reviewed. The results showed that NIRS is a non-invasive cerebral oximetry that provides continuous and measurable cerebral oxygenation information and can be used in a variety of clinical settings.
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Affiliation(s)
- Majid Mokhtari
- Department of Internal Medicine, Pulmonary and Critical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Amirdosara
- Anesthesiology Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Goharani
- Department of Anesthesiology, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Masood Zangi
- Anesthesiology Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Tafrishinejad
- Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Nashibi
- Fellowship of Neuroanesthesia, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Dabbagh
- Fellowship in Cardiac Anesthesiology, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Sadeghi
- Anesthesiology Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeedeh Nateghinia
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Hajiesmaeili
- Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hossein Yousefi-Banaem
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sayehmiri
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Correlation between brain tissue oxygen tension and regional cerebral oximetry in uninjured human brain under conditions of changing ventilation strategy. J Clin Monit Comput 2022; 36:1227-1232. [PMID: 35113286 PMCID: PMC8812359 DOI: 10.1007/s10877-022-00821-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/25/2022] [Indexed: 11/09/2022]
Abstract
Controversy surrounds regional cerebral oximetry (rSO2) because extracranial contamination and unmeasured changes in cerebral arterial:venous ratio confound readings. Correlation of rSO2 with brain tissue oxygen (PbrO2), a “gold standard” for cerebral oxygenation, could help resolve this controversy but PbrO2 measurement is highly invasive. This was a prospective cohort study. The primary aim was to evaluate correlation between PbrO2 and rSO2 and the secondary aim was to investigate the relationship between changing ventilation regimens and measurement of PbrO2 and rSO2. Patients scheduled for elective removal of cerebral metastases were anesthetized with propofol and remifentanil, targeted to a BIS range 40–60. rSO2 was measured using the INVOS 5100B monitor and PbrO2 using the Licox brain monitoring system. The Licox probe was placed into an area of normal brain within the tumor excision corridor. FiO2 and minute ventilation were sequentially adjusted to achieve two set points: (1) FiO2 0.3 and paCO2 30 mmHg, (2) FiO2 1.0 and paCO2 40 mmHg. PbrO2 and rSO2 were recorded at each. Nine participants were included in the final analysis, which showed a positive Spearman’s correlation (r = 0.50, p = 0.036) between PbrO2 and rSO2. From set point 1 to set point 2, PbrO2 increased from median 6.0, IQR 4.0–11.3 to median 22.5, IQR 9.8–43.6, p = 0.015; rSO2 increased from median 68.0, IQR 62.5–80.5 to median 83.0, IQR 74.0–90.0, p = 0.047. Correlation between PbrO2 and rSO2 is evident. Increasing FiO2 and PaCO2 results in significant increases in cerebral oxygenation measured by both monitors.
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Yang B, Liang X, Wu Z, Sun X, Shi Q, Zhan Y, Dan W, Zheng D, Xia Y, Deng B, Xie Y, Jiang L. APOE gene polymorphism alters cerebral oxygen saturation and quantitative EEG in early-stage traumatic brain injury. Clin Neurophysiol 2022; 136:182-190. [DOI: 10.1016/j.clinph.2022.01.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 11/03/2022]
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10
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Washer LA, Abramo T, Hardgrave H, Harris ZL, Meredith M, Moore K, Dalabih A, Williams D, Jorgenson-Stough A, Crawley L. Assessing the Impact of 3% Hypertonic Saline Hyperosmolar Therapy on Intubated Children With Isolated Traumatic Brain Injury by Cerebral Oximetry in a Pediatric Emergency Setting. Pediatr Emerg Care 2021; 37:e791-e804. [PMID: 32106155 DOI: 10.1097/pec.0000000000001959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intubated pediatric patients with isolated traumatic brain injury (TBI) are a diagnostic challenge for early detection of altered cerebral physiology instigated by trauma-induced increased intracranial pressure (ICP) while preventing secondary neuronal damage (secondary insult detection) and assessing the effects of increased ICP therapeutic interventions (3% hypertonic saline [HTS]). Invasive brain tissue oxygen monitoring is guiding new intensive care unit TBI management but is not pediatric emergency department (PED) readily accessible. Objective measurements on pediatric isolated TBI-altered bihemispheric cerebral physiology and treatment effects of 3% HTS are currently lacking. Cerebral oximetry can assess increased ICP-induced abnormal bihemispheric cerebral physiology by measuring regional tissue oxygenation (rcSO2) and cerebral blood volume index (CBVI) and the mechanical cerebrospinal fluid removal effects on the increased ICP-induced abnormal bihemispheric cerebral physiology.In the PED intubated patients with isolated TBI, assessing the 3% HTS therapeutic response is solely by vital signs and limited clinical assessment skills. Objective measurements of the 3% HTS hyperosmolar effects on the PED isolated TBI patients' altered bihemispheric cerebral physiology are lacking. We believe that bihemispheric rcSO2 and CBVI could elucidate similar data on 3% HTS impact and influence in the intubated isolated TBI patients. OBJECTIVE This study aimed to analyze the effects of 3% HTS on bihemispheric rcSO2 and CBVI in intubated patients with isolated TBI. METHODS An observational, retrospective analysis of bihemispheric rcSO2 and CBVI readings in intubated pediatric patients with isolated TBI receiving 3% HTS infusions, was performed. RESULTS From 2010 to 2017, 207 intubated patients with isolated TBI received 3% HTS infusions (median age, 2.9 [1.1-6.9 years]; preintubation Glasgow Coma Scale score, 7 [6-8]). The results were as follows: initial pre-3% HTS, 43% (39.5% to 47.5%; left) and 38% (35% to 42%; right) for rcSO2 < 60%, and 8 (-28 to 21; left) and -15 (-34 to 22; right) for CBVI; post-3% HTS, 68.5% (59.3% to 76%, P < 0.0001; left) and 62.5% (56.0% to 74.8%, P < 0.0001; right) for rcSO2 < 60%, and 12 (-7 to 24, P = 0.04; left) and 14 (-21 to 22, P < 0.0001; right) for CBVI; initial pre-3% HTS, 90% (83% to 91%; left) and 87% (82% to 92%; right) for rcSO2 > 80%, and 16.5 (6 to 33, P < 0.0001; left) and 16.8 (-2.5 to 27.5, P = 0.005; right) for CBVI; and post-3% HTS, 69% (62% to 72.5%, P < 0.0001; left) and 63% (59% to 72%, P < 0.0001; right) for rcSO2 > 80%, and 16.5 (6 to 33, P < 0.0001; left) and 16.8 (-2.5 to 27.5, P = 0.005; right) for CBVI. The following results for cerebral pathology pre-3% HTS were as follows: epidural: 85% (58% to 88.5%) for left rcSO2 and -9.25 (-34 to 19) for left CBVI, and 85.5% (57.5% to 89%) for right rcSO2 and -12.5 (-21 to 27) for CBVI; subdural: 45% (38% to 54%) for left rcSO2 and -9.5 (-25 to 19) for left CBVI, and 40% (33% to 49%) for right rcSO2 and -15 (-30.5 to 5) for CBVI. The following results for cerebral pathology post-3% HTS were as follows: epidural: 66% (58% to 69%, P = 0.03) for left rcSO2 and 15 (-1 to 21, P = 0.0004) for left CBVI, and 63% (52% to 72%, P = 0.009) for right rcSO2, and 15.5 (-22 to 24, P = 0.02) for CBVI; subdural: 63% (56% to 72%, P < 0.0001) for left rcSO2 and 9 (-20 to 22, P < 0.0001) for left CBVI, and 62.5% (48% to 73%, P < 0.0001) for right rcSO2, and 3 (-26 to 22, P < 0.0001) for CBVI. Overall, heart rate showed no significant change. Three percent HTS effect on interhemispheric rcSO2 difference >10 showed rcSO2 < 60%, and subdural hematomas had the greatest reduction (P < 0.001). The greatest positive changes occurred in bihemispheric or one-hemispheric rcSO2 < 60% with an interhemispheric discordance rcSO2 > 10 and required the greatest number of 3% HTS infusions. For 3% HTS 15% rcSO2 change time effect, all patients achieved positive change with subdural hematomas and hemispheric rcSO2 readings <60% with the shortest achievement time of 1.2 minutes (0.59-1.75; P < 0.001). CONCLUSIONS In intubated pediatric patients with isolated TBI who received 3% HTS infusions, bihemispheric rcSO2 and CBVI readings immediately detected and trended the 3% HTS effects on the trauma-induced cerebral pathophysiology. The 3% HTS infusion produced a significant improvement in rcSO2 and CBVI readings and a reduction in interhemispheric rcSO2 discordance differences. In patients with bihemispheric or one-hemispheric rcSO2 readings <60% with or without an interhemispheric discordance, rcSO2 > 10 demonstrated the greatest significant positive delta change and required the greatest numbers of 3% HTS infusions. Overall, 3% HTS produced a significant positive 15% change within 2.1 minutes of infusion, whereas heart rate showed no significant change. During trauma neuroresuscitation, especially in intubated isolated TBI patients requiring 3% HTS, cerebral oximetry has shown its functionality as a rapid adjunct neurological, therapeutic assessment tool and should be considered in the initial emergency department pediatric trauma neurological assessment and neuroresuscitation regimen.
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Affiliation(s)
- Leigh-Ann Washer
- From the Department of Pediatrics, University of Arkansas for Medical Sciences
| | - Thomas Abramo
- From the Department of Pediatrics, University of Arkansas for Medical Sciences
| | | | - Zena Leah Harris
- Department of Pediatrics, Feinberg School of Medicine, Northwestern Medicine, Lurie Children's Hospital, Chicago, IL
| | - Mark Meredith
- Department of Pediatrics, University of Tennessee, LeBonheur Children's Hospital, Memphis, TN
| | - Katherine Moore
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Abudulah Dalabih
- From the Department of Pediatrics, University of Arkansas for Medical Sciences
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Gomez A, Sainbhi AS, Froese L, Batson C, Alizadeh A, Mendelson AA, Zeiler FA. Near Infrared Spectroscopy for High-Temporal Resolution Cerebral Physiome Characterization in TBI: A Narrative Review of Techniques, Applications, and Future Directions. Front Pharmacol 2021; 12:719501. [PMID: 34803673 PMCID: PMC8602694 DOI: 10.3389/fphar.2021.719501] [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] [Received: 06/02/2021] [Accepted: 10/22/2021] [Indexed: 12/31/2022] Open
Abstract
Multimodal monitoring has been gaining traction in the critical care of patients following traumatic brain injury (TBI). Through providing a deeper understanding of the individual patient's comprehensive physiologic state, or "physiome," following injury, these methods hold the promise of improving personalized care and advancing precision medicine. One of the modalities being explored in TBI care is near-infrared spectroscopy (NIRS), given it's non-invasive nature and ability to interrogate microvascular and tissue oxygen metabolism. In this narrative review, we begin by discussing the principles of NIRS technology, including spatially, frequency, and time-resolved variants. Subsequently, the applications of NIRS in various phases of clinical care following TBI are explored. These applications include the pre-hospital, intraoperative, neurocritical care, and outpatient/rehabilitation setting. The utility of NIRS to predict functional outcomes and evaluate dysfunctional cerebrovascular reactivity is also discussed. Finally, future applications and potential advancements in NIRS-based physiologic monitoring of TBI patients are presented, with a description of the potential integration with other omics biomarkers.
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Affiliation(s)
- Alwyn Gomez
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Amanjyot Singh Sainbhi
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Logan Froese
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Carleen Batson
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Arsalan Alizadeh
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Asher A Mendelson
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada.,Section of Critical Care, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Frederick A Zeiler
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada.,Centre on Aging, University of Manitoba, Winnipeg, MB, Canada.,Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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12
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Davie S, Mutch WAC, Monterola M, Fidler K, Funk DJ. The Incidence and Magnitude of Cerebral Desaturation in Traumatic Brain Injury: An Observational Cohort Study. J Neurosurg Anesthesiol 2021; 33:258-262. [PMID: 31633577 DOI: 10.1097/ana.0000000000000652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cerebral ischemia in patients with traumatic brain injury (TBI) may propagate secondary neurological injury. Episodes of cerebral ischemia can be revealed through the use of cerebral oximetry monitoring. The objective of this study was to determine the incidence and severity of regional cerebral oxygen (rSO2) desaturation (rSO2<65%) in patients with severe TBI. Secondary outcomes included changes in other monitoring parameters associated with cerebral desaturation. MATERIALS AND METHODS In this single-center prospective observational cohort study, cerebral oximetry data were collected continuously for up to 72 hours in 18 adult patients with a diagnosis of severe nonpenetrating TBI who were being mechanically ventilated and undergoing intracranial pressure (ICP) monitoring an in intensive care unit in Canada. Mean arterial pressure (MAP), ICP, and cerebral perfusion pressure were collected at 5-minute intervals during the study period. RESULTS Twelve of 18 (67%) patients experienced an episode of cerebral desaturation. The median (interquartile range) nadir rSO2 was 57% (51% to 62%). The duration of desaturation was 265 (57 to 1277) minutes or 8.1% (2.6% to 26.0%) of recording time. In all patients, a linear regression analysis of the area under threshold of 65% for rSO2 was moderately correlated with the area above an ICP threshold of 20 mm Hg (R2=0.52; P<0.01). Similarly, there was a modest correlation between rSO2 and MAP (R2=0.41; P<0.01). These relationships also held true for those patients who experienced cerebral desaturation. Patients having episodes of ICP >20 mm Hg were 6 times more likely to have a cerebral desaturation (relative risk: 6.0; 95% confidence interval: 1.3-34.7). CONCLUSIONS Cerebral desaturations occur frequently in patients with severe TBI, and their duration can be protracted. Episodes of desaturation were moderately correlated with increased ICP and decreased MAP.
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Affiliation(s)
- Sophie Davie
- Department of Anesthesiology and Perioperative Medicine
| | - W Alan C Mutch
- Department of Anesthesiology and Perioperative Medicine
- The Canada North Concussion Network, Winnipeg, MB, Canada
| | | | - Kelsi Fidler
- Department of Anesthesiology and Perioperative Medicine
| | - Duane J Funk
- Department of Anesthesiology and Perioperative Medicine
- Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba
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13
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Roldán M, Kyriacou PA. Near-Infrared Spectroscopy (NIRS) in Traumatic Brain Injury (TBI). SENSORS (BASEL, SWITZERLAND) 2021; 21:1586. [PMID: 33668311 PMCID: PMC7956674 DOI: 10.3390/s21051586] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 01/03/2023]
Abstract
Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently impacts an object or when an object pierces the skull and enters brain tissue. Secondary injuries after traumatic brain injury (TBI) can lead to impairments on cerebral oxygenation and autoregulation. Considering that secondary brain injuries often take place within the first hours after the trauma, noninvasive monitoring might be helpful in providing early information on the brain's condition. Near-infrared spectroscopy (NIRS) is an emerging noninvasive monitoring modality based on chromophore absorption of infrared light with the capability of monitoring perfusion of the brain. This review investigates the main applications of NIRS in TBI monitoring and presents a thorough revision of those applications on oxygenation and autoregulation monitoring. Databases such as PubMed, EMBASE, Web of Science, Scopus, and Cochrane library were utilized in identifying 72 publications spanning between 1977 and 2020 which were directly relevant to this review. The majority of the evidence found used NIRS for diagnosis applications, especially in oxygenation and autoregulation monitoring (59%). It was not surprising that nearly all the patients were male adults with severe trauma who were monitored mostly with continue wave NIRS or spatially resolved spectroscopy NIRS and an invasive monitoring device. In general, a high proportion of the assessed papers have concluded that NIRS could be a potential noninvasive technique for assessing TBI, despite the various methodological and technological limitations of NIRS.
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Affiliation(s)
| | - Panayiotis A. Kyriacou
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Sciences and Engineering, University of London, London EC1V 0HB, UK;
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14
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Mismatch between Tissue Partial Oxygen Pressure and Near-Infrared Spectroscopy Neuromonitoring of Tissue Respiration in Acute Brain Trauma: The Rationale for Implementing a Multimodal Monitoring Strategy. Int J Mol Sci 2021; 22:ijms22031122. [PMID: 33498736 PMCID: PMC7865258 DOI: 10.3390/ijms22031122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/21/2022] Open
Abstract
The brain tissue partial oxygen pressure (PbtO2) and near-infrared spectroscopy (NIRS) neuromonitoring are frequently compared in the management of acute moderate and severe traumatic brain injury patients; however, the relationship between their respective output parameters flows from the complex pathogenesis of tissue respiration after brain trauma. NIRS neuromonitoring overcomes certain limitations related to the heterogeneity of the pathology across the brain that cannot be adequately addressed by local-sample invasive neuromonitoring (e.g., PbtO2 neuromonitoring, microdialysis), and it allows clinicians to assess parameters that cannot otherwise be scanned. The anatomical co-registration of an NIRS signal with axial imaging (e.g., computerized tomography scan) enhances the optical signal, which can be changed by the anatomy of the lesions and the significance of the radiological assessment. These arguments led us to conclude that rather than aiming to substitute PbtO2 with tissue saturation, multiple types of NIRS should be included via multimodal systemic- and neuro-monitoring, whose values then are incorporated into biosignatures linked to patient status and prognosis. Discussion on the abnormalities in tissue respiration due to brain trauma and how they affect the PbtO2 and NIRS neuromonitoring is given.
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15
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Wu Z, Xiong S, Sun X, Shi Q, Dan W, Zhan Y, Xie Y, Jiang L. Effects of Apolipoprotein E Polymorphism on Cerebral Oxygen Saturation After Traumatic Brain Injury. Front Neurol 2020; 11:539627. [PMID: 33262737 PMCID: PMC7688473 DOI: 10.3389/fneur.2020.539627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/26/2020] [Indexed: 01/09/2023] Open
Abstract
Objective: To investigate the effects of the apolipoprotein E gene (APOE) on the cerebral oxygen saturation of patients after traumatic brain injury (TBI). Methods: Clinical data of 114 patients with TBI and 54 normal people were collected. The APOE genotypes of all subjects were determined by quantitative fluorescent polymerase chain reaction (QF-PCR). The regional cerebral oxygen saturation (rScO2) of TBI patients and normal people were monitored by near-infrared spectroscopy (NIRS). Results: The mean rScO2 of patients was (55.06 ± 7.60)% in the early stage of TBI, which was significantly lower than that of normal people (67.21 ± 7.80)% (P < 0.05). Single-factor and multifactor logistic regression analyses showed APOEε4 was an independent risk factor that caused the early decline of rScO2 in TBI patients. Furthermore, in the TBI group, the rScO2 of APOEε4 carriers (52.23 ± 8.02)% was significantly lower than that of non-ε4 carriers (60.33 ± 7.12)% (P < 0.05). But in the normal group, no significant differences in rScO2 were found between APOEε4 carriers and non-carriers. Conclusion: The rScO2 may be significantly decreased after TBI, and APOEε4 may be a risk factor for decreased rScO2 in the early stage of TBI.
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Affiliation(s)
- Zhimin Wu
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Senjie Xiong
- Department of Neurosurgery, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaochuan Sun
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Quanhong Shi
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Dan
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Zhan
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanfeng Xie
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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16
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Roldán M, Abay TY, Kyriacou PA. Non-Invasive Techniques for Multimodal Monitoring in Traumatic Brain Injury: Systematic Review and Meta-Analysis. J Neurotrauma 2020; 37:2445-2453. [DOI: 10.1089/neu.2020.7266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- María Roldán
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Sciences, and Engineering, City University of London, London, United Kingdom
| | - Tomas Ysehak Abay
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Sciences, and Engineering, City University of London, London, United Kingdom
| | - Panayiotis A. Kyriacou
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Sciences, and Engineering, City University of London, London, United Kingdom
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17
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Nitzan M, Nitzan I, Arieli Y. The Various Oximetric Techniques Used for the Evaluation of Blood Oxygenation. SENSORS 2020; 20:s20174844. [PMID: 32867184 PMCID: PMC7506757 DOI: 10.3390/s20174844] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022]
Abstract
Adequate oxygen delivery to a tissue depends on sufficient oxygen content in arterial blood and blood flow to the tissue. Oximetry is a technique for the assessment of blood oxygenation by measurements of light transmission through the blood, which is based on the different absorption spectra of oxygenated and deoxygenated hemoglobin. Oxygen saturation in arterial blood provides information on the adequacy of respiration and is routinely measured in clinical settings, utilizing pulse oximetry. Oxygen saturation, in venous blood (SvO2) and in the entire blood in a tissue (StO2), is related to the blood supply to the tissue, and several oximetric techniques have been developed for their assessment. SvO2 can be measured non-invasively in the fingers, making use of modified pulse oximetry, and in the retina, using the modified Beer–Lambert Law. StO2 is measured in peripheral muscle and cerebral tissue by means of various modes of near infrared spectroscopy (NIRS), utilizing the relative transparency of infrared light in muscle and cerebral tissue. The primary problem of oximetry is the discrimination between absorption by hemoglobin and scattering by tissue elements in the attenuation measurement, and the various techniques developed for isolating the absorption effect are presented in the current review, with their limitations.
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Affiliation(s)
- Meir Nitzan
- Department of Physics/Electro-Optics Engineering, Jerusalem College of Technology, 21 Havaad Haleumi St., Jerusalem 91160, Israel;
- Correspondence:
| | - Itamar Nitzan
- Monash Newborn, Monash Children’s Hospital, Melbourne 3168, Australia;
- Department of Neonatology, Shaare Zedek Medical Center, Shmuel Bait St 12, Jerusalem 9103102, Israel
| | - Yoel Arieli
- Department of Physics/Electro-Optics Engineering, Jerusalem College of Technology, 21 Havaad Haleumi St., Jerusalem 91160, Israel;
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18
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Continuous Near-infrared Spectroscopy Monitoring in Adult Traumatic Brain Injury: A Systematic Review. J Neurosurg Anesthesiol 2020; 32:288-299. [DOI: 10.1097/ana.0000000000000620] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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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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20
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Gerega A, Wojtkiewicz S, Sawosz P, Kacprzak M, Toczylowska B, Bejm K, Skibniewski F, Sobotnicki A, Gacek A, Maniewski R, Liebert A. Assessment of the brain ischemia during orthostatic stress and lower body negative pressure in air force pilots by near-infrared spectroscopy. BIOMEDICAL OPTICS EXPRESS 2020; 11:1043-1060. [PMID: 32133236 PMCID: PMC7041453 DOI: 10.1364/boe.377779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 05/26/2023]
Abstract
A methodology for the assessment of the cerebral hemodynamic reaction to normotensive hypovolemia, reduction in cerebral perfusion and orthostatic stress leading to ischemic hypoxia and reduced muscular tension is presented. Most frequently, the pilots of highly maneuverable aircraft are exposed to these phenomena. Studies were carried out using the system consisting of a chamber that generates low pressure around the lower part of the body - LBNP (lower body negative pressure) placed on the tilt table. An in-house developed 6-channel NIRS system operating at 735 and 850 nm was used in order to assess the oxygenation of the cerebral cortex, based on measurements of diffusely reflected light in reflectance geometry. The measurements were carried out on a group of 12 active pilots and cadets of the Polish Air Force Academy and 12 healthy volunteers. The dynamics of changes in cerebral oxygenation was evaluated as a response to LBNP stimuli with a simultaneous rapid change of the tilt table angle. Parameters based on calculated changes of total hemoglobin concentration were proposed allowing to evaluate differences in reactions observed in control subjects and pilots/cadets. The results of orthogonal partial least squares-discriminant analysis based on these parameters show that the subjects can be classified into their groups with 100% accuracy.
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Affiliation(s)
- Anna Gerega
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Stanislaw Wojtkiewicz
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Piotr Sawosz
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Michal Kacprzak
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Beata Toczylowska
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Karolina Bejm
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Franciszek Skibniewski
- Technical Department of Aeromedical Research and Flight Simulators, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Aleksander Sobotnicki
- Department of Research and Development, Institute of Medical Technology and Equipment, Zabrze, Poland
| | - Adam Gacek
- Department of Research and Development, Institute of Medical Technology and Equipment, Zabrze, Poland
| | - Roman Maniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Adam Liebert
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
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21
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Can Cerebral Near-infrared Spectroscopy Predict Cerebral Ischemic Events in Neurosurgical Patients? A Narrative Review of the Literature. J Neurosurg Anesthesiol 2019; 31:378-384. [DOI: 10.1097/ana.0000000000000522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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22
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Al-Mufti F, Lander M, Smith B, Morris NA, Nuoman R, Gupta R, Lissauer ME, Gupta G, Lee K. Multimodality Monitoring in Neurocritical Care: Decision-Making Utilizing Direct And Indirect Surrogate Markers. J Intensive Care Med 2018; 34:449-463. [PMID: 30205730 DOI: 10.1177/0885066618788022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Substantial progress has been made to create innovative technology that can monitor the different physiological characteristics that precede the onset of secondary brain injury, with the ultimate goal of intervening prior to the onset of irreversible neurological damage. One of the goals of neurocritical care is to recognize and preemptively manage secondary neurological injury by analyzing physiologic markers of ischemia and brain injury prior to the development of irreversible damage. This is helpful in a multitude of neurological conditions, whereby secondary neurological injury could present including but not limited to traumatic intracranial hemorrhage and, specifically, subarachnoid hemorrhage, which has the potential of progressing to delayed cerebral ischemia and monitoring postneurosurgical interventions. In this study, we examine the utilization of direct and indirect surrogate physiologic markers of ongoing neurologic injury, including intracranial pressure, cerebral blood flow, and brain metabolism.
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Affiliation(s)
- Fawaz Al-Mufti
- 1 Division of Neuroendovascular Surgery and Neurocritical Care, Department of Neurology, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,2 Department of Neurosurgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Megan Lander
- 3 Division of Surgical Critical Care, Department of Surgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Brendan Smith
- 4 Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Nicholas A Morris
- 5 Department of Neurology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Rolla Nuoman
- 6 Department of Neurology, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Rajan Gupta
- 3 Division of Surgical Critical Care, Department of Surgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Matthew E Lissauer
- 3 Division of Surgical Critical Care, Department of Surgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Gaurav Gupta
- 7 Division of Neurosurgery, Department of Surgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Kiwon Lee
- 1 Division of Neuroendovascular Surgery and Neurocritical Care, Department of Neurology, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Al-Mufti F, Smith B, Lander M, Damodara N, Nuoman R, El-Ghanem M, Kamal N, Al-Marsoummi S, Alzubaidi B, Nuoaman H, Foreman B, Amuluru K, Gandhi CD. Novel minimally invasive multi-modality monitoring modalities in neurocritical care. J Neurol Sci 2018; 390:184-192. [PMID: 29801883 DOI: 10.1016/j.jns.2018.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/14/2018] [Accepted: 03/25/2018] [Indexed: 11/19/2022]
Abstract
Elevated intracranial pressure (ICP) following brain injury contributes to poor outcomes for patients, primarily by reducing the caliber of cerebral vasculature, and thereby reducing cerebral blood flow. Careful monitoring of ICP is critical in these patients in order to determine prognosis, implement treatment when ICP becomes elevated, and to judge responsiveness to treatment. Currently, the gold standard for monitoring is invasive pressure transducers, usually an intraventricular monitor, which presents significant risk of infection and hemorrhage. These risks made discovering non-invasive methods for monitoring ICP and cerebral perfusion a priority for researchers. Herein we sought to review recent publications on novel minimally invasive multi-modality monitoring techniques that provide surrogate data on ICP, cerebral oxygenation, metabolism and blood flow. While limitations in various forms preclude them from supplanting the use of invasive monitors, these modalities represent useful screening tools within our armamentarium that may be invaluable when the risks of invasive monitoring outweigh the associated benefits.
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Affiliation(s)
- Fawaz Al-Mufti
- Department of Neurology, Neurosurgery and Radiology, Westchester Medical Center at New York Medical College, Valhalla, NY, United States; Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, NJ, United States.
| | - Brendan Smith
- Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Megan Lander
- Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Nitesh Damodara
- Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Rolla Nuoman
- Department of Neurology, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Mohammad El-Ghanem
- Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Naveed Kamal
- Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Sarmad Al-Marsoummi
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Basim Alzubaidi
- Department of Neurology, Neurosurgery and Radiology, Westchester Medical Center at New York Medical College, Valhalla, NY, United States
| | - Halla Nuoaman
- Department of Neurology, Neurosurgery and Radiology, Westchester Medical Center at New York Medical College, Valhalla, NY, United States
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, Division of Neurocritical Care, University of Cincinnati, Cincinnati, OH, United States
| | - Krishna Amuluru
- Department of Neurointerventional Radiology, University of Pittsburgh, Hamot, Erie, PA, United States
| | - Chirag D Gandhi
- Department of Neurosurgery, Westchester Medical Center - New York Medical College, Valhalla, NY, United States
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Lipnick MS, Cahill EA, Feiner JR, Bickler PE. Comparison of Transcranial Doppler and Ultrasound-Tagged Near Infrared Spectroscopy for Measuring Relative Changes in Cerebral Blood Flow in Human Subjects. Anesth Analg 2018; 126:579-587. [DOI: 10.1213/ane.0000000000002590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Effects of Changes in Arterial Carbon Dioxide and Oxygen Partial Pressures on Cerebral Oximeter Performance. Anesthesiology 2017; 128:97-108. [PMID: 29084012 DOI: 10.1097/aln.0000000000001898] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cerebral oximetry (cerebral oxygen saturation; ScO2) is used to noninvasively monitor cerebral oxygenation. ScO2 readings are based on the fraction of reduced and oxidized hemoglobin as an indirect estimate of brain tissue oxygenation and assume a static ratio of arterial to venous intracranial blood. Conditions that alter cerebral blood flow, such as acute changes in PaCO2, may decrease accuracy. We assessed the performance of two commercial cerebral oximeters across a range of oxygen concentrations during normocapnia and hypocapnia. METHODS Casmed FORE-SIGHT Elite (CAS Medical Systems, Inc., USA) and Covidien INVOS 5100C (Covidien, USA) oximeter sensors were placed on 12 healthy volunteers. The fractional inspired oxygen tension was varied to achieve seven steady-state levels including hypoxic and hyperoxic PaO2 values. ScO2 and simultaneous arterial and jugular venous blood gas measurements were obtained with both normocapnia and hypocapnia. Oximeter bias was calculated as the difference between the ScO2 and reference saturation using manufacturer-specified weighting ratios from the arterial and venous samples. RESULTS FORE-SIGHT Elite bias was greater during hypocapnia as compared with normocapnia (4 ± 9% vs. 0 ± 6%; P < 0.001). The INVOS 5100C bias was also lower during normocapnia (5 ± 15% vs. 3 ± 12%; P = 0.01). Hypocapnia resulted in a significant decrease in mixed venous oxygen saturation and mixed venous oxygen tension, as well as increased oxygen extraction across fractional inspired oxygen tension levels (P < 0.0001). Bias increased significantly with increasing oxygen extraction (P < 0.0001). CONCLUSIONS Changes in PaCO2 affect cerebral oximeter accuracy, and increased bias occurs with hypocapnia. Decreased accuracy may represent an incorrect assumption of a static arterial-venous blood fraction. Understanding cerebral oximetry limitations is especially important in patients at risk for hypoxia-induced brain injury, where PaCO2 may be purposefully altered.
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Mehta JN, Parmar LD. The effect of positional changes on oxygenation in patients with head injury in the intensive care unit. J Family Med Prim Care 2017; 6:853-858. [PMID: 29564277 PMCID: PMC5848412 DOI: 10.4103/jfmpc.jfmpc_27_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Following head injury, cardiopulmonary functions are impaired and this disturbs the oxygenation transport pathway. Expanding cardiopulmonary physical therapy to encompass the oxygen transport system as a whole has implication for treatment as well as assessment and treatment outcome. Therefore, the aim of the study is to assess the oxygenation level in head injury patients with relation to body positioning in the intensive care unit (ICU). Methodology: Thirty consecutive patients with head injury with hemodynamically stable were included from the surgical ICU, ages ranging from 15 to 50 years. Noninvasive vital parameters (oxygen saturation [SpO2], pulse rate [PR], respiratory rate [RR], and blood pressure [BP]) were observed and recorded in different body positions at regular intervals of 5 min for 15 min in each position. Results: There was increment in SpO2 value in all positions from 0 min to end of 15 min in supine (98.63 ± 0.36–98.73 ± 0.30), right-side lying (98.77 ± 0.30–98.93 ± 0.20), left-side lying (98.73 ± 0.29–99.03 ± 0.24), and recline sitting (30°–70°) (99.03 ± 0.24–99.50 ± 0.22). However, there was statistically significant increment in recline sitting (30°–70°) compared to other positions (P = 0.036) while other parameters (PR, RR, and BP) were getting stabilized at lower values at end of 15 min in every positions tested. Conclusion: We conclude that upright position bring about significant increase in arterial SpO2 compared to any other positions. Other vital parameters were seen to stabilize at lower values at the end of 15 min in every position tested.
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Affiliation(s)
- Jigar Nayankumar Mehta
- Department of Physiotherapy, K M Patel Institute of Physiotherapy, Shree Krishna Hospital Karamsad, Vadodara, Gujarat, India
| | - Lata D Parmar
- Department of Physiotherapy, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
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Weigl W, Milej D, Janusek D, Wojtkiewicz S, Sawosz P, Kacprzak M, Gerega A, Maniewski R, Liebert A. Application of optical methods in the monitoring of traumatic brain injury: A review. J Cereb Blood Flow Metab 2016; 36:1825-1843. [PMID: 27604312 PMCID: PMC5094301 DOI: 10.1177/0271678x16667953] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/28/2016] [Accepted: 07/18/2016] [Indexed: 01/19/2023]
Abstract
We present an overview of the wide range of potential applications of optical methods for monitoring traumatic brain injury. The MEDLINE database was electronically searched with the following search terms: "traumatic brain injury," "head injury," or "head trauma," and "optical methods," "NIRS," "near-infrared spectroscopy," "cerebral oxygenation," or "cerebral oximetry." Original reports concerning human subjects published from January 1980 to June 2015 in English were analyzed. Fifty-four studies met our inclusion criteria. Optical methods have been tested for detection of intracranial lesions, monitoring brain oxygenation, assessment of brain perfusion, and evaluation of cerebral autoregulation or intracellular metabolic processes in the brain. Some studies have also examined the applicability of optical methods during the recovery phase of traumatic brain injury . The limitations of currently available optical methods and promising directions of future development are described in this review. Considering the outstanding technical challenges, the limited number of patients studied, and the mixed results and opinions gathered from other reviews on this subject, we believe that optical methods must remain primarily research tools for the present. More studies are needed to gain confidence in the use of these techniques for neuromonitoring of traumatic brain injury patients.
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Affiliation(s)
- Wojciech Weigl
- Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, Akademiska Hospital, Uppsala, Sweden
| | - Daniel Milej
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Dariusz Janusek
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Stanisław Wojtkiewicz
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Piotr Sawosz
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Michał Kacprzak
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Anna Gerega
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Roman Maniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Adam Liebert
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
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Rettig JS, Duncan ED, Tasker RC. Mechanical Ventilation during Acute Brain-Injury in Children. Paediatr Respir Rev 2016; 20:17-23. [PMID: 26972477 DOI: 10.1016/j.prrv.2016.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/10/2016] [Indexed: 01/05/2023]
Abstract
Mechanical ventilation in the brain-injured pediatric patient requires many considerations, including the type and severity of lung and brain injury and how progression of such injury will develop. This review focuses on neurological breathing patterns at presentation, the effect of brain injury on the lung, developmental aspects of blood gas tensions on cerebral blood flow, and strategies used during mechanical ventilation in infants and children receiving neurological intensive care. Taking these basic principles, our clinical approach is informed by balancing the blood gas tension targets that follow from the ventilation support we choose and the intracranial consequences of these choices on vascular and hydrodynamic physiology. As such, we are left with two key decisions: a low tidal volume strategy for the lung versus the consequence of hypercapnia on the brain; and the use of positive end expiratory pressure to optimize oxygenation versus the consequence of impaired cerebral venous return from the brain and resultant intracranial hypertension.
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Affiliation(s)
- Jordan S Rettig
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine
| | - Elizabeth D Duncan
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine
| | - Robert C Tasker
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine; Department of Neurology; Boston Children's Hospital and Harvard Medical School, Boston, MA.
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Tsai HI, Chung PCH, Lee CW, Yu HP. Cerebral perfusion monitoring in acute care surgery: current and perspective use. Expert Rev Med Devices 2016; 13:865-75. [DOI: 10.1080/17434440.2016.1219655] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Sen AN, Gopinath SP, Robertson CS. Clinical application of near-infrared spectroscopy in patients with traumatic brain injury: a review of the progress of the field. NEUROPHOTONICS 2016; 3:031409. [PMID: 27226973 PMCID: PMC4874161 DOI: 10.1117/1.nph.3.3.031409] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 03/31/2016] [Indexed: 05/24/2023]
Abstract
Near-infrared spectroscopy (NIRS) is a technique by which the interaction between light in the near-infrared spectrum and matter can be quantitatively measured to provide information about the particular chromophore. Study into the clinical application of NIRS for traumatic brain injury (TBI) began in the 1990s with early reports of the ability to detect intracranial hematomas using NIRS. We highlight the advances in clinical applications of NIRS over the past two decades as they relate to TBI. We discuss recent studies evaluating NIRS techniques for intracranial hematoma detection, followed by the clinical application of NIRS in intracranial pressure and brain oxygenation measurement, and conclude with a summary of potential future uses of NIRS in TBI patient management.
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Affiliation(s)
- Anish N. Sen
- Baylor College of Medicine, Department of Neurosurgery, 7200 Cambridge Street, Suite 9A, Houston, Texas 77030, United States
| | - Shankar P. Gopinath
- Baylor College of Medicine, Department of Neurosurgery, 7200 Cambridge Street, Suite 9A, Houston, Texas 77030, United States
| | - Claudia S. Robertson
- Baylor College of Medicine, Department of Neurosurgery, 7200 Cambridge Street, Suite 9A, Houston, Texas 77030, United States
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Gelabert-González M, Arán-Echabe E. Neuromonitorización en el traumatismo craneoencefálico grave pediátrico. Neurocirugia (Astur) 2016; 27:204-5. [DOI: 10.1016/j.neucir.2016.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 02/19/2016] [Indexed: 10/22/2022]
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Chung DY, Claassen J, Agarwal S, Schmidt JM, Mayer SA. Assessment of Noninvasive Regional Brain Oximetry in Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome. J Intensive Care Med 2016; 31:415-9. [PMID: 26732768 DOI: 10.1177/0885066615623465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 12/01/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) leads to small- and large-vessel circulatory dysfunction. While aggressive lowering of elevated blood pressure is the usual treatment for PRES, excessive blood pressure reduction may lead to ischemia or infarction, particularly when PRES is accompanied by reversible cerebral vasoconstriction syndrome (RCVS). Regional cerebral oximetry using near-infrared spectroscopy is a noninvasive modality that is commonly used intraoperatively and in intensive care settings to monitor regional cerebral oxygenation (rSO2) and may be useful in guiding treatment in select cases of PRES and RCVS. RESULTS We report a case of a patient with PRES complicated by infarction and RCVS where the optimal blood pressure management was unclear. A decision was made to decrease blood pressure which resulted in an improved neurological examination and increase in rSO2 from 40% to 55% in at-risk brain. Infarcted brain as determined by diffusion-weighted magnetic resonance imaging and computed tomography perfusion imaging showed no change in rSO2 during the same time period. Furthermore, there was a qualitative change in the rSO2-mean arterial pressure (MAP) relationship, suggesting an alteration in cerebrovascular autoregulation as a result of lowering blood pressure. CONCLUSIONS Regional cerebral oximetry can provide valuable diagnostic feedback in complicated cases of PRES and RCVS.
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Affiliation(s)
- David Y Chung
- Department of Neurology, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA
| | - Jan Claassen
- Department of Neurology and Neurosurgery, Columbia University, New York, NY, USA
| | - Sachin Agarwal
- Department of Neurology and Neurosurgery, Columbia University, New York, NY, USA
| | - J Michael Schmidt
- Department of Neurology and Neurosurgery, Columbia University, New York, NY, USA
| | - Stephan A Mayer
- Department of Critical Care, Mount Sinai Hospital, New York, NY, USA
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Vespa P, Menon D, Le Roux P. The International Multi-disciplinary Consensus Conference on Multimodality Monitoring: future directions and emerging technologies. Neurocrit Care 2015; 21 Suppl 2:S270-81. [PMID: 25208681 DOI: 10.1007/s12028-014-0049-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Neuromonitoring has evolved rapidly in recent years and there now are many new monitors that have revealed a great deal about the ongoing pathophysiology of brain injury and coma. Further evolution will include the consolidation of multi-modality monitoring (MMM), the development of next-generation informatics tools to identify complex physiologic events and decision support tools to permit targeted individualized care. In this review, we examine future directions and emerging technologies in neuromonitoring including: (1) device development, (2) what is the current limitation(s) of MMM in its present format(s), (3) what would improve the ability of MMM to enhance neurocritical care, and (4) how do we develop evidence for use of MMM?
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Affiliation(s)
- Paul Vespa
- Neurocritical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Lund A, Secher NH, Hirasawa A, Ogoh S, Hashimoto T, Schytz HW, Ashina M, Sørensen H. Ultrasound tagged near infrared spectroscopy does not detect hyperventilation-induced reduction in cerebral blood flow. Scandinavian Journal of Clinical and Laboratory Investigation 2015; 76:82-7. [DOI: 10.3109/00365513.2015.1101485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kerz T, Beyer C, Huthmann A, Kalasauskas D, Amr AN, Boor S, Welschehold S. Continuous-wave near-infrared spectroscopy is not related to brain tissue oxygen tension. J Clin Monit Comput 2015; 30:641-7. [DOI: 10.1007/s10877-015-9755-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/17/2015] [Indexed: 01/21/2023]
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Edlow BL, Rosenthal ES. Diagnostic, Prognostic, and Advanced Imaging in Severe Traumatic Brain Injury. CURRENT TRAUMA REPORTS 2015. [DOI: 10.1007/s40719-015-0018-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Reis C, Wang Y, Akyol O, Ho WM, Ii RA, Stier G, Martin R, Zhang JH. What's New in Traumatic Brain Injury: Update on Tracking, Monitoring and Treatment. Int J Mol Sci 2015; 16:11903-65. [PMID: 26016501 PMCID: PMC4490422 DOI: 10.3390/ijms160611903] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI), defined as an alteration in brain functions caused by an external force, is responsible for high morbidity and mortality around the world. It is important to identify and treat TBI victims as early as possible. Tracking and monitoring TBI with neuroimaging technologies, including functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), positron emission tomography (PET), and high definition fiber tracking (HDFT) show increasing sensitivity and specificity. Classical electrophysiological monitoring, together with newly established brain-on-chip, cerebral microdialysis techniques, both benefit TBI. First generation molecular biomarkers, based on genomic and proteomic changes following TBI, have proven effective and economical. It is conceivable that TBI-specific biomarkers will be developed with the combination of systems biology and bioinformation strategies. Advances in treatment of TBI include stem cell-based and nanotechnology-based therapy, physical and pharmaceutical interventions and also new use in TBI for approved drugs which all present favorable promise in preventing and reversing TBI.
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Affiliation(s)
- Cesar Reis
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Yuechun Wang
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Physiology, School of Medicine, University of Jinan, Guangzhou 250012, China.
| | - Onat Akyol
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
| | - Wing Mann Ho
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Neurosurgery, University Hospital Innsbruck, Tyrol 6020, Austria.
| | - Richard Applegate Ii
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Gary Stier
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Robert Martin
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - John H Zhang
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA.
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Davies DJ, Su Z, Clancy MT, Lucas SJE, Dehghani H, Logan A, Belli A. Near-Infrared Spectroscopy in the Monitoring of Adult Traumatic Brain Injury: A Review. J Neurotrauma 2015; 32:933-41. [PMID: 25603012 DOI: 10.1089/neu.2014.3748] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cerebral near-infrared spectroscopy (NIRS) has long represented an exciting prospect for the noninvasive monitoring of cerebral tissue oxygenation and perfusion in the context of traumatic brain injury (TBI), although uncertainty still exists regarding the reliability of this technology specifically within this field. We have undertaken a review of the existing literature relating to the application of NIRS within TBI. We discuss current "state-of-the-art" NIRS monitoring, provide a brief background of the technology, and discuss the evidence regarding the ability of NIRS to substitute for established invasive monitoring in TBI.
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Affiliation(s)
- David J Davies
- 1 Department of Neurosurgery Clinical Research, Queen Elizabeth Hospital , Edgbaston, Birmingham, United Kingdom
| | - Zhangjie Su
- 1 Department of Neurosurgery Clinical Research, Queen Elizabeth Hospital , Edgbaston, Birmingham, United Kingdom
| | - Michael T Clancy
- 2 School of Computational Science Medical Imaging Group, University of Birmingham , Edgbaston, Birmingham, United Kingdom
| | - Samuel J E Lucas
- 3 Department of Exercise Physiology, School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham , Edgbaston, Birmingham, United Kingdom
| | - Hamid Dehghani
- 4 Department of Medical Imaging, School of Computer Science, University of Birmingham , Edgbaston, Birmingham, United Kingdom
| | - Ann Logan
- 5 Department of Molecular Neuroscience, School of Clinical and Experimental Medicine, University of Birmingham , Edgbaston, Birmingham, United Kingdom
| | - Antonio Belli
- 6 Department of Surgical Neurology, National Institute for Health Research, Queen Elizabeth Hospital , Edgbaston, Birmingham, United Kingdom
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