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Vu EL, Dunne EC, Bradley A, Zhou A, Carroll MS, Rand CM, Brady KM, Stewart TM, Weese-Mayer DE. Cerebral Autoregulation During Orthostatic Challenge in Congenital Central Hypoventilation Syndrome. Am J Respir Crit Care Med 2021; 205:340-349. [PMID: 34788206 DOI: 10.1164/rccm.202103-0732oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Congenital Central Hypoventilation Syndrome (CCHS) is a rare autonomic disorder with altered regulation of breathing, heart rate (HR), and blood pressure (BP). Aberrant cerebral oxygenation in response to hypercapnia/hypoxia in CCHS raises concern that altered cerebral autoregulation may contribute to CCHS-related, variably impaired neurodevelopment. OBJECTIVES Evaluate cerebral autoregulation in response to orthostatic challenge in CCHS cases vs. controls. METHODS CCHS and age- and sex-matched control subjects were studied with head-up tilt (HUT) testing to induce orthostatic stress. 50 CCHS and 100 control HUT recordings were included. HR, BP, and cerebral oxygen saturation (rSO2) were continuously monitored. Cerebral oximetry index (COx), a real-time measure of cerebral autoregulation based on these measures, was calculated. MAIN RESULTS HUT resulted in greater mean BP decrease from baseline in CCHS vs. controls (11% vs. 6%; p<0.05) and a diminished increase in HR in CCHS vs. controls (11% vs. 18%; p<0.01) in the 5 minutes after tilt-up. Despite a similar COx at baseline, orthostatic provocation within 5 minutes of tilt-up caused a 50% greater increase in COx (p<0.01) and a 29% increase in minutes of impaired autoregulation (p<0.02) in CCHS vs. controls (4.0 vs. 3.1 min). CONCLUSIONS Cerebral autoregulatory mechanisms appear intact in CCHS, but the greater hypotension observed in CCHS consequent to orthostatic provocation is associated with greater values of COx/impaired autoregulation when BP is below lower limits of autoregulation. Effects of repeated orthostatic challenges in everyday living in CCHS necessitate further study to determine their influence on neurodevelopmental disease burden.
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Affiliation(s)
- Eric L Vu
- Northwestern University Feinberg School of Medicine, 12244, Anesthesiology, Chicago, Illinois, United States.,Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Division of Cardiovascular Anesthesia, Department of Anesthesiology, Chicago, Illinois, United States;
| | - Emma C Dunne
- Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Division of Autonomic Medicine, Department of Pediatrics, Chicago, Illinois, United States
| | - Allison Bradley
- Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Division of Autonomic Medicine, Department of Pediatrics, Chicago, Illinois, United States
| | - Amy Zhou
- Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Division of Autonomic Medicine, Department of Pediatrics, Chicago, Illinois, United States
| | - Michael S Carroll
- Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Data Analytics and Reporting, Chicago, Illinois, United States.,Northwestern University Feinberg School of Medicine, 12244, Pediatrics, Chicago, Illinois, United States
| | - Casey M Rand
- Stanley Manne Children's Research Institute, 2430, Chicago, Illinois, United States.,Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Division of Autonomic Medicine, Department of Pediatrics, Chicago, Illinois, United States
| | - Kenneth M Brady
- Northwestern University Feinberg School of Medicine, 12244, Anesthesiology, Chicago, Illinois, United States.,Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Division of Cardiovascular Anesthesia, Department of Anesthesiology, Chicago, Illinois, United States.,Northwestern University Feinberg School of Medicine, 12244, Department of Pediatrics, Chicago, Illinois, United States
| | - Tracey M Stewart
- Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Division of Autonomic Medicine, Department of Pediatrics, Chicago, Illinois, United States
| | - Debra E Weese-Mayer
- Stanley Manne Children's Research Institute, 2430, Chicago, Illinois, United States.,Ann and Robert H Lurie Children's Hospital of Chicago, 2429, Division of Autonomic Medicine, Department of Pediatrics, Chicago, Illinois, United States.,Northwestern University Feinberg School of Medicine, 12244, Department of Pediatrics, Chicago, Illinois, United States
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10
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Chung HU, Rwei AY, Hourlier-Fargette A, Xu S, Lee K, Dunne EC, Xie Z, Liu C, Carlini A, Kim DH, Ryu D, Kulikova E, Cao J, Odland IC, Fields KB, Hopkins B, Banks A, Ogle C, Grande D, Park JB, Kim J, Irie M, Jang H, Lee J, Park Y, Kim J, Jo HH, Hahm H, Avila R, Xu Y, Namkoong M, Kwak JW, Suen E, Paulus MA, Kim RJ, Parsons BV, Human KA, Kim SS, Patel M, Reuther W, Kim HS, Lee SH, Leedle JD, Yun Y, Rigali S, Son T, Jung I, Arafa H, Soundararajan VR, Ollech A, Shukla A, Bradley A, Schau M, Rand CM, Marsillio LE, Harris ZL, Huang Y, Hamvas A, Paller AS, Weese-Mayer DE, Lee JY, Rogers JA. Skin-interfaced biosensors for advanced wireless physiological monitoring in neonatal and pediatric intensive-care units. Nat Med 2020; 26:418-429. [PMID: 32161411 PMCID: PMC7315772 DOI: 10.1038/s41591-020-0792-9] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Abstract
Standard of care management in neonatal and pediatric intensive care units (NICUs and PICUs) involve continuous monitoring of vital signs with hard-wired devices that adhere to the skin and, in certain instances, include catheter-loaded pressure sensors that insert into the arteries. These protocols involve risks for complications and impediments to clinical care and skin-to-skin contact between parent and child. Here we present a wireless, non-invasive technology that not only offers measurement equivalency to these management standards but also supports a range of important additional features (without limitations or shortcomings of existing approaches), supported by data from pilot clinical studies in the neonatal intensive care unit (NICU) and pediatric ICU (PICU). The combined capabilities of these platforms extend beyond clinical quality measurements of vital signs (heart rate, respiration rate, temperature and blood oxygenation) to include novel modalities for (1) tracking movements and changes in body orientation, (2) quantifying the physiological benefits of skin-to-skin care (e.g. Kangaroo care) for neonates, (3) capturing acoustic signatures of cardiac activity by directly measuring mechanical vibrations generated through the skin on the chest, (4) recording vocal biomarkers associated with tonality and temporal characteristics of crying impervious to confounding ambient noise, and (5) monitoring a reliable surrogate for systolic blood pressure. The results have potential to significantly enhance the quality of neonatal and pediatric critical care.
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Affiliation(s)
- Ha Uk Chung
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Alina Y Rwei
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Aurélie Hourlier-Fargette
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Shuai Xu
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - KunHyuck Lee
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Emma C Dunne
- Division of Pediatric Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Zhaoqian Xie
- State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Claire Liu
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Andrea Carlini
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Dong Hyun Kim
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Dennis Ryu
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Sibel Inc, Evanston, IL, USA
| | | | | | - Ian C Odland
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Kelsey B Fields
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Brad Hopkins
- Division of Pediatric Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Anthony Banks
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Christopher Ogle
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Dominic Grande
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Jun Bin Park
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Jongwon Kim
- Photo-Electronic Hybrids Research Center, Korea Institute of Science and Technology (KIST), Seoul, South Korea.,Department of Mechanical Engineering, Kyung Hee University, Yongin, Republic of Korea
| | - Masahiro Irie
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Hokyung Jang
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Yerim Park
- Department of Computer Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jungwoo Kim
- Department of Computer Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Han Heul Jo
- Department of Computer Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Hyoungjo Hahm
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Raudel Avila
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.,Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL, USA
| | - Yeshou Xu
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.,Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL, USA.,Key Laboratory of C&PC Structures of the Ministry of Education, Southeast University, Nanjing, China
| | - Myeong Namkoong
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Jean Won Kwak
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Emily Suen
- Department of Neurobiology, Northwestern University, Evanston, IL, USA
| | - Max A Paulus
- Department of Biology, Northwestern University, Evanston, IL, USA
| | - Robin J Kim
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Blake V Parsons
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA
| | - Kelia A Human
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Seung Sik Kim
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Manish Patel
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Sibel Inc, Evanston, IL, USA.,University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| | - William Reuther
- Department of Graphic Design and Industrial Design at North Carolina State University, Raleigh, NC, USA
| | - Hyun Soo Kim
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Sung Hoon Lee
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Yeojeong Yun
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Taeyoung Son
- Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Inhwa Jung
- Department of Mechanical Engineering, Kyung Hee University, Yongin, Republic of Korea
| | - Hany Arafa
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA.,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Vinaya R Soundararajan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ayelet Ollech
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Avani Shukla
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Allison Bradley
- Division of Pediatric Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Molly Schau
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Casey M Rand
- Division of Pediatric Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Lauren E Marsillio
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Division of Pediatric Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Zena L Harris
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Division of Pediatric Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Yonggang Huang
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.,Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL, USA
| | - Aaron Hamvas
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Amy S Paller
- Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Debra E Weese-Mayer
- Division of Pediatric Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. .,Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. .,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Jong Yoon Lee
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA. .,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA. .,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Sibel Inc, Evanston, IL, USA.
| | - John A Rogers
- Simpson Querrey Institute, Northwestern University, Chicago, IL, USA. .,Center for Bio-integrated Electronics, Northwestern University, Evanston, IL, USA. .,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA. .,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA. .,Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA. .,Department of Chemistry, Northwestern University, Evanston, IL, USA. .,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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