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Hazenberg L, Aries M, Beqiri E, Mess WH, van Mook W, Delnoij T, Zeiler FA, van Kuijk S, Tas J. Are NIRS-derived cerebral autoregulation and ABPopt values different between hemispheres in hypoxic-ischemic brain injury patients following cardiac arrest? J Clin Monit Comput 2023; 37:1427-1430. [PMID: 37195622 DOI: 10.1007/s10877-023-01008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/01/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE Near-infrared spectroscopy (NIRS) has been suggested as a non-invasive monitoring technique to set cerebral autoregulation (CA) guided ABP targets (ABPopt) in comatose patients with hypoxic-ischemic brain injury (HIBI) following cardiac arrest. We aimed to determine whether NIRS-derived CA and ABPopt values differ between left and right-sided recordings in these patients. METHODS Bifrontal regional oxygen saturation (rSO2) was measured using INVOS or Fore-Sight devices. The Cerebral Oximetry index (COx) was determined as a CA measure. ABPopt was calculated using a published algorithm with multi-window weighted approach. A paired Wilcoxon signed rank test and intraclass correlation coefficients (ICC) were used to compare (1) systematic differences and (2) degree of agreement between left and right-sided measurements. RESULTS Eleven patients were monitored. In one patient there was malfunctioning of the right-sided optode and in one patient not any ABPopt value was calculated. Comparison of rSO2 and COx was possible in ten patients and ABPopt in nine patients. The average recording time was 26 (IQR, 22-42) hours. The ABPopt values were not significantly different between the bifrontal recordings (80 (95%-CI 76-84) and 82 (95%-CI 75-84) mmHg) for the left and right recordings, p = 1.0). The ICC for ABPopt was high (0.95, 0.78-0.98, p < 0.001). Similar results were obtained for rSO2 and COx. CONCLUSION We found no differences between left and right-sided NIRS recordings or CA estimation in comatose and ventilated HIBI patients. This suggests that in these patients without signs of localized pathology unilateral recordings might be sufficient to estimate CA status or provide ABPopt targets.
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Affiliation(s)
- L Hazenberg
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - Mjh Aries
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- School of Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - E Beqiri
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - W H Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Wnka van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Academy for Postgraduate Training, Maastricht University Medical Center+, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - T Delnoij
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - F A Zeiler
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
- Department of Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Manitoba, Canada
- Division of Anesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Smj van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J Tas
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- School of Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
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Mulder EG, de Haas S, Mohseni Z, Schartmann N, Abo Hasson F, Alsadah F, van Kuijk S, van Drongelen J, Spaanderman M, Ghossein-Doha C. Cardiac output and peripheral vascular resistance during normotensive and hypertensive pregnancy - a systematic review and meta-analysis. BJOG 2021; 129:696-707. [PMID: 33630403 PMCID: PMC9291763 DOI: 10.1111/1471-0528.16678] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In-depth insight into haemodynamic changes during normotensive pregnancy may help identify women at risk for gestational hypertensive complications. OBJECTIVES To determine the magnitude of changes in cardiac output and its determinants stroke volume and heart rate, and total peripheral vascular resistance during singleton normotensive and hypertensive pregnancies. SEARCH STRATEGY PubMed (NCBI) and Embase (Ovid) databases were searched from their inception up to November 2019. SELECTION CRITERIA Studies reporting original measurements of haemodynamic parameters during pregnancy together with a non-pregnant reference measurement. Studies including women using antihypertensive medication were excluded. DATA COLLECTION AND ANALYSIS Pooled mean differences between pregnant and non-pregnant women, and absolute values of haemodynamic parameters were calculated for predefined gestational intervals using a random-effects model in normotensive and hypertensive pregnancy. Meta-regression analysis was used to analyse group differences in adjustments and absolute values during pregnancy. MAIN RESULTS In normotensive pregnancies, cardiac output increased from the first weeks on, reaching its highest level early in the third trimester (mean difference, 1.41 l·min1 ; 95% CI 1.18-1.63 l·min-1 ). In parallel, vascular resistance decreased progressively until its nadir in the early third trimester (mean difference, -331 dyn·sec-1 ·cm-5 ; 95% CI -384 to -277 dyn·sec-1 ·cm-5 ) and then increased slightly at term. In hypertensive pregnancies, the initial cardiac output increase was higher and vascular resistance did not change throughout gestation compared with reference values. CONCLUSIONS Hemodynamic changes in women who eventually develop hypertensive complications are substantially different. Serial monitoring and plotting against developed normograms can identify women at risk and may allow timely intervention. TWEETABLE ABSTRACT Monitoring haemodynamic changes in pregnancy helps identify women at risk for hypertensive complications.
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Affiliation(s)
- E G Mulder
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S de Haas
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Z Mohseni
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - N Schartmann
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - F Abo Hasson
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - F Alsadah
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Smj van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J van Drongelen
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mea Spaanderman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C Ghossein-Doha
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Hendrix M, Bons J, van Haren A, van Kuijk S, van Doorn W, Kimenai DM, Bekers O, Spaanderman M, Al-Nasiry S. Role of sFlt-1 and PlGF in the screening of small-for-gestational age neonates during pregnancy: A systematic review. Ann Clin Biochem 2019; 57:44-58. [PMID: 31762291 DOI: 10.1177/0004563219882042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 12/17/2022]
Abstract
Background Fetal growth restriction, i.e. the restriction of genetically predetermined growth potential due to placental dysfunction, is a major cause of neonatal morbidity and mortality. The consequences of inadequate fetal growth can be life-long, but the risks can be reduced substantially if the condition is identified prenatally. Currently, screening strategies are based on ultrasound detection of a small-for-gestational age fetus and do not take into account the underlying vascular pathology in the placenta. Measurement of maternal circulating angiogenic biomarkers placental growth factor, sFlt-1 (soluble FMS-like tyrosine kinase-1) are increasingly used in studies on fetal growth restriction as they reflect the pathophysiological process in the placenta. However, interpretation of the role of angiogenic biomarkers in prediction of fetal growth restriction is hampered by the varying design, population, timing, assay technique and cut-off values used in these studies. Methods We conducted a systematic-review in PubMed (MEDLINE), EMBASE (Ovid) and Cochrane to explore the predictive performance of maternal concentrations of placental growth factor, sFlt-1 and their ratio for fetal growth restriction and small-for-gestational age, at different gestational ages, and describe the longitudinal changes in biomarker concentrations and optimal discriminatory cut-off values. Results We included 26 studies with 2514 cases with small-for-gestational age, 27 cases of fetal growth restriction, 582 cases mixed small-for-gestational age/fetal growth restriction and 29,374 reference. The largest mean differences for the two biomarkers and their ratio were found after 26 weeks of gestational age and not in the first trimester. The ROC-AUC varied between 0.60 and 0.89 with sensitivity and specificity matching the different cut-off values or a preset false-positive rate of 10%. Conclusions Most of the studies did not make a distinction between small-for-gestational age and fetal growth restriction, and therefore the small-for-gestational age group consists of fetuses with growth restriction and fetuses that are constitutionally normal. The biomarkers can be a valuable screening tool for small-for-gestational age pregnancies, but unfortunately, there is not yet a clear cut-off value to use for screening. More research is needed to see if these biomarkers are sufficiently able to differentiate growth restriction on their own and how these biomarkers in combination with other relevant clinical and ultrasound parameters can be used in clinical routine diagnostics.
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Affiliation(s)
- Mle Hendrix
- Department of Obstetrics & Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Jap Bons
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A van Haren
- Department of Obstetrics & Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Smj van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Wptm van Doorn
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - D M Kimenai
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - O Bekers
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Mea Spaanderman
- Department of Obstetrics & Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - S Al-Nasiry
- Department of Obstetrics & Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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Meertens L, Smits L, van Kuijk S, Aardenburg R, van Dooren I, Langenveld J, Zwaan IM, Spaanderman M, Scheepers H. External validation and clinical usefulness of first-trimester prediction models for small- and large-for-gestational-age infants: a prospective cohort study. BJOG 2019; 126:472-484. [PMID: 30358080 PMCID: PMC6590121 DOI: 10.1111/1471-0528.15516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2018] [Indexed: 12/19/2022]
Abstract
Objective To assess the external validity of all published first‐trimester prediction models based on routinely collected maternal predictors for the risk of small‐ and large‐for‐gestational‐age (SGA and LGA) infants. Furthermore, the clinical potential of the best‐performing models was evaluated. Design Multicentre prospective cohort. Setting Thirty‐six midwifery practices and six hospitals (in the Netherlands). Population Pregnant women were recruited at <16 weeks of gestation between 1 July 2013 and 31 December 2015. Methods Prediction models were systematically selected from the literature. Information on predictors was obtained by a web‐based questionnaire. Birthweight centiles were corrected for gestational age, parity, fetal sex, and ethnicity. Main outcome measures Predictive performance was assessed by means of discrimination (C‐statistic) and calibration. Results The validation cohort consisted of 2582 pregnant women. The outcomes of SGA <10th percentile and LGA >90th percentile occurred in 203 and 224 women, respectively. The C‐statistics of the included models ranged from 0.52 to 0.64 for SGA (n = 6), and from 0.60 to 0.69 for LGA (n = 6). All models yielded higher C‐statistics for more severe cases of SGA (<5th percentile) and LGA (>95th percentile). Initial calibration showed poor‐to‐moderate agreement between the predicted probabilities and the observed outcomes, but this improved substantially after recalibration. Conclusion The clinical relevance of the models is limited because of their moderate predictive performance, and because the definitions of SGA and LGA do not exclude constitutionally small or large infants. As most clinically relevant fetal growth deviations are related to ‘vascular’ or ‘metabolic’ factors, models predicting hypertensive disorders and gestational diabetes are likely to be more specific. Tweetable abstract The clinical relevance of prediction models for the risk of small‐ and large‐for‐gestational‐age is limited. The clinical relevance of prediction models for the risk of small‐ and large‐for‐gestational‐age is limited.
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Affiliation(s)
- Lje Meertens
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Ljm Smits
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Smj van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - R Aardenburg
- Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Ima van Dooren
- Department of Obstetrics and Gynaecology, Sint Jans Gasthuis Weert, Weert, the Netherlands
| | - J Langenveld
- Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - I M Zwaan
- Department of Obstetrics and Gynaecology, Laurentius Hospital, Roermond, the Netherlands
| | - Mea Spaanderman
- Department of Obstetrics and Gynaecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Hcj Scheepers
- Department of Obstetrics and Gynaecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre, Maastricht, the Netherlands
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