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Oppermann C, Dohrn N, Pardes HY, Klein MF, Eriksen T, Gögenur I. Real time organ hypoperfusion detection using Indocyanine Green in a piglet model. Surg Endosc 2024; 38:4296-4305. [PMID: 38869642 PMCID: PMC11289266 DOI: 10.1007/s00464-024-10938-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/17/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Preserving sufficient oxygen supply to the tissue is fundamental for maintaining organ function. However, our ability to identify those at risk and promptly recognize tissue hypoperfusion during abdominal surgery is limited. To address this problem, we aimed to develop a new method of perfusion monitoring that can be used during surgical procedures and aid surgeons' decision-making. METHODS In this experimental porcine study, thirteen subjects were randomly assigned one organ of interest [stomach (n = 3), ascending colon (n = 3), rectum (n = 3), and spleen (n = 3)]. After baseline perfusion recordings, using high-frequency, low-dose bolus injections with weight-adjusted (0.008 mg/kg) ICG, organ-supplying arteries were manually and completely occluded leading to hypoperfusion of the target organ. Continuous organ perfusion monitoring was performed throughout the experimental conditions. RESULTS After manual occlusion of pre-selected organ-supplying arteries, occlusion of the peripheral arterial supply translated in an immediate decrease in oscillation signal in most organs (3/3 ventricle, 3/3 ascending colon, 3/3 rectum, 2/3 spleen). Occlusion of the central arterial supply resulted in a further decrease or complete disappearance of the oscillation curves in the ventricle (3/3), ascending colon (3/3), rectum (3/3), and spleen (1/3). CONCLUSION Continuous organ-perfusion monitoring using a high-frequency, low-dose ICG bolus regimen can detect organ hypoperfusion in real-time.
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Affiliation(s)
- Carolin Oppermann
- Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
| | - Niclas Dohrn
- Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
- Department of Surgery, Copenhagen University Hospital, Herlev & Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Helin Yikilmaz Pardes
- Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
| | - Mads Falk Klein
- Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
| | - Thomas Eriksen
- Institute for Clinical Veterinary Medicine, University of Copenhagen, Dyrelægevej 16, 1870, Frederiksberg C, Denmark
| | - Ismail Gögenur
- Department of Surgery, Copenhagen University Hospital, Herlev & Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
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Nguyen A, Patel AB, Kioutchoukova IP, Diaz MJ, Lucke-Wold B. Mechanisms of Mitochondrial Oxidative Stress in Brain Injury: From Pathophysiology to Therapeutics. OXYGEN 2023; 3:163-178. [PMID: 37082315 PMCID: PMC10111246 DOI: 10.3390/oxygen3020012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Mitochondrial oxidative stress has been implicated in various forms of brain injury, both traumatic and non-traumatic. Due to its oxidative demand, the brain is intimately dependent on its mitochondrial functioning. However, there remains appreciable heterogeneity in the development of these injuries regarding ROS and their effect on the sequelae. These include traumatic insults such as TBIs and intracranial hemorrhaging secondary to this. In a different vein, such injuries may be attributed to other etiologies such as infection, neoplasm, or spontaneous hemorrhage (strokes, aneurysms). Clinically, the manner of treatment may also be adjusted in relation to each injury and its unique progression in the context of ROS. In the current review, then, the authors highlight the role of mitochondrial ROS in various forms of brain injury, emphasizing both the collective and unique elements of each form. Lastly, these narratives are met with the current therapeutic landscape and the role of emerging therapies in treating reactive oxygen species in brain injuries.
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Affiliation(s)
- Andrew Nguyen
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Anjali B. Patel
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | | | - Michael J. Diaz
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, 1600 SW Archer Rd., Gainesville, FL 32610, USA
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Abstract
Pericytes, attached to the surface of capillaries, play an important role in regulating local blood flow. Using optogenetic tools and genetically encoded reporters in conjunction with confocal and multiphoton imaging techniques, the 3D structure, anatomical organization, and physiology of pericytes have recently been the subject of detailed examination. This work has revealed novel functions of pericytes and morphological features such as tunneling nanotubes in brain and tunneling microtubes in heart. Here, we discuss the state of our current understanding of the roles of pericytes in blood flow control in brain and heart, where functions may differ due to the distinct spatiotemporal metabolic requirements of these tissues. We also outline the novel concept of electro-metabolic signaling, a universal mechanistic framework that links tissue metabolic state with blood flow regulation by pericytes and vascular smooth muscle cells, with capillary KATP and Kir2.1 channels as primary sensors. Finally, we present major unresolved questions and outline how they can be addressed.
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Affiliation(s)
- Thomas A Longden
- Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA; ,
- Laboratory of Neurovascular Interactions, Center for Biomedical Engineering and Technology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Guiling Zhao
- Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA; ,
- Laboratory of Molecular Cardiology, Center for Biomedical Engineering and Technology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ashwini Hariharan
- Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA; ,
- Laboratory of Neurovascular Interactions, Center for Biomedical Engineering and Technology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - W Jonathan Lederer
- Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA; ,
- Laboratory of Molecular Cardiology, Center for Biomedical Engineering and Technology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Zama Cavicchi F, Iesu E, Franchi F, Nobile L, Annoni F, Vincent JL, Scolletta S, Creteur J, Taccone FS. Low hemoglobin and venous saturation levels are associated with poor neurological outcomes after cardiac arrest. Resuscitation 2020; 153:202-208. [PMID: 32592732 DOI: 10.1016/j.resuscitation.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Hemoglobin (Hb) is a main determinant of tissue oxygen delivery and anemia could be particularly harmful in post-anoxic brain injury. The aim of this study was to evaluate the association of Hb and venous Hb oxygen saturation (SvO2/ScvO2) with long-term neurological outcome in patients admitted after cardiac arrest (CA). METHODS Analysis of adult CA patients admitted to the Department of Intensive Care of the Erasme University Hospital (Brussels, Belgium) over 9 years. We retrieved all data concerning CA characteristics as well as Hb during the first 48 h since injury as well as the need for red blood cells transfusions (RBCT). Minimum Hb and Hb oxygen saturation values were recorded. Neurological outcome was evaluated 3 months after CA. Unfavorable neurological outcome (UO) was defined as a Cerebral Performance Categories (CPC) score of 3-5. RESULTS We treated 414 patients patients with CA, including 231 (56%) out-of-hospital cardiac arrest (OHCA) and 158 (38%) with an initial shockable rhythm. Median Hb concentration on admission was 12.0 [9.9-13.7] g/dL and the lowest Hb concentration was 10.0 [8.1-11.0] g/dL; 127 patients (31%) received at least one RBCT. Hb oxygen saturation on admission was 67 [59-74]%, while the lowest value was 60 [53-68]%. Low Hb and Hb oxygen saturation values were independently associated with UO; the optimal cut-off to predict UO was <9.9 g/dL and <60%, respectively. CONCLUSIONS Low hemoglobin values and low values of oxygen venous saturation are significantly associated with unfavorable neurological outcome in adult patients resuscitated from cardiac arrest.
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Affiliation(s)
- Federica Zama Cavicchi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Enrica Iesu
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Federico Franchi
- Department of Emergency Medicine, Surgery and Neurosciences, Intensive Care Unit, Università di Siena, Siena, Italy
| | - Leda Nobile
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Filippo Annoni
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Sabino Scolletta
- Department of Emergency Medicine, Surgery and Neurosciences, Intensive Care Unit, Università di Siena, Siena, Italy
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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Licker M, Triponez F, Ellenberger C, Karenovics W. Less Fluids and a More Physiological Approach. Turk J Anaesthesiol Reanim 2016; 44:230-232. [PMID: 27909601 DOI: 10.5152/tjar.2016.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Marc Licker
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Switzerland
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery, University Hospital of Geneva, Switzerland
| | - Christoph Ellenberger
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Switzerland
| | - Wolfram Karenovics
- Department of Thoracic and Endocrine Surgery, University Hospital of Geneva, Switzerland
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Wolff CB, Collier DJ, Shah M, Saxena M, Brier TJ, Kapil V, Green D, Lobo M. A Discussion on the Regulation of Blood Flow and Pressure. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 876:129-135. [PMID: 26782204 DOI: 10.1007/978-1-4939-3023-4_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- Christopher B Wolff
- Barts and the London School of Medicine and Dentistry, William Harvey Research Institute, Centre for Clinical Pharmacology, William Harvey Heart Centre, Queen Mary University of London, London, UK.
| | - David J Collier
- Barts and the London School of Medicine and Dentistry, William Harvey Research Institute, Centre for Clinical Pharmacology, William Harvey Heart Centre, Queen Mary University of London, London, UK
| | - Mussadiq Shah
- Barts and the London School of Medicine and Dentistry, William Harvey Research Institute, Centre for Clinical Pharmacology, William Harvey Heart Centre, Queen Mary University of London, London, UK
| | - Manish Saxena
- Barts and the London School of Medicine and Dentistry, William Harvey Research Institute, Centre for Clinical Pharmacology, William Harvey Heart Centre, Queen Mary University of London, London, UK
| | - Timothy J Brier
- Barts and the London School of Medicine and Dentistry, William Harvey Research Institute, Centre for Clinical Pharmacology, William Harvey Heart Centre, Queen Mary University of London, London, UK
| | - Vikas Kapil
- Barts and the London School of Medicine and Dentistry, William Harvey Research Institute, Centre for Clinical Pharmacology, William Harvey Heart Centre, Queen Mary University of London, London, UK
- Barts BP Clinic, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - David Green
- Anaesthetics Department, King's College School of Medicine and Dentistry, London, UK
| | - Melvin Lobo
- Barts and the London School of Medicine and Dentistry, William Harvey Research Institute, Centre for Clinical Pharmacology, William Harvey Heart Centre, Queen Mary University of London, London, UK
- Barts BP Clinic, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Caldwell M, Hapuarachchi T, Highton D, Elwell C, Smith M, Tachtsidis I. BrainSignals Revisited: Simplifying a Computational Model of Cerebral Physiology. PLoS One 2015; 10:e0126695. [PMID: 25961297 PMCID: PMC4427507 DOI: 10.1371/journal.pone.0126695] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
Multimodal monitoring of brain state is important both for the investigation of healthy cerebral physiology and to inform clinical decision making in conditions of injury and disease. Near-infrared spectroscopy is an instrument modality that allows non-invasive measurement of several physiological variables of clinical interest, notably haemoglobin oxygenation and the redox state of the metabolic enzyme cytochrome c oxidase. Interpreting such measurements requires the integration of multiple signals from different sources to try to understand the physiological states giving rise to them. We have previously published several computational models to assist with such interpretation. Like many models in the realm of Systems Biology, these are complex and dependent on many parameters that can be difficult or impossible to measure precisely. Taking one such model, BrainSignals, as a starting point, we have developed several variant models in which specific regions of complexity are substituted with much simpler linear approximations. We demonstrate that model behaviour can be maintained whilst achieving a significant reduction in complexity, provided that the linearity assumptions hold. The simplified models have been tested for applicability with simulated data and experimental data from healthy adults undergoing a hypercapnia challenge, but relevance to different physiological and pathophysiological conditions will require specific testing. In conditions where the simplified models are applicable, their greater efficiency has potential to allow their use at the bedside to help interpret clinical data in near real-time.
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Affiliation(s)
- Matthew Caldwell
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Tharindi Hapuarachchi
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, University College London, London, UK
| | - David Highton
- Neurocritical Care Unit, University College Hospitals, London, UK
| | - Clare Elwell
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Martin Smith
- Neurocritical Care Unit, University College Hospitals, London, UK
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
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