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Busch DR, Rusin CG, Miller-Hance W, Kibler K, Baker WB, Heinle JS, Fraser CD, Yodh AG, Licht DJ, Brady KM. Continuous cerebral hemodynamic measurement during deep hypothermic circulatory arrest. BIOMEDICAL OPTICS EXPRESS 2016; 7:3461-3470. [PMID: 27699112 PMCID: PMC5030024 DOI: 10.1364/boe.7.003461] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 05/03/2023]
Abstract
While survival of children with complex congenital heart defects has improved in recent years, roughly half suffer neurological deficits suspected to be related to cerebral ischemia. Here we report the first demonstration of optical diffuse correlation spectroscopy (DCS) for continuous and non-invasive monitoring of cerebral microvascular blood flow during complex human neonatal or cardiac surgery. Comparison between DCS and Doppler ultrasound flow measurements during deep hypothermia, circulatory arrest, and rewarming were in good agreement. Looking forward, DCS instrumentation, alone and with NIRS, could provide access to flow and metabolic biomarkers needed by clinicians to adjust neuroprotective therapy during surgery.
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Affiliation(s)
- David R. Busch
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Craig G. Rusin
- Departments of Pediatrics and Cardiology, Baylor College of Medicine, Houston, TX, 77030 USA
| | - Wanda Miller-Hance
- Department of Pediatric Cardiovascular Anesthesiology, Baylor College of Medicine, Houston, TX, 77030 USA
| | - Kathy Kibler
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX, 77030, USA
| | - Wesley B. Baker
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeffrey S. Heinle
- Department of Surgery, Texas Children’s Hospital, Houston, TX, 77030, USA
| | - Charles D. Fraser
- Department of Surgery, Texas Children’s Hospital, Houston, TX, 77030, USA
| | - Arjun G. Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daniel J. Licht
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Kenneth M. Brady
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, 77030, USA
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Apostolidou I, Morrissette G, Sarwar MF, Konia MR, Kshettry VR, Wahr JA, Lobbestael AA, Nussmeier NA. Cerebral Oximetry During Cardiac Surgery: The Association Between Cerebral Oxygen Saturation and Perioperative Patient Variables. J Cardiothorac Vasc Anesth 2012; 26:1015-21. [DOI: 10.1053/j.jvca.2012.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Indexed: 12/13/2022]
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MacLeod DB, Ikeda K, Vacchiano C, Lobbestael A, Wahr JA, Shaw AD. Development and Validation of a Cerebral Oximeter Capable of Absolute Accuracy. J Cardiothorac Vasc Anesth 2012; 26:1007-14. [DOI: 10.1053/j.jvca.2012.06.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Indexed: 11/11/2022]
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Lee JK, Blaine Easley R, Brady KM. Neurocognitive monitoring and care during pediatric cardiopulmonary bypass-current and future directions. Curr Cardiol Rev 2011; 4:123-39. [PMID: 19936287 PMCID: PMC2779352 DOI: 10.2174/157340308784245766] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 12/17/2007] [Accepted: 12/21/2007] [Indexed: 11/22/2022] Open
Abstract
Neurologic injury in patients with congenital heart disease remains an important source of morbidity and mortality. Advances in surgical repair and perioperative management have resulted in longer life expectancies for these patients. Current practice and research must focus on identifying treatable risk factors for neurocognitive dysfunction, advancing methods for perioperative neuromonitoring, and refining treatment and care of the congenital heart patient with potential neurologic injury. Techniques for neuromonitoring and future directions will be discussed.
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Affiliation(s)
- Jennifer K Lee
- Departments of Anesthesiology/Critical Care Medicine and Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Wolf M, Greisen G. Advances in near-infrared spectroscopy to study the brain of the preterm and term neonate. Clin Perinatol 2009; 36:807-34, vi. [PMID: 19944837 DOI: 10.1016/j.clp.2009.07.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article reviews tissue oximetry and imaging to study the preterm and newborn infant brain by near-infrared spectroscopy. These two technologies are now advanced; nearly 100 reports on their use in newborn infants have been published, and commercial instruments are available. The precision of oximetry, however, is a limitation for its clinical use of assessing cerebral oxygenation. Imaging of brain function needs very well defined protocols for sensory stimulation as well as signal analysis to provide meaningful results.
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Affiliation(s)
- Martin Wolf
- Biomedical Optics Research Laboratory, Clinic of Neonatology, University Hospital Zurich, Frauenklinikstr. 10, 8091 Zurich, Switzerland.
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Chakravarti S, Srivastava S, Mittnacht AJC. Near Infrared Spectroscopy (NIRS) in Children. Semin Cardiothorac Vasc Anesth 2008; 12:70-9. [DOI: 10.1177/1089253208316444] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Near infrared spectroscopy (NIRS) is a noninvasive method for the in vivo monitoring of tissue oxygenation. Originally used predominantly to assess cerebral oxygenation, NIRS has gained widespread popularity in many clinical settings in all age groups. Changes in regional tissue oxygenation as detected by NIRS may reflect the delicate balance between oxygen delivery and consumption in more than one organ system. However, more studies are required to establish the ability of NIRS monitoring to improve patient outcome. This review provides a comprehensive description of NIRS in children.
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