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Kartal A, Robba C, Helmy A, Wolf S, Aries MJH. How to Define and Meet Blood Pressure Targets After Traumatic Brain Injury: A Narrative Review. Neurocrit Care 2024:10.1007/s12028-024-02048-5. [PMID: 38982005 DOI: 10.1007/s12028-024-02048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/13/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Traumatic brain injury (TBI) poses a significant challenge to healthcare providers, necessitating meticulous management of hemodynamic parameters to optimize patient outcomes. This article delves into the critical task of defining and meeting continuous arterial blood pressure (ABP) and cerebral perfusion pressure (CPP) targets in the context of severe TBI in neurocritical care settings. METHODS We narratively reviewed existing literature, clinical guidelines, and emerging technologies to propose a comprehensive approach that integrates real-time monitoring, individualized cerebral perfusion target setting, and dynamic interventions. RESULTS Our findings emphasize the need for personalized hemodynamic management, considering the heterogeneity of patients with TBI and the evolving nature of their condition. We describe the latest advancements in monitoring technologies, such as autoregulation-guided ABP/CPP treatment, which enable a more nuanced understanding of cerebral perfusion dynamics. By incorporating these tools into a proactive monitoring strategy, clinicians can tailor interventions to optimize ABP/CPP and mitigate secondary brain injury. DISCUSSION Challenges in this field include the lack of standardized protocols for interpreting multimodal neuromonitoring data, potential variability in clinical decision-making, understanding the role of cardiac output, and the need for specialized expertise and customized software to have individualized ABP/CPP targets regularly available. The patient outcome benefit of monitoring-guided ABP/CPP target definitions still needs to be proven in patients with TBI. CONCLUSIONS We recommend that the TBI community take proactive steps to translate the potential benefits of personalized ABP/CPP targets, which have been implemented in certain centers, into a standardized and clinically validated reality through randomized controlled trials.
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Affiliation(s)
- Ahmet Kartal
- University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany.
| | - Chiara Robba
- Anesthesia and Intensive Care, IRCCS Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Sciences, University of Genoa, Genoa, Italy
| | - Adel Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Stefan Wolf
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcel J H Aries
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
- Institute of Mental Health and Neurosciences, University Maastricht, Maastricht, The Netherlands
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2
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Nguyen T, Park S, Park J, Sodager A, George T, Gandjbakhche A. Application of the Single Source-Detector Separation Algorithm in Wearable Neuroimaging Devices: A Step toward Miniaturized Biosensor for Hypoxia Detection. Bioengineering (Basel) 2024; 11:385. [PMID: 38671806 PMCID: PMC11048477 DOI: 10.3390/bioengineering11040385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Most currently available wearable devices to noninvasively detect hypoxia use the spatially resolved spectroscopy (SRS) method to calculate cerebral tissue oxygen saturation (StO2). This study applies the single source-detector separation (SSDS) algorithm to calculate StO2. Near-infrared spectroscopy (NIRS) data were collected from 26 healthy adult volunteers during a breath-holding task using a wearable NIRS device, which included two source-detector separations (SDSs). These data were used to derive oxyhemoglobin (HbO) change and StO2. In the group analysis, both HbO change and StO2 exhibited significant change during a breath-holding task. Specifically, they initially decreased to minimums at around 10 s and then steadily increased to maximums, which were significantly greater than baseline levels, at 25-30 s (p-HbO < 0.001 and p-StO2 < 0.05). However, at an individual level, the SRS method failed to detect changes in cerebral StO2 in response to a short breath-holding task. Furthermore, the SSDS algorithm is more robust than the SRS method in quantifying change in cerebral StO2 in response to a breath-holding task. In conclusion, these findings have demonstrated the potential use of the SSDS algorithm in developing a miniaturized wearable biosensor to monitor cerebral StO2 and detect cerebral hypoxia.
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Affiliation(s)
| | | | | | | | | | - Amir Gandjbakhche
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 49 Convent Drive, Bethesda, MD 20892-4480, USA; (T.N.); (S.P.); (J.P.); (A.S.); (T.G.)
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3
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Lin L, Zeng H, Wang S, Cheng L, Wang K, Li G. A joint evaluation method of dynamic spectrum extraction methods for non-invasive blood component measurement based on stability coefficient, data point adoption rate, and smoothness of the spectrum. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107971. [PMID: 38128463 DOI: 10.1016/j.cmpb.2023.107971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Dynamic spectrum (DS) theory is a new non-invasive detection method of human blood components that can theoretically eliminate individual differences in static tissues and the influence of other measurement conditions to achieve blood component analysis with high precision. In order to obtain a high signal-to-noise ratio dynamic spectrum, researchers have proposed various dynamic spectrum extraction methods. METHODS In this article, we propose three indexes: stability coefficient (SC), data point adoption rate (DAR), and smoothness of spectrum (SS). These solve the difficulty in evaluating different dynamic spectrum extraction methods without establishing mathematical models. RESULTS In this study, DS is extracted using different dynamic spectrum extraction methods from the experimental data of 677 volunteers. Then three indexes, SC, DAR, and SS, are calculated. The trends in the scatter plot of the relationship between the three indexes and modeling results of hemoglobin, red blood cell count, and white blood cell count and the related coefficients demonstrate that SC, DAR, and SS are feasible and effective for evaluation. The results show that the root mean square extraction performs best, while the peak-to-peak value and the fast Fourier transform extraction are the worst. CONCLUSIONS This study proposes feasible and effective indexes for evaluating dynamic spectrum extraction methods, providing a possibility for further research on high-precision dynamic spectrum extraction methods.
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Affiliation(s)
- Ling Lin
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, China.
| | - Honghui Zeng
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, China
| | - Shuo Wang
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, China
| | - Leiyang Cheng
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, China
| | - Kang Wang
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, China
| | - Gang Li
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, China
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4
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Leadley G, Austin T, Bale G. Review of measurements and imaging of cytochrome-c-oxidase in humans using near-infrared spectroscopy: an update. BIOMEDICAL OPTICS EXPRESS 2024; 15:162-184. [PMID: 38223181 PMCID: PMC10783912 DOI: 10.1364/boe.501915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/21/2023] [Indexed: 01/16/2024]
Abstract
This review examines advancements in the measurement and imaging of oxidized cytochrome-c-oxidase (oxCCO) using near-infrared spectroscopy (NIRS) in humans since 2016. A total of 34 published papers were identified, with a focus on both adult and neonate populations. The NIRS-derived oxCCO signal has been demonstrated to correlate with physiological parameters and hemodynamics. New instrumentation, such as systems that allow the imaging of changes of oxCCO with diffuse optical tomography or combine the oxCCO measurement with diffuse correlation spectroscopy measures of blood flow, have advanced the field in the past decade. However, variability in its response across different populations and paradigms and lack of standardization limit its potential as a reliable and valuable indicator of brain health. Future studies should address these issues to fulfill the vision of oxCCO as a clinical biomarker.
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Affiliation(s)
- Georgina Leadley
- Department of Paediatrics, University of Cambridge, UK
- Department of Engineering, University of Cambridge, UK
- Department of Medical Physics and Biomedical Engineering, UCL, UK
| | - Topun Austin
- Department of Paediatrics, University of Cambridge, UK
| | - Gemma Bale
- Department of Engineering, University of Cambridge, UK
- Department of Physics, University of Cambridge, UK
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5
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Beqiri E, Smielewski P, Guérin C, Czosnyka M, Robba C, Bjertnæs L, Frisvold SK. Neurological and respiratory effects of lung protective ventilation in acute brain injury patients without lung injury: brain vent, a single centre randomized interventional study. Crit Care 2023; 27:115. [PMID: 36941683 PMCID: PMC10026451 DOI: 10.1186/s13054-023-04383-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/25/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Lung protective ventilation (LPV) comprising low tidal volume (VT) and high positive end-expiratory pressure (PEEP) may compromise cerebral perfusion in acute brain injury (ABI). In patients with ABI, we investigated whether LPV is associated with increased intracranial pressure (ICP) and/or deranged cerebral autoregulation (CA), brain compensatory reserve and oxygenation. METHODS In a prospective, crossover study, 30 intubated ABI patients with normal ICP and no lung injury were randomly assigned to receive low VT [6 ml/kg/predicted (pbw)]/at either low (5 cmH2O) or high PEEP (12 cmH2O). Between each intervention, baseline ventilation (VT 9 ml/kg/pbw and PEEP 5 cmH2O) were resumed. The safety limit for interruption of the intervention was ICP above 22 mmHg for more than 5 min. Airway and transpulmonary pressures were continuously monitored to assess respiratory mechanics. We recorded ICP by using external ventricular drainage or a parenchymal probe. CA and brain compensatory reserve were derived from ICP waveform analysis. RESULTS We included 27 patients (intracerebral haemorrhage, traumatic brain injury, subarachnoid haemorrhage), of whom 6 reached the safety limit, which required interruption of at least one intervention. For those without intervention interruption, the ICP change from baseline to "low VT/low PEEP" and "low VT/high PEEP" were 2.2 mmHg and 2.3 mmHg, respectively, and considered clinically non-relevant. None of the interventions affected CA or oxygenation significantly. Interrupted events were associated with high baseline ICP (p < 0.001), low brain compensatory reserve (p < 0.01) and mechanical power (p < 0.05). The transpulmonary driving pressure was 5 ± 2 cmH2O in both interventions. Partial arterial pressure of carbon dioxide was kept in the range 34-36 mmHg by adjusting the respiratory rate, hence, changes in carbon dioxide were not associated with the increase in ICP. CONCLUSIONS The present study found that most patients did not experience any adverse effects of LPV, neither on ICP nor CA. However, in almost a quarter of patients, the ICP rose above the safety limit for interrupting the interventions. Baseline ICP, brain compensatory reserve, and mechanical power can predict a potentially deleterious effect of LPV and can be used to personalize ventilator settings. Trial registration NCT03278769 . Registered September 12, 2017.
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Affiliation(s)
- Erta Beqiri
- Department of Clinical Neurosciences, Neurosurgery Department, University of Cambridge, Cambridge, UK
| | - Peter Smielewski
- Department of Clinical Neurosciences, Neurosurgery Department, University of Cambridge, Cambridge, UK
| | - Claude Guérin
- University of Lyon, Lyon, France
- INSERM955, Créteil, France
| | - Marek Czosnyka
- Department of Clinical Neurosciences, Neurosurgery Department, University of Cambridge, Cambridge, UK
| | - Chiara Robba
- IRCCS for Oncology and Neuroscience, Policlinico San Martino, Genoa, Italy
- Department of Surgical Science Diagnostic and Integrated, University of Genova, Genoa, Italy
| | - Lars Bjertnæs
- Department of Anaesthesia and Intensive Care, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Shirin K Frisvold
- Department of Anaesthesia and Intensive Care, University Hospital of North Norway, Tromsø, Norway.
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
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6
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Leyba K, Paiyabhroma N, Salvas JP, Damen FW, Janvier A, Zub E, Bernis C, Rouland R, Dubois CJ, Badaut J, Richard S, Marchi N, Goergen CJ, Sicard P. Neurovascular hypoxia after mild traumatic brain injury in juvenile mice correlates with heart-brain dysfunctions in adulthood. Acta Physiol (Oxf) 2023; 238:e13933. [PMID: 36625322 DOI: 10.1111/apha.13933] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/20/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
AIM Retrospective studies suggest that mild traumatic brain injury (mTBI) in pediatric patients may lead to an increased risk of cardiac events. However, the exact functional and temporal dynamics and the associations between heart and brain pathophysiological trajectories are not understood. METHODS A single impact to the left somatosensory cortical area of the intact skull was performed on juvenile mice (17 days postnatal). Cerebral 3D photoacoustic imaging was used to measure the oxygen saturation (sO2 ) in the impacted area 4 h after mTBI followed by 2D and 4D echocardiography at days 7, 30, 90, and 190 post-impact. At 8 months, we performed a dobutamine stress test to evaluate cardiac function. Lastly, behavioral analyses were conducted 1 year after initial injury. RESULTS We report a rapid and transient decrease in cerebrovascular sO2 and increased hemoglobin in the impacted left brain cortex. Cardiac analyses showed long-term diastolic dysfunction and a diminished systolic strain response under stress in the mTBI group. At the molecular level, cardiac T-p38MAPK and troponin I expression was pathologic modified post-mTBI. We found linear correlations between brain sO2 measured immediately post-mTBI and long-term cardiac strain after 8 months. We report that initial cerebrovascular hypoxia and chronic cardiac dysfunction correlated with long-term behavioral changes hinting at anxiety-like and memory maladaptation. CONCLUSION Experimental juvenile mTBI induces time-dependent cardiac dysfunction that corresponds to the initial neurovascular sO2 dip and is associated with long-term behavioral modifications. These imaging biomarkers of the heart-brain axis could be applied to improve clinical pediatric mTBI management.
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Affiliation(s)
- Katherine Leyba
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Nitchawat Paiyabhroma
- PhyMedExp, INSERM/CNRS/Université de Montpellier, IPAM/Biocampus, Montpellier, France
| | - John P Salvas
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Frederick W Damen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Alicia Janvier
- Institute de Genomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Emma Zub
- Institute de Genomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Corinne Bernis
- Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Inserm/Université Paul Sabatier UMR1048, Toulouse, France
| | | | | | - Jerome Badaut
- Univ. Bordeaux, CNRS, CRMSB, UMR 5536, Bordeaux, France
| | - Sylvain Richard
- PhyMedExp, INSERM/CNRS/Université de Montpellier, IPAM/Biocampus, Montpellier, France
| | - Nicola Marchi
- Institute de Genomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Pierre Sicard
- PhyMedExp, INSERM/CNRS/Université de Montpellier, IPAM/Biocampus, Montpellier, France
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7
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Valle D, Villarreal XP, Lunny C, Chalamgari A, Wajid M, Mahmood A, Buthani S, Lucke-Wold B. Surgical Management of Neurotrauma: When to Intervene. JOURNAL OF CLINICAL TRIALS AND REGULATIONS 2022; 4:41-55. [PMID: 36643025 PMCID: PMC9840531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Neurotrauma, often defined as abrupt damage to the brain or spinal cord, is a substantial cause of mortality and morbidity that is widely recognized. As such, establishing an effective course of action is crucial to the enhancement of neurotrauma guidelines and patient outcomes in healthcare worldwide. Following the onset of neurotraumatic injuries, time is perhaps the most critical facet in diminishing mortality and morbidity rates. Thus, procuring the airway should be of utmost priority in a patient to allow for optimal ventilation, with a shift in focus resorting to surgical interventions after the patient reaches a suitable care facility. In particular, ventriculoperitoneal shunt (VPS) procedures have long been utilized to treat traumatic brain and spinal cord injuries to direct additional cerebrospinal fluid (CSF) from the lateral ventricles through a ventricular catheter attached to a valve that is further connected to a distal catheter. Decompressive cranio omie (DCs), cranioplasties, and intracranial pressure measurements (ICP) are also frequently performed in combination with VPS to manage intracranial hypertension and cerebral edema. Although the current surgical methods utilized in the treatment of neurotrauma prove to be highly efficacious in the prevention of adverse outcomes, emergent therapies are growing in popularity. Of interest, the Three Pillars Expansive Craniotomy, cisternostomy, and external lumbar drainages are cutting-edge procedures with promising results that can potentially usher change in the neurosurgical industry but require additional examination.
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Affiliation(s)
- Daisy Valle
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Xuban Palau Villarreal
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Caroline Lunny
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Anjalika Chalamgari
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Manahil Wajid
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Arman Mahmood
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Siya Buthani
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Brandon Lucke-Wold
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
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8
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Poon CS, Langri DS, Rinehart B, Rambo TM, Miller AJ, Foreman B, Sunar U. First-in-clinical application of a time-gated diffuse correlation spectroscopy system at 1064 nm using superconducting nanowire single photon detectors in a neuro intensive care unit. BIOMEDICAL OPTICS EXPRESS 2022; 13:1344-1356. [PMID: 35414986 PMCID: PMC8973196 DOI: 10.1364/boe.448135] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 06/02/2023]
Abstract
Recently proposed time-gated diffuse correlation spectroscopy (TG-DCS) has significant advantages compared to conventional continuous wave (CW)-DCS, but it is still in an early stage and clinical capability has yet to be established. The main challenge for TG-DCS is the lower signal-to-noise ratio (SNR) when gating for the deeper traveling late photons. Longer wavelengths, such as 1064 nm have a smaller effective attenuation coefficient and a higher power threshold in humans, which significantly increases the SNR. Here, we demonstrate the clinical utility of TG-DCS at 1064 nm in a case study on a patient with severe traumatic brain injury admitted to the neuro-intensive care unit (neuroICU). We showed a significant correlation between TG-DCS early (ρ = 0.67) and late (ρ = 0.76) gated against invasive thermal diffusion flowmetry. We also analyzed TG-DCS at high temporal resolution (50 Hz) to elucidate pulsatile flow data. Overall, this study demonstrates the first clinical translation capability of the TG-DCS system at 1064 nm using a superconducting nanowire single-photon detector.
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Affiliation(s)
- Chien-Sing Poon
- Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH 45435, USA
| | - Dharminder S. Langri
- Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH 45435, USA
| | - Benjamin Rinehart
- Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH 45435, USA
| | | | | | - Brandon Foreman
- Dept of Neurology & Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Ulas Sunar
- Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH 45435, USA
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9
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Wilde EA, Wanner I, Kenney K, Gill J, Stone JR, Disner S, Schnakers C, Meyer R, Prager EM, Haas M, Jeromin A. A Framework to Advance Biomarker Development in the Diagnosis, Outcome Prediction, and Treatment of Traumatic Brain Injury. J Neurotrauma 2022; 39:436-457. [PMID: 35057637 PMCID: PMC8978568 DOI: 10.1089/neu.2021.0099] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Elisabeth A. Wilde
- University of Utah, Neurology, 383 Colorow, Salt Lake City, Utah, United States, 84108
- VA Salt Lake City Health Care System, 20122, 500 Foothill Dr., Salt Lake City, Utah, United States, 84148-0002
| | - Ina Wanner
- UCLA, Semel Institute, NRB 260J, 635 Charles E. Young Drive South, Los Angeles, United States, 90095-7332, ,
| | - Kimbra Kenney
- Uniformed Services University of the Health Sciences, Neurology, Center for Neuroscience and Regenerative Medicine, 4301 Jones Bridge Road, Bethesda, Maryland, United States, 20814
| | - Jessica Gill
- National Institutes of Health, National Institute of Nursing Research, 1 cloister, Bethesda, Maryland, United States, 20892
| | - James R. Stone
- University of Virginia, Radiology and Medical Imaging, Box 801339, 480 Ray C. Hunt Dr. Rm. 185, Charlottesville, Virginia, United States, 22903, ,
| | - Seth Disner
- Minneapolis VA Health Care System, 20040, Minneapolis, Minnesota, United States
- University of Minnesota Medical School Twin Cities, 12269, 10Department of Psychiatry and Behavioral Sciences, Minneapolis, Minnesota, United States
| | - Caroline Schnakers
- Casa Colina Hospital and Centers for Healthcare, 6643, Pomona, California, United States
- Ronald Reagan UCLA Medical Center, 21767, Los Angeles, California, United States
| | - Restina Meyer
- Cohen Veterans Bioscience, 476204, New York, New York, United States
| | - Eric M Prager
- Cohen Veterans Bioscience, 476204, External Affairs, 535 8th Ave, New York, New York, United States, 10018
| | - Magali Haas
- Cohen Veterans Bioscience, 476204, 535 8th Avenue, 12th Floor, New York City, New York, United States, 10018,
| | - Andreas Jeromin
- Cohen Veterans Bioscience, 476204, Translational Sciences, Cambridge, Massachusetts, United States
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10
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Abdallah N, Abo Elela A, Maghawry H, Alkonaiesy R. Effect of different mechanical ventilation modes on cerebral blood flow during thoracoscopic surgery in neonates: A randomised controlled trial. Indian J Anaesth 2022; 66:651-656. [PMID: 36388436 PMCID: PMC9662094 DOI: 10.4103/ija.ija_1065_21] [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: 12/14/2021] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/28/2022] Open
Abstract
Background and Aims: Infants exposed to major surgery are at risk of injuries to the immature brain because of reduced arterial oxygen saturation. This study compared the effect of volume-controlled ventilation (VCV) versus pressure-controlled ventilation (PCV) on cerebral oxygenation in neonates subjected to repair of tracheoesophageal fistula (TEF) under video-assisted thoracoscopic surgery (VATS). Methods: This randomised controlled study included 30 full-term neonates scheduled for VATS for managing TEF under general anaesthesia. They were randomised to either VC group (n = 15), who received VCV, or PC group (n = 15), who received PCV. Cerebral oxygenation (rScO2) was monitored throughout the surgery with documentation of episodes of cerebral desaturation. Peripheral oxygen saturation, partial pressure of carbon dioxide (PaCO2), and end-tidal carbon dioxide were recorded at baseline, after induction of anaesthesia, and every 30 min till the end of the surgery. Results: rScO2 was significantly higher in the PC group than the VC group at baseline and was significantly higher in the VC group after 15 min (P = 0.041). Later, it was comparable in both the groups up to 60 min after starting the surgery. Cerebral desaturation was significantly more common in the PC group (80%) compared to VC group (33.3%) (P = 0.010). PC group required higher fraction of inspired oxygen and positive end-expiratory pressure to prevent cerebral desaturation. PaCO2 was significantly higher in the PC group than the VC group at 30 and 60 min (P = 0.005 and 0.029). Conclusion: VCV is safer than PCV for cerebral oxygenation during VATS in neonates.
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11
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Zhong W, Ji Z, Sun C. A Review of Monitoring Methods for Cerebral Blood Oxygen Saturation. Healthcare (Basel) 2021; 9:healthcare9091104. [PMID: 34574878 PMCID: PMC8466732 DOI: 10.3390/healthcare9091104] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/13/2021] [Accepted: 07/31/2021] [Indexed: 01/02/2023] Open
Abstract
In recent years, cerebral blood oxygen saturation has become a key indicator during the perioperative period. Cerebral blood oxygen saturation monitoring is conducive to the early diagnosis and treatment of cerebral ischemia and hypoxia. The present study discusses the three most extensively used clinical methods for cerebral blood oxygen saturation monitoring from different aspects: working principles, relevant parameters, current situations of research, commonly used equipment, and relative advantages of different methods. Furthermore, through comprehensive comparisons of the methods, we find that near-infrared spectroscopy (NIRS) technology has significant potentials and broad applications prospects in terms of cerebral oxygen saturation monitoring. Despite the current NIRS technology, the only bedside non-invasive cerebral oxygen saturation monitoring technology, still has many defects, it is more in line with the future development trend in the field of medical and health, and will become the main method gradually.
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Affiliation(s)
- Wentao Zhong
- College of Bioengineering, Chongqing University, Chongqing 400044, China; (W.Z.); (C.S.)
| | - Zhong Ji
- College of Bioengineering, Chongqing University, Chongqing 400044, China; (W.Z.); (C.S.)
- Key Laboratory of Biorheological Science and Technology, Chongqing University, Ministry of Education, Chongqing 400044, China
- Correspondence:
| | - Changlong Sun
- College of Bioengineering, Chongqing University, Chongqing 400044, China; (W.Z.); (C.S.)
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12
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Poon CS, Rinehart B, Langri DS, Rambo TM, Miller AJ, Foreman B, Sunar U. Noninvasive Optical Monitoring of Cerebral Blood Flow and EEG Spectral Responses after Severe Traumatic Brain Injury: A Case Report. Brain Sci 2021; 11:1093. [PMID: 34439712 PMCID: PMC8394546 DOI: 10.3390/brainsci11081093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/16/2022] Open
Abstract
Survivors of severe brain injury may require care in a neurointensive care unit (neuro-ICU), where the brain is vulnerable to secondary brain injury. Thus, there is a need for noninvasive, bedside, continuous cerebral blood flow monitoring approaches in the neuro-ICU. Our goal is to address this need through combined measurements of EEG and functional optical spectroscopy (EEG-Optical) instrumentation and analysis to provide a complementary fusion of data about brain activity and function. We utilized the diffuse correlation spectroscopy method for assessing cerebral blood flow at the neuro-ICU in a patient with traumatic brain injury. The present case demonstrates the feasibility of continuous recording of noninvasive cerebral blood flow transients that correlated well with the gold-standard invasive measurements and with the frequency content changes in the EEG data.
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Affiliation(s)
- Chien-Sing Poon
- Department of Biomedical Engineering, Wright State University, Dayton, OH 45435, USA; (C.-S.P.); (B.R.); (D.S.L.)
| | - Benjamin Rinehart
- Department of Biomedical Engineering, Wright State University, Dayton, OH 45435, USA; (C.-S.P.); (B.R.); (D.S.L.)
| | - Dharminder S. Langri
- Department of Biomedical Engineering, Wright State University, Dayton, OH 45435, USA; (C.-S.P.); (B.R.); (D.S.L.)
| | | | | | - Brandon Foreman
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA;
| | - Ulas Sunar
- Department of Biomedical Engineering, Wright State University, Dayton, OH 45435, USA; (C.-S.P.); (B.R.); (D.S.L.)
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