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Zuiki M, Ohta M, Fujita N, Uda D, Uesugi M, Yamano A, Ichise E, Morimoto H, Hashiguchi K, Kinoshita D, Hasegawa T, Iehara T. The prediction of estimated cerebral perfusion pressure with trans-systolic time in preterm and term infants. Eur J Pediatr 2024:10.1007/s00431-024-05511-9. [PMID: 38488878 DOI: 10.1007/s00431-024-05511-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/28/2024] [Accepted: 03/02/2024] [Indexed: 03/17/2024]
Abstract
It is important to monitor cerebral perfusion in infants because hypo- and hyperperfusion can contribute to neurological injury. This study aimed to clarify the relationship between trans-systolic time (TST) and critical closing pressure (CrCP) or estimated cerebral perfusion pressure (CPPe) in neonates. Moreover, we aimed to determine the TST values in preterm and term infants with stable cerebral perfusion to clarify normative reference data. This multicentre prospective study included infants with arterial lines admitted to the neonatal intensive care units between December 2021 and August 2023. TST, CrCP, and CPPe were calculated using middle cerebral artery waveforms recorded using transcranial Doppler ultrasonography when clinicians collected arterial blood samples. Three hundred and sixty samples were obtained from 112 infants with a gestational age of 32 (interquartile range, 27-37) weeks and a birth weight of 1481 (956-2355) g. TST was positively correlated with CPPe (r = 0.60, p < 0.001), but not with CrCP (r = 0.08, p = 0.10). The normative reference values of TST in preterm and term infants without samples of hyper- or hypocapnia and/or hyper- or hypotension, which may affect cerebral perfusion, were as follows: ≤ 29 weeks, 0.12 (0.11-0.14) s; 30-36 weeks, 0.14 (0.12-0.15) s; and ≥ 37 weeks, 0.16 (0.14-0.17) s, respectively. Conclusion: TST in neonates significantly correlated with CPPe, but not with CrCP. TST may be a good predictor of cerebral perfusion and potentially have wider clinical applications. What is Known: • Trans-systolic time (TST) is used in evaluating the effects of increased intracranial pressure on cerebral haemodynamics. However, little is known about the efficacy of TST in predicting neonatal cerebral perfusion pressure. What is New: • This study added evidence that TST correlated with estimated cerebral perfusion pressure, but not with critical closing pressure. Additionally, we showed the normative reference values of the TST in preterm and term infants.
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Affiliation(s)
- Masashi Zuiki
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan.
| | - Mikito Ohta
- Department of Neonatology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Naoe Fujita
- Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Kyoto, Japan
| | - Daisuke Uda
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan
| | - Madoka Uesugi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan
| | - Akio Yamano
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan
| | - Eisuke Ichise
- Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Kyoto, Japan
| | - Hidechika Morimoto
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan
| | - Kanae Hashiguchi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan
| | - Daisuke Kinoshita
- Department of Neonatology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Tatsuji Hasegawa
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan
| | - Tomoko Iehara
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan
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2
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Blanca D, Schwarz EC, Olgers TJ, Ter Avest E, Azizi N, Bouma HR, Ter Maaten JC. Intra-and inter-observer variability of point of care ultrasound measurements to evaluate hemodynamic parameters in healthy volunteers. Ultrasound J 2023; 15:22. [PMID: 37145390 PMCID: PMC10163179 DOI: 10.1186/s13089-023-00322-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a valuable tool for assessing the hemodynamic status of acute patients. Even though POCUS often uses a qualitative approach, quantitative measurements have potential advantages in evaluating hemodynamic status. Several quantitative ultrasound parameters can be used to assess the hemodynamic status and cardiac function. However, only limited data on the feasibility and reliability of the quantitative hemodynamic measurements in the point-of-care setting are available. This study investigated the intra- and inter-observer variability of PoCUS measurements of quantitative hemodynamic parameters in healthy volunteers. METHODS In this prospective observational study, three sonographers performed three repeated measurements of eight different hemodynamic parameters in healthy subjects. An expert panel of two experienced sonographers evaluated the images' quality. The repeatability (intra-observer variability) was determined by calculating the coefficient of variation (CV) between the separate measurements for each observer. The reproducibility (inter-observer variability) was assessed by determining the intra-class correlation coefficient (ICC). RESULTS 32 subjects were included in this study, on whom, in total, 1502 images were obtained for analysis. All parameters were in a normal physiological range. Stroke volume (SV), cardiac output (CO), and inferior vena cava diameter (IVC-D) showed high repeatability (CV under 10%) and substantial reproducibility (ICC 0.61-0.80). The other parameters had only moderate repeatability and reproducibility. CONCLUSIONS We demonstrated good inter-observer reproducibility and good intra-observer repeatability for CO, SV and IVC-D taken in healthy subjects by emergency care physicians.
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Affiliation(s)
- Deborah Blanca
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Department of Internal Medicine, Ospedale Maggiore Policlinico, Università Degli Studi di Milano, Milan, Italy.
| | - Esther C Schwarz
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tycho Joan Olgers
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ewoud Ter Avest
- Department of Emergency Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Nasim Azizi
- Department of Emergency Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Hjalmar R Bouma
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Cornelis Ter Maaten
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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3
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Pereira SS, Sinha AK, Shah DK, Kempley ST. Cardiovascular changes following cerebral blood flow measurements using Doppler ultrasound in extremely preterm infants. Acta Paediatr 2022; 111:2098-2099. [PMID: 35766125 DOI: 10.1111/apa.16470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sujith S Pereira
- Neonatal Unit, Homerton University Hospital, Homerton Healthcare NHS Foundation Trust, London, UK.,Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ajay K Sinha
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Neonatal Unit, Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Divyen K Shah
- Neonatal Unit, Royal London Hospital, Bart's Health NHS Trust, London, UK.,Centre for Neuroscience and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephen T Kempley
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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4
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Cerebral Arterial Asymmetries in the Neonate: Insight into the Pathogenesis of Stroke. Symmetry (Basel) 2022. [DOI: 10.3390/sym14030456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Neonatal and adult strokes are more common in the left than in the right cerebral hemisphere in the middle cerebral arterial territory, and adult extracranial and intracranial vessels are systematically left-dominant. The aim of the research reported here was to determine whether the asymmetric vascular ground plan found in adults was present in healthy term neonates (n = 97). A new transcranial Doppler ultrasonography dual-view scanning protocol, with concurrent B-flow and pulsed wave imaging, acquired multivariate data on the neonatal middle cerebral arterial structure and function. This study documents for the first-time systematic asymmetries in the middle cerebral artery origin and distal trunk of healthy term neonates and identifies commensurately asymmetric hemodynamic vulnerabilities. A systematic leftward arterial dominance was found in the arterial caliber and cortically directed blood flow. The endothelial wall shear stress was also asymmetric across the midline and varied according to vessels’ geometry. We conclude that the arterial structure and blood supply in the brain are laterally asymmetric in newborns. Unfavorable shearing forces, which are a by-product of the arterial asymmetries described here, might contribute to a greater risk of cerebrovascular pathology in the left hemisphere.
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Chang D, Brown Q, Tsui G, He Y, Liu J, Shi L, Rodríguez-Contreras A. Distinct Cellular Profiles of Hif1a and Vegf mRNA Localization in Microglia, Astrocytes and Neurons during a Period of Vascular Maturation in the Auditory Brainstem of Neonate Rats. Brain Sci 2021; 11:brainsci11070944. [PMID: 34356178 PMCID: PMC8304335 DOI: 10.3390/brainsci11070944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 01/09/2023] Open
Abstract
Defining the relationship between vascular development and the expression of hypoxia-inducible factors (Hifs) and vascular endothelial growth factor (Vegf) in the auditory brainstem is important to understand how tissue hypoxia caused by oxygen shortage contributes to sensory deficits in neonates. In this study, we used histology, molecular labeling, confocal microscopy and 3D image processing methods to test the hypothesis that significant maturation of the vascular bed in the medial nucleus of the trapezoid body (MNTB) occurs during the postnatal period that precedes hearing onset. Isolectin-B4 histochemistry experiments suggested that the MNTB vasculature becomes more elaborate between P5 and P10. When combined with a cell proliferation marker and immunohistochemistry, we found that vascular growth coincides with a switch in the localization of proliferating cells to perivascular locations, and an increase in the density of microglia within the MNTB. Furthermore, microglia were identified as perivascular cells with proliferative activity during the period of vascular maturation. Lastly, combined in situ hybridization and immunohistochemistry experiments showed distinct profiles of Hif1a and Vegf mRNA localization in microglia, astrocytes and MNTB principal neurons. These results suggest that different cells of the neuro-glio-vascular unit are likely targets of hypoxic insult in the auditory brainstem of neonate rats.
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Affiliation(s)
- Daphne Chang
- Center for Discovery and Innovation, Department of Biology, Institute for Ultrafast Spectroscopy and Lasers, City University of New York, City College, New York, NY 10031, USA; (D.C.); (Q.B.); (G.T.)
| | - Quetanya Brown
- Center for Discovery and Innovation, Department of Biology, Institute for Ultrafast Spectroscopy and Lasers, City University of New York, City College, New York, NY 10031, USA; (D.C.); (Q.B.); (G.T.)
| | - Grace Tsui
- Center for Discovery and Innovation, Department of Biology, Institute for Ultrafast Spectroscopy and Lasers, City University of New York, City College, New York, NY 10031, USA; (D.C.); (Q.B.); (G.T.)
| | - Ye He
- Neuroscience Initiative, Advanced Science Research Center at the Graduate Center, City University of New York, New York, NY 10031, USA; (Y.H.); (J.L.)
| | - Jia Liu
- Neuroscience Initiative, Advanced Science Research Center at the Graduate Center, City University of New York, New York, NY 10031, USA; (Y.H.); (J.L.)
| | - Lingyan Shi
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
- Correspondence: (L.S.); (A.R.-C.)
| | - Adrián Rodríguez-Contreras
- Center for Discovery and Innovation, Department of Biology, Institute for Ultrafast Spectroscopy and Lasers, City University of New York, City College, New York, NY 10031, USA; (D.C.); (Q.B.); (G.T.)
- Correspondence: (L.S.); (A.R.-C.)
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6
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Abduljalil K, Pan X, Pansari A, Jamei M, Johnson TN. A Preterm Physiologically Based Pharmacokinetic Model. Part I: Physiological Parameters and Model Building. Clin Pharmacokinet 2021; 59:485-500. [PMID: 31583613 DOI: 10.1007/s40262-019-00825-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Developmental physiology can alter pharmacotherapy in preterm populations. Because of ethical and clinical constraints in studying this vulnerable age group, physiologically based pharmacokinetic models offer a viable alternative approach to predicting drug pharmacokinetics and pharmacodynamics in this population. However, such models require comprehensive information on the changes of anatomical, physiological and biochemical variables, where such data are not available in a single source. OBJECTIVE The objective of this study was to integrate the relevant physiological parameters required to build a physiologically based pharmacokinetic model for the preterm population. METHODS Published information on developmental preterm physiology and some drug-metabolising enzymes were collated and analysed. Equations were generated to describe the changes in parameter values during growth. RESULTS Data on organ size show different growth patterns that were quantified as functions of bodyweight to retain physiological variability and correlation. Protein binding data were quantified as functions of age as the body weight was not reported in the original articles. Ontogeny functions were derived for cytochrome P450 1A2, 3A4 and 2C9. Tissue composition values and how they change with age are limited. CONCLUSIONS Despite the limitations identified in the availability of some tissue composition values, the data presented in this article provide an integrated resource of system parameters needed for building a preterm physiologically based pharmacokinetic model.
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Affiliation(s)
- Khaled Abduljalil
- Simcyp Division Level 2-Acero, Certara UK Limited, 1 Concourse Way, Sheffield, S1 2BJ, UK.
| | - Xian Pan
- Simcyp Division Level 2-Acero, Certara UK Limited, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Amita Pansari
- Simcyp Division Level 2-Acero, Certara UK Limited, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Masoud Jamei
- Simcyp Division Level 2-Acero, Certara UK Limited, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Trevor N Johnson
- Simcyp Division Level 2-Acero, Certara UK Limited, 1 Concourse Way, Sheffield, S1 2BJ, UK
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7
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Pereira SS, Sinha AK, Shah DK, Kempley ST. Common carotid artery blood flow volume in extremely preterm infants. Acta Paediatr 2021; 110:1157-1165. [PMID: 33145798 DOI: 10.1111/apa.15655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to determine carotid blood flow volume, a surrogate for cerebral blood flow, using Doppler ultrasound in extremely preterm infants. METHODS In infants <29 weeks, right common carotid artery flow volume (RCCAF) was calculated from vessel diameter and intensity-weighted mean velocity measured using Doppler ultrasound on days 1 and 3. In addition, left ventricular output (LVO), ductus arteriosus characteristics and invasive mean arterial blood pressure (MABP) were obtained. RESULTS Sixty infants with mean gestation of 25.8 weeks were studied. The median RCCAF increased from 12 (IQR 9-15) mL/kg/min on day 1, to 14 (IQR 12-18) mL/kg/min on day 3 (p = 0.007). RCCAF was positively correlated with invasive MABP on days 1 and 3. RCCAF significantly correlated with LVO in infants with closing or closed ductus arteriosus on day 1. Using multiple regression analysis, RCCAF was significantly associated with invasive MABP on day 1 and to inotropic treatment on day 3. CONCLUSION Doppler ultrasound can be used to measure RCCAF in extremely preterm infants receiving intensive care. RCCAF increased during the first three days and was positively related to invasive MABP on day 1. Values were lower than previously described in more mature infants. CLINICAL TRIAL REGISTRATION ISRCTN 83507686.
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Affiliation(s)
- Sujith S. Pereira
- Centre for Genomics and Child Health Blizard Institute Barts and the London School of Medicine Queen Mary University of London London UK
- Neonatal Unit Homerton University Hospital Foundation NHS Trust London UK
| | - Ajay K. Sinha
- Centre for Genomics and Child Health Blizard Institute Barts and the London School of Medicine Queen Mary University of London London UK
- Neonatal Unit Royal London Hospital, Barts Health NHS Trust London UK
| | - Divyen K. Shah
- Neonatal Unit Royal London Hospital, Barts Health NHS Trust London UK
- Centre for Neuroscience and Trauma Blizard Institute Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK
| | - Stephen T. Kempley
- Centre for Genomics and Child Health Blizard Institute Barts and the London School of Medicine Queen Mary University of London London UK
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8
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Portnova GV, Maslennikova AV, Proskurnina EV. The Relationship between Carotid Doppler Ultrasound and EEG Metrics in Healthy Preschoolers and Adults. Brain Sci 2020; 10:brainsci10100755. [PMID: 33092107 PMCID: PMC7589929 DOI: 10.3390/brainsci10100755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022] Open
Abstract
Despite widespread using electroencephalography (EEG) and Doppler ultrasound in pediatric neurology clinical practice, there are still no well-known correlations between these methods that could contribute to a better understanding of brain processes and development of neurological pathology. This study aims to reveal relationship between EEG and Doppler ultrasound methods. We compared two cohorts of adults and preschool children with no history of neurological or mental diseases. The data analysis included investigation of EEG and carotid blood flow indexes, which are significant in neurological diagnosis, as well as calculation of linear and non-linear EEG parameters and ratios between the systolic peak velocities of carotid arteries and carotid blood asymmetry. We have found age-dependent correlations between EEG and power Doppler ultrasound imaging (PDUI) data. Carotid blood flow asymmetry correlated with delta-rhythm power spectral density only in preschoolers. The ratios of blood flow velocities in the internal carotid arteries to those in the common carotid arteries correlated with higher peak alpha frequency and lower fractal dimension; moreover, they were associated with lower Epworth sleepiness scale scores. The study revealed significant correlations between EEG and PDUI imaging indexes, which are different for healthy children and adults. Despite the fact that the correlations were associated with non-clinical states such as overwork or stress, we assumed that the investigated parameters could be applicable for clinical trials.
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Affiliation(s)
- Galina V. Portnova
- Laboratory of the Human Higher Nervous Activity, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, 117485 Moscow, Russia;
- Correspondence:
| | - Aleksandra V. Maslennikova
- Laboratory of the Human Higher Nervous Activity, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, 117485 Moscow, Russia;
| | - Elena V. Proskurnina
- Laboratory of Molecular Biology, Research Centre for Medical Genetics, 115522 Moscow, Russia;
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9
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Pereira S, Reeves J, Birch M, Finton-James S, Verma K, Krug R, Sinha A, Kempley S. A realistic flow phantom model of the carotid artery in preterm infants for training and research. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2020; 28:145-154. [PMID: 32831887 DOI: 10.1177/1742271x20902189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/17/2019] [Indexed: 11/15/2022]
Abstract
Introduction Cerebral blood flow is increasingly monitored in preterm infants. Doppler ultrasound of the carotid artery is a widely available method but is operator dependent. Our aim was to design and produce a realistic flow phantom model of the carotid artery of preterm infants. Methods Data from cerebral blood flow measurements using Doppler ultrasound of the right common carotid artery from 21 premature newborn infants were used to produce a Doppler flow phantom model with three different vessel diameters. Vessel diameter, continuous and pulsatile flow volume measurements were performed by two blinded observers (with more than eight and 20 years of experience). Results Vessel diameter measurements using the phantom were underestimated by 7%. Continuous flow volume measurements were overestimated by 7% by both observers (observer 1 mean difference 1.5 ± 1.96 SD -3.3 to 6.3 ml/min versus observer 2, 1.9 ± 1.96 SD -3.6 to 7.4 ml/min). Pulsatile flow measurements were overestimated by 12.6% by observer 1 (2.7 ± 1.96 SD -0.6 to 5.9 ml/min) and by 7.8% by observer 2 (1.7 ± 1.96 SD -1.6 to 4.9 ml/min). There was good interobserver and intraobserver reliability for the majority of measurements using continuous and pulsatile flow. Conclusion It is feasible to produce a realistic flow phantom model of the neonatal carotid artery of preterm infants. Diameter measurements were underestimated and flow measurements were overestimated. These errors fell within acceptable limits for in vivo measurements. If these limitations were related to materials, this could be explored using a wall-less model. The flow phantom could be utilised for research and training clinicians in measuring cerebral blood flow using the carotid artery in this vulnerable group of infants.
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Affiliation(s)
- Sujith Pereira
- Neonatal Unit, Homerton University Hospital NHS Foundation Trust, London, UK.,Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Jonathan Reeves
- Clinical Physics, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Malcolm Birch
- Clinical Physics, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Sakthi Finton-James
- Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Komal Verma
- Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Robert Krug
- Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Ajay Sinha
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK.,Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Stephen Kempley
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
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10
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Pereira SS, Sinha AK, Morris JK, Wertheim DF, Shah DK, Kempley ST. Blood pressure intervention levels in preterm infants: pilot randomised trial. Arch Dis Child Fetal Neonatal Ed 2019; 104:F298-F305. [PMID: 30049724 DOI: 10.1136/archdischild-2017-314159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the feasibility of a trial allocating different blood pressure (BP) intervention levels for treatment in extremely preterm infants. DESIGN Three-arm open randomised controlled trial performed between February 2013 and April 2015. SETTING Single tertiary level neonatal intensive care unit. PATIENTS Infants born <29 weeks' gestation were eligible to participate, if parents consented and they did not have a major congenital malformation. INTERVENTIONS Infants were randomised to different levels of mean arterial BP at which they received cardiovascular support: active (<30 mm Hg), moderate (<gestational age mm Hg) or permissive (signs of poor perfusion or <19 mm Hg). Once this threshold was breached, all were managed using the same treatment guideline. BP profiles were downloaded continuously; cardiac output and carotid blood flow were measured at 1 day and 3 days, and amplitude integrated EEG was recorded during the first week. Cranial ultrasound scans were reviewed blind to study allocation. MAIN OUTCOME MEASURE Inotrope usage and achieved BP. RESULTS Of 134 cases screened, 60 were enrolled, with mean gestation 25.8 weeks (SD 1.5) and birth weight 817 g (SD 190). Invasively measured BP on the first day and inotrope usage were highest in the active and lowest in the permissive arms. There were no differences in haemodynamic or EEG variables or in clinical complications. Predefined cranial ultrasound findings did not differ significantly; no infants in the active arm had parenchymal brain lesions. CONCLUSION The BP threshold used to trigger treatment affects the achieved BP and inotrope usage, and it was possible to explore these effects using this study design. TRIAL REGISTRATION NUMBER ISRCTN83507686.
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Affiliation(s)
- Sujith Stanley Pereira
- Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Ajay Kumar Sinha
- Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Joan Katherine Morris
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - David F Wertheim
- Faculty of Science, Engineering and Computing, Kingston University, Kingston, UK
| | - Divyen K Shah
- Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Stephen Terence Kempley
- Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
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11
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Sidor M, Premachandra L, Hanna B, Nair N, Misra A. Carotid Flow as a Surrogate for Cardiac Output Measurement in Hemodynamically Stable Participants. J Intensive Care Med 2018; 35:650-655. [DOI: 10.1177/0885066618775694] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: Evaluation of common carotid artery (CCA) blood flow can provide valuable information regarding the hemodynamic status of a patient. Utilizing ultrasound, we aimed to evaluate the correlation between cardiac output and different hemodynamic parameters in the CCA, namely systolic carotid flow (SCF), corrected flow time (CFT), and total carotid flow (TCF). Methods: We studied a pilot sample of 20 healthy volunteers. Hemodynamic parameters were collected in the right CCA and the heart at rest (baseline), 1-leg compression, 2-leg compression, and passive leg raise. Nonparametric Spearman correlation was calculated using STATA 13 software. Results: This study demonstrated the feasibility and safety of the leg compression testing as a hemodynamic maneuver to simulate volume depletion status. We demonstrated a direct correlation between cardiac output and SCF of 0.67 with a P value < 0.001. Interestingly, TCF calculated based on volume–time integral (VTI) in the carotid artery showed positive correlation of only 0.41, with P < 0.06, and it did not reach statistical significance. We also found a positive correlation between CFT and cardiac output at baseline 0.57, with P < 0.001. Conclusion: Variations in cardiac preload and the subsequent alterations in cardiac output were directly translatable into variations in the carotid blood flow. This supports the potential for using carotid flow as a surrogate for cardiac output. The most promising parameters were SCF, CFT, and carotid systolic VTI. Further work is needed to validate these correlations and utilize these acquired carotid parameters to guide fluid management and predict fluid responsiveness.
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Affiliation(s)
- Marian Sidor
- Division of Rheumatology and Connective Tissue Research, Department of Medicine, RWJ-Rutgers University, New Brunswick, NJ, USA
| | - Lalith Premachandra
- Department of Neurocritical Care, Neurotherapeutics and Neurosurgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Bishoy Hanna
- Department of Pulmonary Disease and Critical Care Medicine, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Nanda Nair
- BayCare Medical Group Cardiology and Heart and Vascular Institute of Florida, Safety Harbor, FL, USA
| | - Amit Misra
- Urgent Care Medicine, Kaiser Permanente, Bakersfield, CA, USA
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12
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Pereira SS, Kempley ST, Wertheim DF, Sinha AK, Morris JK, Shah DK. Investigation of EEG Activity Compared with Mean Arterial Blood Pressure in Extremely Preterm Infants. Front Neurol 2018. [PMID: 29535674 PMCID: PMC5834421 DOI: 10.3389/fneur.2018.00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Cerebral electrical activity in extremely preterm infants is affected by various factors including blood gas and circulatory parameters. Objective To investigate whether continuously measured invasive mean arterial blood pressure (BP) is associated with electroencephalographic (EEG) discontinuity in extremely preterm infants. Study design This prospective observational study examined 51 newborn infants born <29 weeks gestation in the first 3 days after birth. A single channel of raw EEG was used to quantify discontinuity. Mean BP was acquired using continuous invasive measurement and Doppler ultrasound was used to measure left ventricular output (LVO) and common carotid artery blood flow (CCAF). Results Median gestation and birthweight were 25.6 weeks and 760 g, respectively. Mean discontinuity reduced significantly between days 1 and 3. EEG discontinuity was significantly related to gestation, pH and BP. LVO and CCAF were not associated with EEG discontinuity. Conclusion Continuously measured invasive mean arterial BP was found to have a negative relationship with EEG discontinuity; increasing BP was associated with lower EEG discontinuity. This did not appear to be mediated by surrogates of systemic or cerebral blood flow. Infants receiving inotropic support had significantly increased EEG discontinuity on the first day after birth.
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Affiliation(s)
- Sujith S Pereira
- Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.,Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Stephen T Kempley
- Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.,Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - David F Wertheim
- Faculty of Science, Engineering and Computing, Kingston University, Kingston upon Thames, United Kingdom
| | - Ajay K Sinha
- Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.,Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Joan K Morris
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Divyen K Shah
- Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.,Centre for Neuroscience and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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13
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Shi L, Sordillo LA, Rodríguez-Contreras A, Alfano R. Transmission in near-infrared optical windows for deep brain imaging. JOURNAL OF BIOPHOTONICS 2016; 9:38-43. [PMID: 26556561 PMCID: PMC4827444 DOI: 10.1002/jbio.201500192] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/14/2015] [Accepted: 10/21/2015] [Indexed: 05/02/2023]
Abstract
Near-infrared (NIR) radiation has been employed using one- and two-photon excitation of fluorescence imaging at wavelengths 650-950 nm (optical window I) for deep brain imaging; however, longer wavelengths in NIR have been overlooked due to a lack of suitable NIR-low band gap semiconductor imaging detectors and/or femtosecond laser sources. This research introduces three new optical windows in NIR and demonstrates their potential for deep brain tissue imaging. The transmittances are measured in rat brain tissue in the second (II, 1,100-1,350 nm), third (III, 1,600-1,870 nm), and fourth (IV, centered at 2,200 nm) NIR optical tissue windows. The relationship between transmission and tissue thickness is measured and compared with the theory. Due to a reduction in scattering and minimal absorption, window III is shown to be the best for deep brain imaging, and windows II and IV show similar but better potential for deep imaging than window I.
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Affiliation(s)
- Lingyan Shi
- Institute for Ultrafast Spectroscopy and Lasers, Department of Physics, the City College of the City University of New York, 160 Convent Avenue, New York, NY 10031, USA.
- Department of Biology, the City College of the City University of New York, 160 Convent Avenue, New York, NY 10031, USA.
| | - Laura A Sordillo
- Institute for Ultrafast Spectroscopy and Lasers, Department of Physics, the City College of the City University of New York, 160 Convent Avenue, New York, NY 10031, USA
| | - Adrián Rodríguez-Contreras
- Institute for Ultrafast Spectroscopy and Lasers, Department of Physics, the City College of the City University of New York, 160 Convent Avenue, New York, NY 10031, USA
- Department of Biology, the City College of the City University of New York, 160 Convent Avenue, New York, NY 10031, USA
| | - Robert Alfano
- Institute for Ultrafast Spectroscopy and Lasers, Department of Physics, the City College of the City University of New York, 160 Convent Avenue, New York, NY 10031, USA
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14
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Shi L, Shumyatsky P, Rodríguez-Contreras A, Alfano R. Terahertz spectroscopy of brain tissue from a mouse model of Alzheimer's disease. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:15014. [PMID: 26818714 PMCID: PMC4728211 DOI: 10.1117/1.jbo.21.1.015014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 01/04/2016] [Indexed: 05/20/2023]
Abstract
The terahertz (THz) absorption and index of refraction of brain tissues from a mouse model of Alzheimer’s disease (AD) and a control wild-type (normal) mouse were compared using THz time-domain spectroscopy (THz-TDS). Three dominating absorption peaks associated to torsional–vibrational modes were observed in AD tissue, at about 1.44, 1.8, and 2.114 THz, closer to the peaks of free tryptophan molecules than in normal tissue. A possible reason is that there is more free tryptophan in AD brain tissue, while in normal brain tissue more tryptophan is attached to other molecules. Our study suggests that THz-absorption modes may be used as an AD biomarker fingerprint in brain, and that THz-TDS is a promising technique for early diagnosis of AD.
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Affiliation(s)
- Lingyan Shi
- The City College of New York, Institute for Ultrafast Spectroscopy and Lasers, Department of Physics, 160 Convent Avenue, New York, New York 10031, United States
- The City College of New York, Department of Biology, 160 Convent Avenue, New York, New York 10031, United States
- Address all correspondence to: Lingyan Shi, E-mail:
| | - Pavel Shumyatsky
- The City College of New York, Institute for Ultrafast Spectroscopy and Lasers, Department of Physics, 160 Convent Avenue, New York, New York 10031, United States
| | - Adrián Rodríguez-Contreras
- The City College of New York, Institute for Ultrafast Spectroscopy and Lasers, Department of Physics, 160 Convent Avenue, New York, New York 10031, United States
- The City College of New York, Department of Biology, 160 Convent Avenue, New York, New York 10031, United States
| | - Robert Alfano
- The City College of New York, Institute for Ultrafast Spectroscopy and Lasers, Department of Physics, 160 Convent Avenue, New York, New York 10031, United States
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15
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Bates S, Odd D, Luyt K, Mannix P, Wach R, Evans D, Heep A. Superior vena cava flow and intraventricular haemorrhage in extremely preterm infants. J Matern Fetal Neonatal Med 2015; 29:1581-7. [PMID: 26115229 DOI: 10.3109/14767058.2015.1054805] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the relationship between superior vena cava flow (SVCF) measurements within the first 24 h of life, and development of intraventricular haemorrhage (IVH) in extremely preterm infants. STUDY DESIGN Single centre retrospective cohort study of 108 preterm infants born less than 28 weeks' gestation. Main outcome measure was degree of IVH at day 7 postnatal age. RESULTS The mean GA of the study group was 25.4 weeks. Mean SVCF was lower (75 ml/kg/min) in infants later diagnosed with IVH (n = 46) compared to infants, who did not develop IVH (87.7 ml/kg/min, p = 0.055). PDA diameter was inversely associated with SVCF (p = 0.024) and reversal of flow in the descending aorta (p = 0.001). Sensitivity analysis did not confirm an independent association of SVCF with development of IVH [OR 0.990 (0.978-1.002), p = 0.115]. CONCLUSION Our study describes early SVCF in extremely preterm infants is associated with the extent of ductal shunting, but insensitive in predicting IVH.
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Affiliation(s)
- Sarah Bates
- a Neonatal Intensive Care Unit , Southmead Hospital, North Bristol NHS Trust , Bristol , UK , and
| | - David Odd
- a Neonatal Intensive Care Unit , Southmead Hospital, North Bristol NHS Trust , Bristol , UK , and.,b School of Clinical Science, University of Bristol , Bristol , UK
| | - Karen Luyt
- b School of Clinical Science, University of Bristol , Bristol , UK
| | - Paul Mannix
- a Neonatal Intensive Care Unit , Southmead Hospital, North Bristol NHS Trust , Bristol , UK , and
| | - Richard Wach
- a Neonatal Intensive Care Unit , Southmead Hospital, North Bristol NHS Trust , Bristol , UK , and
| | - David Evans
- a Neonatal Intensive Care Unit , Southmead Hospital, North Bristol NHS Trust , Bristol , UK , and
| | - Axel Heep
- a Neonatal Intensive Care Unit , Southmead Hospital, North Bristol NHS Trust , Bristol , UK , and.,b School of Clinical Science, University of Bristol , Bristol , UK
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16
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Gassner M, Killu K, Bauman Z, Coba V, Rosso K, Blyden D. Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods. J Ultrasound 2014; 18:127-33. [PMID: 26191100 DOI: 10.1007/s40477-014-0139-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Cardiac output (CO) measurement in the intensive care unit (ICU) requires invasive devices such as the pulmonary artery (PA) catheter or arterial waveform pulse contour analysis (PCA). This study tests the accuracy and feasibility of point of care ultrasound (POCUS) of the common carotid artery to estimate the CO non-invasively and compare it to existing invasive CO measurement modalities. METHODS Patients admitted to the surgical and cardiothoracic ICU in a tertiary university-affiliated academic center during a 4-month period, with invasive hemodynamic monitoring devices for management, were included in this cohort study. Common carotid artery POCUS was performed to measure the CO and the results were compared to an invasive device. RESULTS Intensivists and ICU fellows, using ultrasound of the common carotid artery, obtained the CO measurements. Images of the Doppler flow and volume were obtained at the level of the thyroid gland. Concurrent CO measured via invasive devices was recorded. The patient cohort comprised 36 patients; 52 % were females. The average age was 59 ± 13 years, and 66 % were monitored via PCA device and 33 % via PA catheter. Intraclass correlation coefficient (ICC) analysis demonstrated almost perfect correlation (0.8152) between measurements of CO via ultrasound vs. invasive modalities. The ICC between POCUS and the invasive measurement via PCA was 0.84 and via PA catheter 0.74, showing substantial agreement between the ultrasound and both invasive modalities. CONCLUSIONS Common carotid artery POCUS offers a non-invasive method of measuring the CO in the critically ill population.
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Affiliation(s)
- Marika Gassner
- Division of Trauma and Critical Care/Department of Surgery/Senior Staff, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, Michigan, MI 48202 USA
| | - Keith Killu
- Division of Trauma and Critical Care/Department of Surgery/Senior Staff, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, Michigan, MI 48202 USA
| | - Zachary Bauman
- Division of Trauma and Critical Care/Department of Surgery/Senior Staff, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, Michigan, MI 48202 USA
| | - Victor Coba
- Division of Trauma and Critical Care/Department of Surgery/Senior Staff, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, Michigan, MI 48202 USA
| | - Kelly Rosso
- Division of Trauma and Critical Care/Department of Surgery/Senior Staff, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, Michigan, MI 48202 USA
| | - Dionne Blyden
- Division of Trauma and Critical Care/Department of Surgery/Senior Staff, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, Michigan, MI 48202 USA
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17
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Browne JE. A review of Doppler ultrasound quality assurance protocols and test devices. Phys Med 2014; 30:742-51. [PMID: 25212384 DOI: 10.1016/j.ejmp.2014.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 02/07/2023] Open
Abstract
In this paper, an overview of Doppler ultrasound quality assurance (QA) testing will be presented in three sections. The first section will review the different Doppler ultrasound parameters recommended by professional bodies for use in QA protocols. The second section will include an evaluation and critique of the main test devices used to assess Doppler performance, while the final section of this paper will discuss which of the wide range of test devices have been found to be most suitable for inclusion in Doppler QA programmes. Pulsed Wave Spectral Doppler, Colour Doppler Imaging QA test protocols have been recommended over the years by various professional bodies, including the UK's Institute of Physics and Engineering in Medicine (IPEM), the American Institute for Ultrasound in Medicine (AIUM), and the International Electrotechnical Commission (IEC). However, despite the existence of such recommended test protocols, very few commercial or research test devices exist which can measure the full range of both PW Doppler ultrasound and colour Doppler imaging performance parameters, particularly quality control measurements such as: (i) Doppler sensitivity (ii) colour Doppler spatial resolution (iii) colour Doppler temporal resolution (iv) colour Doppler velocity resolution (v) clutter filter performance and (vi) tissue movement artefact suppression. In this review, the merits of the various commercial and research test devices will be considered and a summary of results obtained from published studies which have made use of some of these Doppler test devices, such as the flow, string, rotating and belt phantom, will be presented.
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Affiliation(s)
- Jacinta E Browne
- Medical Ultrasound Group, School of Physics and IEO, FOCAS Institute, Dublin Institute of Technology, Kevin Street, Dublin 8, Ireland.
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18
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Farrugia R, Rojas H, Rabe H. Diagnosis and management of hypotension in neonates. Future Cardiol 2014; 9:669-79. [PMID: 24020669 DOI: 10.2217/fca.13.59] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The diagnosis and management of hypotension in neonates is a frequently encountered issue in the intensive care setting. There is an ongoing debate as to the appropriateness of blood pressure monitoring as an indicator of organ perfusion and tissue hypoxia. These ultimately determine morbidity and mortality in the sick newborn. This article explores the methods available for the assessment of organ perfusion and speculates on other means that may become available in the future. Different modalities of treatment currently in use are discussed, with the aim of using information gained from perfusion monitoring techniques to determine the optimal choice of therapy.
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Affiliation(s)
- Ryan Farrugia
- Neonatal & Paediatric Intensive Care Unit, Department of Paediatrics, Mater Dei Hospital, Malta.
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