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Kaiser HA, Bauer T, Riva T, Greif R, Riedel T, Theiler L, Nabecker S. Carbon dioxide and cardiac output as major contributors to cerebral oxygenation during apnoeic oxygenation. Sci Rep 2024; 14:3617. [PMID: 38351038 PMCID: PMC10864331 DOI: 10.1038/s41598-023-49238-3] [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: 12/12/2022] [Accepted: 12/06/2023] [Indexed: 02/16/2024] Open
Abstract
Apnoeic oxygenation has experienced a resurgence in interest in critical care and perioperative medicine. However, its effect on cerebral oxygenation and factors influencing it, have not yet been investigated in detail. By using near-infrared spectroscopy, we intended to provide further evidence for the safety of apnoeic oxygenation and to increase our understanding of the association between cerebral perfusion, haemodynamic, respiratory and demographic factors. In this secondary analysis of a prospective randomized controlled noninferiority trial, we recruited 125 patients, who underwent surgery under general anaesthesia with neuromuscular blockade. Arterial blood samples were taken every 2 min for a total of 15 min under apnoeic oxygenation with 100% oxygen. Near-infrared spectroscopy and cardiac output were continuously measured. Statistical analysis was performed using uni- and multivariable statistics. Ninety-one complete data sets were analysed. In six patients the SpO2 fell below 92% (predefined study termination criterion). The significant average increase of cerebral oxygenation was 0.5%/min and 2.1 mmHg/min for the arterial pressure of carbon dioxide (paCO2). The median cardiac output increased significantly from 5.0 l/min (IQR 4.5-6.0) to 6.5 l/min (IQR 5.7-7.5). The most significant effect on cerebral oxygenation was exhibited by the variable paCO2 and non-specific patient factors, followed by cardiac output and paO2. Apnoeic oxygenation proves to have a high safety profile while significantly increasing cerebral oxygenation, paCO2 and cardiac output. In reverse, NIRS might act as a reliable clinical surrogate of paCO2 and cardiac output during stable arterial oxygenation.
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Grants
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
- no ID The study was supported by a departmental research grant of the Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, Bern, Switzerland.
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Affiliation(s)
- Heiko Andreas Kaiser
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Bauer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Unit for Research and Innovation, Department of Paediatric Anaesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - Robert Greif
- University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Thomas Riedel
- Department of Paediatrics, Cantonal Hospital Graubünden, Chur, Switzerland
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, University Children's Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Theiler
- Department of Anaesthesia, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Sabine Nabecker
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Anaesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, Canada.
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Sandru S, Buzescu D, Zahiu CDM, Spataru A, Panaitescu AM, Isac S, Balan CI, Zagrean AM, Pavel B. Near-Infrared Spectroscopy Usefulness in Validation of Hyperventilation Test. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101396. [PMID: 36295560 PMCID: PMC9607377 DOI: 10.3390/medicina58101396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/23/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022]
Abstract
Background: The hyperventilation test is used in clinical practice for diagnosis and therapeutic purposes; however, in the absence of a standardized protocol, the procedure varies significantly, predisposing tested subjects to risks such as cerebral hypoxia and ischemia. Near-infrared spectroscopy (NIRS), a noninvasive technique performed for cerebral oximetry monitoring, was used in the present study to identify the minimum decrease in the end-tidal CO2 (ETCO2) during hyperventilation necessary to induce changes on NIRS. Materials and Methods: We recruited 46 volunteers with no preexisting medical conditions. Each subject was asked to breathe at a baseline rate (8−14 breaths/min) for 2 min and then to hyperventilate at a double respiratory rate for the next 4 min. The parameters recorded during the procedure were the regional cerebral oxyhemoglobin and deoxyhemoglobin concentrations via NIRS, ETCO2, and the respiratory rate. Results: During hyperventilation, ETCO2 values dropped (31.4 ± 12.2%) vs. baseline in all subjects. Changes in cerebral oximetry were observed only in those subjects (n = 30) who registered a decrease (%) in ETCO2 of 37.58 ± 10.34%, but not in the subjects (n = 16) for which the decrease in ETCO2 was 20.31 ± 5.6%. According to AUC-ROC analysis, a cutoff value of ETCO2 decrease >26% was found to predict changes in oximetry (AUC-ROC = 0.93, p < 0.0001). Seven subjects reported symptoms, such as dizziness, vertigo, and numbness, throughout the procedure. Conclusions: The rise in the respiratory rate alone cannot effectively predict the occurrence of a cerebral vasoconstrictor response induced by hyperventilation, and synchronous ETCO2 and cerebral oximetry monitoring could be used to validate this clinical test. NIRS seems to be a useful tool in predicting vasoconstriction following hyperventilation.
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Affiliation(s)
- Stefan Sandru
- Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Dan Buzescu
- Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Carmen Denise Mihaela Zahiu
- Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence: (C.D.M.Z.); (B.P.)
| | - Ana Spataru
- Department of Critical Care, King’s College Hospital Denmark Hill, London SE5 9RS, UK
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital Bucharest, 011171 Bucharest, Romania
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Sebastian Isac
- Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cosmin Ion Balan
- Department I of Cardiovascular Anesthesiology and Intensive Care, “Prof. C. C Iliescu” Emergency Institute for Cardiovascular Diseases, 050474 Bucharest, Romania
| | - Ana-Maria Zagrean
- Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Bogdan Pavel
- Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence: (C.D.M.Z.); (B.P.)
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Hyland-Monks R, Marchant D, Cronin L. Self-Paced Endurance Performance and Cerebral Hemodynamics of the Prefrontal Cortex: A Scoping Review of Methodology and Findings. Percept Mot Skills 2022; 129:1089-1114. [PMID: 35609231 PMCID: PMC9301167 DOI: 10.1177/00315125221101017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent research has suggested that top-down executive function associated with the prefrontal cortex is key to the decision-making processes and pacing of endurance performance. A small but growing body of literature has investigated the neurological underpinnings of these processes by subjecting the prefrontal cortex to functional near-infrared spectroscopy (fNIRS) measurement during self-paced endurance task performance. Given that fNIRS measurement for these purposes is a relatively recent development, the principal aim of this review was to assess the methodological rigor and findings of this body of research. We performed a systematic literature search to collate research assessing prefrontal cortex oxygenation via fNIRS during self-paced endurance performance. A total of 17 studies met the criteria for inclusion. We then extracted information concerning the methodology and findings from the studies reviewed. Promisingly, most of the reviewed studies reported having adopted commonplace and feasible best practice guidelines. However, a lack of adherence to these guidelines was evident in some areas. For instance, there was little evidence of measures to tackle and remove artifacts from data. Lastly, the reviewed studies provide insight into the significance of cerebral oxygenation to endurance performance and the role of the prefrontal cortex in pacing behavior. Therefore, future research that better follows the guidelines presented will help advance our understanding of the role of the brain in endurance performance and aid in the development of techniques to improve or maintain prefrontal cortex (PFC) oxygenation to help bolster endurance performance.
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Affiliation(s)
- Robert Hyland-Monks
- Department of Sport and Physical Activity, 6249Edge Hill University, Ormskirk, UK
| | - David Marchant
- Department of Sport and Physical Activity, 6249Edge Hill University, Ormskirk, UK
| | - Lorcan Cronin
- Department of Sport and Physical Activity, 6249Edge Hill University, Ormskirk, UK
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Scholkmann F, Zohdi H, Wolf M, Wolf U. Frontal Cerebral Oxygenation in Humans at Rest: A Mirror Symmetry in the Correlation with Cardiorespiratory Activity. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1395:45-51. [PMID: 36527612 DOI: 10.1007/978-3-031-14190-4_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although several studies published reference values for frontal cerebral tissue oxygen saturation (StO2) measured with near-infrared spectroscopy (NIRS) based cerebral oximetry, a detailed investigation, whether and which factors from systemic physiology are related to the individual StO2 values, is missing. AIM We investigated how the state of the cardiorespiratory system is linked to StO2 values at rest. SUBJECTS AND METHODS Absolute StO2 values (median over a 5 min resting-phase while sitting) were obtained from 126 healthy subjects (age: 24.0 ± 0.2 years, 45 males, 81 females) over the left and right prefrontal cortex (PFC) by employing frequency-domain NIRS as part of a systemic physiology augmented functional near-infrared spectroscopy (SPA-fNIRS) study. In addition, heart rate (HR) and respiration rate (RR) were measured, and the pulse respiration quotient (PRQ) was determined (PRQ = HR/RR). General additive models (GAM) were used to analyse the data. RESULTS The GAM analysis revealed a specific relationship between the overall PFC StO2 values (mean over right and left PFC) and the variables HR and RR: HR was positively correlated with mean StO2, while RR showed no correlation. In the mirror case, RR was negatively linearly correlated with the frontal cerebral oxygenation asymmetry (FCOA), which was not correlated with HR. The right PFC StO2 was not linked to the RR, whereas the left PFC StO2 was. Positive correlations of the PRQ with the mean PFC StO2 as well as the FCOA were also found. GAM modelling revealed that the individual FCOA values are explained to a large extent (deviance explained: 88.8%) by the individual mean PFC StO2 and PRQ. We conclude that (i) the state of the cardiorespiratory system is significantly correlated with StO2 values and (ii) there is a mirror symmetry with regard to the impact of cardiorespiratory parameters on the mean PFC StO2 and FCOA.
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Robba C, Cardim D, Ball L, Battaglini D, Dabrowski W, Bassetti M, Giacobbe DR, Czosnyka M, Badenes R, Pelosi P, Matta B. The Use of Different Components of Brain Oxygenation for the Assessment of Cerebral Haemodynamics: A Prospective Observational Study on COVID-19 Patients. Front Neurol 2021; 12:735469. [PMID: 34987461 PMCID: PMC8722102 DOI: 10.3389/fneur.2021.735469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction: The role of near-infrared spectroscopy (NIRS) for the evaluation of cerebral haemodynamics is gaining increasing popularity because of its noninvasive nature. The aim of this study was to evaluate the role of the integral components of regional cerebral oxygenation (rSO2) measured by NIRS [i.e., arterial-oxyhemoglobin (O2Hbi) and venous-deoxyhemoglobin (HHbi)-components], as indirect surrogates of cerebral blood flow (CBF) in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19). We compared these findings to the gold standard technique for noninvasive CBF assessment, Transcranial Doppler (TCD). Methods: Mechanically ventilated patients with COVID-19 admitted to the Intensive Care Unit (ICU) of Policlinico San Martino Hospital, Genova, Italy, who underwent multimodal neuromonitoring (including NIRS and TCD), were included. rSO2 and its components [relative changes in O2Hbi, HHbi, and total haemoglobin (cHbi)] were compared with TCD (cerebral blood flow velocity, CBFV). Changes (Δ) in CBFV and rSO2, ΔO2Hbi, ΔHHbi, and ΔcHbi after systemic arterial blood pressure (MAP) modifications induced by different manoeuvres (e.g., rescue therapies and haemodynamic manipulation) were assessed using mixed-effect linear regression analysis and repeated measures correlation coefficients. All values were normalised as percentage changes from the baseline (Δ%). Results: One hundred and four measurements from 25 patients were included. Significant effects of Δ%MAP on Δ%CBF were observed after rescue manoeuvres for CBFV, ΔcHbi, and ΔO2Hbi. The highest correlation was found between ΔCBFV and ΔΔO2Hbi (R = 0.88, p < 0.0001), and the poorest between ΔCBFV and ΔΔHHbi (R = 0.34, p = 0.002). Conclusions: ΔO2Hbi had the highest accuracy to assess CBF changes, reflecting its role as the main component for vasomotor response after changes in MAP. The use of indexes derived from the different components of rSO2 can be useful for the bedside evaluation of cerebral haemodynamics in mechanically ventilated patients with COVID-19.
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Affiliation(s)
- Chiara Robba
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy,San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Danilo Cardim
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy,San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Denise Battaglini
- San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Wojciech Dabrowski
- Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy,Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy,Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Marek Czosnyka
- Brain Physics Laboratory, Department of Clinical Neurosciences, Neurosurgery Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Rafael Badenes
- Department of Anesthesia and Intensive Care, Hospital Clinic Universitari, INCLIVA Research Health Institute, University of Valencia, Valencia, Spain,*Correspondence: Rafael Badenes
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy,San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Basil Matta
- Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
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Mahmoodkalayeh S, Kratkiewicz K, Manwar R, Shahbazi M, Ansari MA, Natarajan G, Asano E, Avanaki K. Wavelength and pulse energy optimization for detecting hypoxia in photoacoustic imaging of the neonatal brain: a simulation study. BIOMEDICAL OPTICS EXPRESS 2021; 12:7458-7477. [PMID: 35003846 PMCID: PMC8713673 DOI: 10.1364/boe.439147] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/10/2021] [Accepted: 10/20/2021] [Indexed: 05/03/2023]
Abstract
Cerebral hypoxia is a severe injury caused by oxygen deprivation to the brain. Hypoxia in the neonatal period increases the risk for the development of neurological disorders, including hypoxic-ischemic encephalopathy, cerebral palsy, periventricular leukomalacia, and hydrocephalus. It is crucial to recognize hypoxia as soon as possible because early intervention improves outcomes. Photoacoustic imaging, using at least two wavelengths, through a spectroscopic analysis, can measure brain oxygen saturation. Due to the spectral coloring effect arising from the dependency of optical properties of biological tissues to the wavelength of light, choosing the right wavelength-pair for efficient and most accurate oxygen saturation measurement and consequently quantifying hypoxia at a specific depth is critical. Using a realistic neonate head model and Monte Carlo simulations, we found practical wavelength-pairs that quantified regions with hypoxia most accurately at different depths down to 22 mm into the cortex neighboring the lateral ventricle. We also demonstrated, for the first time, that the accuracy of the sO2 measurement can be increased by adjusting the level of light energy for each wavelength-pair. Considering the growing interest in photoacoustic imaging of the brain, this work will assist in a more accurate use of photoacoustic spectroscopy and help in the clinical translation of this promising imaging modality. Please note that explaining the effect of acoustic aberration of the skull is not in the scope of this study.
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Affiliation(s)
- Sadreddin Mahmoodkalayeh
- Department of Physics, Shahid Beheshti University, Tehran, Iran
- Laser and Plasma Research Institute, Shahid Beheshti University, Tehran, Iran
- These authors have contributed equally
| | - Karl Kratkiewicz
- Wayne State University, Bioengineering Department, Detroit, Michigan 48201, USA
| | - Rayyan Manwar
- Richard and Loan Hill Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois 60607, USA
| | - Meysam Shahbazi
- Laser and Plasma Research Institute, Shahid Beheshti University, Tehran, Iran
| | - Mohammad Ali Ansari
- Laser and Plasma Research Institute, Shahid Beheshti University, Tehran, Iran
| | - Girija Natarajan
- Wayne State University School of Medicine, Department of Neurology, Detroit, Michigan 48201, USA
- Wayne State University School of Medicine, Department of Pediatrics, Detroit, Michigan 48201, USA
| | - Eishi Asano
- Wayne State University School of Medicine, Department of Neurology, Detroit, Michigan 48201, USA
- Wayne State University School of Medicine, Department of Pediatrics, Detroit, Michigan 48201, USA
| | - Kamran Avanaki
- Richard and Loan Hill Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois 60607, USA
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois 60607, USA
- These authors have contributed equally
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Defenderfer J, Forbes S, Wijeakumar S, Hedrick M, Plyler P, Buss AT. Frontotemporal activation differs between perception of simulated cochlear implant speech and speech in background noise: An image-based fNIRS study. Neuroimage 2021; 240:118385. [PMID: 34256138 PMCID: PMC8503862 DOI: 10.1016/j.neuroimage.2021.118385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/10/2021] [Accepted: 07/09/2021] [Indexed: 10/27/2022] Open
Abstract
In this study we used functional near-infrared spectroscopy (fNIRS) to investigate neural responses in normal-hearing adults as a function of speech recognition accuracy, intelligibility of the speech stimulus, and the manner in which speech is distorted. Participants listened to sentences and reported aloud what they heard. Speech quality was distorted artificially by vocoding (simulated cochlear implant speech) or naturally by adding background noise. Each type of distortion included high and low-intelligibility conditions. Sentences in quiet were used as baseline comparison. fNIRS data were analyzed using a newly developed image reconstruction approach. First, elevated cortical responses in the middle temporal gyrus (MTG) and middle frontal gyrus (MFG) were associated with speech recognition during the low-intelligibility conditions. Second, activation in the MTG was associated with recognition of vocoded speech with low intelligibility, whereas MFG activity was largely driven by recognition of speech in background noise, suggesting that the cortical response varies as a function of distortion type. Lastly, an accuracy effect in the MFG demonstrated significantly higher activation during correct perception relative to incorrect perception of speech. These results suggest that normal-hearing adults (i.e., untrained listeners of vocoded stimuli) do not exploit the same attentional mechanisms of the frontal cortex used to resolve naturally degraded speech and may instead rely on segmental and phonetic analyses in the temporal lobe to discriminate vocoded speech.
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Affiliation(s)
- Jessica Defenderfer
- Speech and Hearing Science, University of Tennessee Health Science Center, Knoxville, TN, United States.
| | - Samuel Forbes
- Psychology, University of East Anglia, Norwich, England.
| | | | - Mark Hedrick
- Speech and Hearing Science, University of Tennessee Health Science Center, Knoxville, TN, United States.
| | - Patrick Plyler
- Speech and Hearing Science, University of Tennessee Health Science Center, Knoxville, TN, United States.
| | - Aaron T Buss
- Psychology, University of Tennessee, Knoxville, TN, United States.
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McKnight JC, Mulder E, Ruesch A, Kainerstorfer JM, Wu J, Hakimi N, Balfour S, Bronkhorst M, Horschig JM, Pernett F, Sato K, Hastie GD, Tyack P, Schagatay E. When the human brain goes diving: using near-infrared spectroscopy to measure cerebral and systemic cardiovascular responses to deep, breath-hold diving in elite freedivers. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200349. [PMID: 34176327 DOI: 10.1098/rstb.2020.0349] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Continuous measurements of haemodynamic and oxygenation changes in free living animals remain elusive. However, developments in biomedical technologies may help to fill this knowledge gap. One such technology is continuous-wave near-infrared spectroscopy (CW-NIRS)-a wearable and non-invasive optical technology. Here, we develop a marinized CW-NIRS system and deploy it on elite competition freedivers to test its capacity to function during deep freediving to 107 m depth. We use the oxyhaemoglobin and deoxyhaemoglobin concentration changes measured with CW-NIRS to monitor cerebral haemodynamic changes and oxygenation, arterial saturation and heart rate. Furthermore, using concentration changes in oxyhaemoglobin engendered by cardiac pulsation, we demonstrate the ability to conduct additional feature exploration of cardiac-dependent haemodynamic changes. Freedivers showed cerebral haemodynamic changes characteristic of apnoeic diving, while some divers also showed considerable elevations in venous blood volumes close to the end of diving. Some freedivers also showed pronounced arterial deoxygenation, the most extreme of which resulted in an arterial saturation of 25%. Freedivers also displayed heart rate changes that were comparable to diving mammals both in magnitude and patterns of change. Finally, changes in cardiac waveform associated with heart rates less than 40 bpm were associated with changes indicative of a reduction in vascular compliance. The success here of CW-NIRS to non-invasively measure a suite of physiological phenomenon in a deep-diving mammal highlights its efficacy as a future physiological monitoring tool for human freedivers as well as free living animals. This article is part of the theme issue 'Measuring physiology in free-living animals (Part II)'.
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Affiliation(s)
- J Chris McKnight
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, St Andrews, UK.,Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Eric Mulder
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Alexander Ruesch
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Jana M Kainerstorfer
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA.,Neuroscience Institute, Carnegie Mellon University, 4400 Forbes Ave., Pittsburgh, PA 15213, USA
| | - Jingyi Wu
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Naser Hakimi
- Artinis Medical Systems BV, Einsteinweg 17, 6662 PW Elst, The Netherlands
| | - Steve Balfour
- Sea Mammal Research Unit Instrumentation Group, Scottish Oceans Institute, University of St Andrews, St Andrews, UK
| | - Mathijs Bronkhorst
- Artinis Medical Systems BV, Einsteinweg 17, 6662 PW Elst, The Netherlands
| | - Jörn M Horschig
- Artinis Medical Systems BV, Einsteinweg 17, 6662 PW Elst, The Netherlands
| | - Frank Pernett
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Katsufumi Sato
- Atmosphere and Ocean Research Institute, The University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa, Chiba 277-8564, Japan
| | - Gordon D Hastie
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, St Andrews, UK
| | - Peter Tyack
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, St Andrews, UK
| | - Erika Schagatay
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.,Swedish Winter Sport Research Center (SWSRC), Mid Sweden University, Östersund, Sweden
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9
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Effects on cerebral blood flow of position changes, hyperoxia, CO2 partial pressure variations and the Valsalva manoeuvre: A study in healthy volunteers. Eur J Anaesthesiol 2021; 38:49-57. [PMID: 33074942 DOI: 10.1097/eja.0000000000001356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Maintaining adequate blood pressure to ensure proper cerebral blood flow (CBF) during surgery is challenging. Induced mild hypotension, sitting position or unavoidable intra-operative circumstances such as haemorrhage, added to variations in carbon dioxide and oxygen tensions, may influence perfusion. Several of these circumstances may coincide and it is unclear how these may affect CBF. OBJECTIVE To describe the variation in transcranial Doppler and regional cerebral oxygen saturation (rSO2), as a surrogate of CBF, after cardiac preload and gravitational positional changes. DESIGN Observational study. SETTING Operating room at Hospital Clínic de Barcelona. VOLUNTEERS Ten healthy volunteers, white, both sexes. INTERVENTIONS Measurements were performed in the supine, sitting and standing positions during hyperoxia, hypocapnia and hypercapnia protocols and after a Valsalva manoeuvre. MAIN OUTCOME MEASURES Cardiac index (CI), haemodynamic and respiratory variables, maximal and mean velocities (Vmax, Vmean) (transcranial Doppler) and rSO2 were acquired. Results were analysed using a generalised estimating equation technique. RESULTS CI increases more than 16% after a preload challenge were not accompanied by differences in rSO2 or Vmax - Vmean. With positional changes, Vmean decreased more than 7% (P = 0.042) from the supine to the seated position. Hyperoxia induced a cerebral rSO2 increase more than 6% (P = 0.0001) with decreases in Vmax, Vmean and CI values more than 3% (P = 0.001, 0.022 and 0.001) in the supine and standing position. During hypocapnia, CI rose more than 20% from supine to seated and standing (P = 0.0001) with a 4.5% decrease in cerebral rSO2 (P = 0.001) and a decrease of Vmax - Vmean more than 24% in all positions (P = 0.001). Hypercapnia increased cerebral rSO2 more than 17% (P = 0.001), Vmax - Vmean more than 30% (P = 0.001) with no changes in CI. After a Valsalva manoeuvre, rSO2 decreased more than 3% in the right hemisphere in the upright position (P = 0.001). Vmax - Vmean decreased more than 10% (P = 0.001) with no changes in CI. CONCLUSION CBF changes in response to cerebral vasoconstriction and vasodilatation were detected with rSO2 and transcranial Doppler in healthy volunteers during cardiac preload and in different body positions. Acute hypercapnia had a greater effect on recorded brain parameters than hypocapnia.
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Zohdi H, Scholkmann F, Wolf U. Individual Differences in Hemodynamic Responses Measured on the Head Due to a Long-Term Stimulation Involving Colored Light Exposure and a Cognitive Task: A SPA-fNIRS Study. Brain Sci 2021; 11:54. [PMID: 33466405 PMCID: PMC7824905 DOI: 10.3390/brainsci11010054] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/20/2020] [Accepted: 12/30/2020] [Indexed: 12/11/2022] Open
Abstract
When brain activity is measured by neuroimaging, the canonical hemodynamic response (increase in oxygenated hemoglobin ([O2Hb]) and decrease in deoxygenated hemoglobin ([HHb]) is not always seen in every subject. The reason for this intersubject-variability of the responses is still not completely understood. This study is performed with 32 healthy subjects, using the systemic physiology augmented functional near-infrared spectroscopy (SPA-fNIRS) approach. We investigate the intersubject variability of hemodynamic and systemic physiological responses, due to a verbal fluency task (VFT) under colored light exposure (CLE; blue and red). Five and seven different hemodynamic response patterns were detected in the subgroup analysis of the blue and red light exposure, respectively. We also found that arterial oxygen saturation and mean arterial pressure were positively correlated with [O2Hb] at the prefrontal cortex during the CLE-VFT independent of the color of light and classification of the subjects. Our study finds that there is substantial intersubject-variability of cerebral hemodynamic responses, which is partially explained by subject-specific systemic physiological changes induced by the CLE-VFT. This means that both subgroup analyses and the additional assessment of systemic physiology are of crucial importance to achieve a comprehensive understanding of the effects of a CLE-VFT on human subjects.
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Affiliation(s)
- Hamoon Zohdi
- Institute of Complementary and Integrative Medicine, University of Bern, 3012 Bern, Switzerland; (H.Z.); (F.S.)
| | - Felix Scholkmann
- Institute of Complementary and Integrative Medicine, University of Bern, 3012 Bern, Switzerland; (H.Z.); (F.S.)
- Biomedical Optics Research Laboratory, Neonatology Research, Department of Neonatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Ursula Wolf
- Institute of Complementary and Integrative Medicine, University of Bern, 3012 Bern, Switzerland; (H.Z.); (F.S.)
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Robu CB, Koninckx A, Docquier MA, Grosu I, De Kerchove L, Mastrobuoni S, Momeni M. Advanced Age and Sex Influence Baseline Regional Cerebral Oxygen Saturation as Measured by Near-Infrared Spectroscopy: Subanalysis of a Prospective Study. J Cardiothorac Vasc Anesth 2020; 34:3282-3289. [DOI: 10.1053/j.jvca.2020.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 02/01/2023]
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Tabone L, Khirani S, Olmo Arroyo J, Amaddeo A, Sabil A, Fauroux B. Cerebral Oxygenation During Respiratory Events in Children with Sleep-Disordered Breathing and Associated Disorders. J Pediatr 2019; 214:134-140.e7. [PMID: 31540763 DOI: 10.1016/j.jpeds.2019.07.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/12/2019] [Accepted: 07/12/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate changes in cerebral oxygenation by means of near-infrared spectroscopy during respiratory events in children with sleep-disordered breathing (SDB) and associated disorders. STUDY DESIGN Sixty-five children suspected of having SDB underwent a respiratory polygraphy with simultaneous recording of cerebral oxygenation indices. Respiratory events were analyzed by type of event, duration, variations of pulse oximetry (oxygen saturation [SpO2]), cerebral tissue oxygenation index (TOI), and heart rate. Data were categorized according to the severity of SDB and age. RESULTS There were 540 obstructive and mixed apneas, 172 central apneas, and 393 obstructive hypopneas analyzed. The mean decreases in SpO2 and TOI were 4.1 ± 3.1% and 3.4 ± 2.8%, respectively. The mean TOI decrease was significantly smaller for obstructive hypopnea compared with apneas. The TOI decrease was significantly less in children with mild SDB as compared with those with moderate-to-severe SDB and in children >7 years as compared with those <7 years old. TOI decreases correlated significantly with SpO2 decreases, duration of event, and age, regardless of the type of event. In a multivariable regression model, predictive factors of TOI decreases were the type of respiratory event, SpO2 decrease, apnea-hypopnea index, and age. CONCLUSIONS In children with SDB and associated disorders, cerebral oxygenation variations depend on the type of respiratory event, severity of SDB, and age.
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Affiliation(s)
- Laurence Tabone
- Research Unit French Institute of Health and Medical Research U 955, team 13, Créteil, France.
| | - Sonia Khirani
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France; EA 7330 VIFASOM (Vigilance, Fatigue, Sleep and Public Health), Paris Descartes University, Paris, France; ASV Santé, Gennevilliers, France
| | - Jorge Olmo Arroyo
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France
| | - Alessandro Amaddeo
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France; EA 7330 VIFASOM (Vigilance, Fatigue, Sleep and Public Health), Paris Descartes University, Paris, France
| | | | - Brigitte Fauroux
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France; EA 7330 VIFASOM (Vigilance, Fatigue, Sleep and Public Health), Paris Descartes University, Paris, France
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Tanaka N, Yamamoto M, Abe T, Osawa T, Matsumoto R, Shinohara N, Saito H, Uchida Y, Morimoto Y. Changes of Cerebral Blood Volume During Robot-Assisted Laparoscopic Radical Prostatectomy: Observational Prospective Study Using Near-Infrared Time-Resolved Spectroscopy. J Endourol 2019; 33:995-1001. [PMID: 31111734 DOI: 10.1089/end.2019.0217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Robot-assisted laparoscopic radical prostatectomy (RARP) requires a steep head-down tilt and pneumoperitoneum, which may cause an increase in cerebral blood volume (CBV). With a new near-infrared time-resolved spectroscopy device, the tNIRS-1, we can measure the absolute value of the cerebral hemoglobin concentration and hence calculate CBV and cerebral oxygen saturation (rSO2). Using this device, we evaluated the time course of CBV during surgery and also evaluated the changes in rSO2 simultaneously. Materials and Methods: We performed a prospective observational study of 21 patients scheduled for RARP. We evaluated CBV and rSO2 by using the tNIRS-1 at 10 time points during surgery. Results: The CBV was 2.92 ± 0.38 mL ·100 g-1 after the end of anesthetic preparation. It significantly increased to 3.05 ± 0.44 mL ·100 g-1 after the head-down tilt and was around 3.1 mL ·100 g-1 until 120 minutes after the head-down tilt. However, just before the return to the horizontal position, it decreased to 2.93 ± 0.46 mL ·100 g-1 and then decreased more after the return to the horizontal position. Changes in rSO2 over time were within only 3%, and no significant differences from the control value were observed. Conclusions: The increase in CBV was <10% despite the steep head-down tilt and pneumoperitoneum, and it was compensated for at around the end of surgery. Clinically significant changes in rSO2 were not observed during the surgery.
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Affiliation(s)
- Nobuhiro Tanaka
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masataka Yamamoto
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashige Abe
- Department of Renal and Genitourinary Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takahiro Osawa
- Department of Renal and Genitourinary Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Renal and Genitourinary Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hitoshi Saito
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yosuke Uchida
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuji Morimoto
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Chatterjee SA, Fox EJ, Daly JJ, Rose DK, Wu SS, Christou EA, Hawkins KA, Otzel DM, Butera KA, Skinner JW, Clark DJ. Interpreting Prefrontal Recruitment During Walking After Stroke: Influence of Individual Differences in Mobility and Cognitive Function. Front Hum Neurosci 2019; 13:194. [PMID: 31316360 PMCID: PMC6611435 DOI: 10.3389/fnhum.2019.00194] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/23/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Functional near-infrared spectroscopy (fNIRS) is a valuable neuroimaging approach for studying cortical contributions to walking function. Recruitment of prefrontal cortex during walking has been a particular area of focus in the literature. The present study investigated whether task-related change in prefrontal recruitment measured by fNIRS is affected by individual differences in people post-stroke. The primary hypotheses were that poor mobility function would contribute to prefrontal over-recruitment during typical walking, and that poor cognitive function would contribute to a ceiling in prefrontal recruitment during dual-task walking (i.e., walking with a cognitive task). Methods: Thirty-three adults with chronic post-stroke hemiparesis performed three tasks: typical walking at preferred speed (Walk), serial-7 subtraction (Serial7), and walking combined with serial-7 subtraction (Dual-Task). Prefrontal recruitment was measured with fNIRS and quantified as the change in oxygenated hemoglobin concentration (ΔO2Hb) between resting and active periods for each task. Spatiotemporal gait parameters were measured on an electronic walkway. Stepwise regression was used to assess how prefrontal recruitment was affected by individual differences including age, sex, stroke region, injured hemisphere, stroke chronicity, 10-meter walking speed, balance confidence measured by Activities-specific Balance Confidence (ABC) Scale, sensorimotor impairment measured by Fugl-Meyer Assessment, and cognitive function measured by Mini-Mental State Examination (MMSE). Results: For Walk, poor balance confidence (ABC Scale score) significantly predicted greater prefrontal recruitment (ΔO2Hb; R 2 = 0.25, p = 0.003). For Dual-Task, poor cognitive function (MMSE score) significantly predicted lower prefrontal recruitment (ΔO2Hb; R 2 = 0.25, p = 0.002). Conclusions: Poor mobility function predicted higher prefrontal recruitment during typical walking, consistent with compensatory over-recruitment. Poor cognitive function predicted lower prefrontal recruitment during dual-task walking, consistent with a recruitment ceiling effect. These findings indicate that interpretation of prefrontal recruitment should carefully consider the characteristics of the person and demands of the task.
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Affiliation(s)
- Sudeshna A. Chatterjee
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Emily J. Fox
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
- Brooks Rehabilitation, Jacksonville, FL, United States
| | - Janis J. Daly
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Dorian K. Rose
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Samuel S. Wu
- Department of Biostatistics, University of Florida, Gainesville, FL, United States
| | - Evangelos A. Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Kelly A. Hawkins
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Dana M. Otzel
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | - Katie A. Butera
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Jared W. Skinner
- Geriatric Research, Education and Clinical Center, Malcom Randall VA Medical Center, Gainesville, FL, United States
| | - David J. Clark
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
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Walter LM, Ahmed B, Odoi A, Cooney H, Horne RSC, Wong FY. Bradycardias are associated with more severe effects on cerebral oxygenation in very preterm infants than in late preterm infants. Early Hum Dev 2018; 127:33-41. [PMID: 30245358 DOI: 10.1016/j.earlhumdev.2018.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Commonly the magnitude and frequency of bradycardia is underestimated in the neonatal unit due to the long averaging time used in bedside oximeters. We aimed to assess the frequency and severity of bradycardia in preterm infants using the lowest averaging time (2 s) available on a clinical oximeter, compared with bradycardia detected using electrocardiogram (ECG), and whether bradycardia severity and postmenstrual age affected cerebral oxygenation. METHODS Preterm infants (10 M/9F) were studied longitudinally at 26-31 (very preterm) and 32-38 weeks (late preterm) postmenstrual age. Heart rate falls calculated from ECG were used to determine mild or moderate/severe (MS) bradycardias. Cerebral tissue oxygenation index (TOI, %) was recorded and fractional tissue oxygen extraction (FTOE) calculated. RESULTS Of the 615 bradycardias scored using ECG criteria, 10% were not detected by oximetry. TOI falls associated with bradycardias were greater for MS bradycardias compared with Mild for both groups (p < 0.001 for both). The FTOE associated with MS bradycardias was higher for the very preterm compared with the late preterm group (p < 0.001). In very preterm infants 61% of MS and 35% Mild bradycardias were associated with TOI nadirs below 55%. CONCLUSION Even the most sensitive oximeter setting underestimates bradycardias. The cerebral effect from bradycardias in very preterm infants is more severe than in late preterm infants. Even the mild bradycardias are associated with falls in cerebral oxygenation. Routine NIRS monitoring of cerebral oxygenation in NICUs may increase staff awareness for interventions to reduce the repetitive falls in cerebral oxygenation in preterm infants.
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Affiliation(s)
- Lisa M Walter
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Bushra Ahmed
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Alexsandria Odoi
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Hannah Cooney
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Flora Y Wong
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia; Monash Newborn, Monash Children's Hospital, Melbourne, Australia.
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Dewhirst E, Walia H, Samora WP, Beebe AC, Klamar JE, Tobias JD. Changes in cerebral oxygenation based on intraoperative ventilation strategy. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:253-258. [PMID: 30100768 PMCID: PMC6065577 DOI: 10.2147/mder.s158262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Cerebral oxygenation can be monitored clinically by cerebral oximetry (regional oxygen saturation, rSO2) using near-infrared spectroscopy (NIRS). Changes in rSO2 have been shown to precede changes in pulse oximetry, providing an early detection of clinical deterioration. Cerebral oximetry values may be affected by various factors, including changes in ventilation. The aim of this study was to evaluate the changes in rSO2 during intraoperative changes in mechanical ventilation. Patients and methods Following the approval of the institutional review board (IRB), tissue and cerebral oxygenation were monitored intraoperatively using NIRS. Prior to anesthetic induction, the NIRS monitor was placed on the forehead and over the deltoid muscle to obtain baseline values. NIRS measurements were recorded each minute over a 5-min period during general anesthesia at four phases of ventilation: 1) normocarbia (35–40 mmHg) with a low fraction of inspired oxygen (FiO2) of 0.3; 2) hypocarbia (25–30 mmHg) and low FiO2 of 0.3; 3) hypocarbia and a high FiO2 of 0.6; and 4) normocarbia and a high FiO2. NIRS measurements during each phase were compared with sequential phases using paired t-tests. Results The study cohort included 30 adolescents. Baseline cerebral and tissue oxygenation were 81% ± 9% and 87% ± 5%, respectively. During phase 1, cerebral rSO2 was 83% ± 8%, which decreased to 79% ± 8% in phase 2 (hypocarbia and low FiO2). Cerebral oxygenation partially recovered during phase 3 (81% ± 9%) with the increase in FiO2 and then returned to baseline during phase 4 (83% ± 8%). Each sequential change (e.g., phase 1 to phase 2) in cerebral oxygenation was statistically significant (p < 0.01). Tissue oxygenation remained at 87%–88% throughout the study. Conclusion Cerebral oxygenation declined slightly during general anesthesia with the transition from normocarbia to hypocarbic conditions. The rSO2 decrease related to hypocarbia was easily reversed with a return to baseline values by the administration of supplemental oxygen (60% vs. 30%).
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Affiliation(s)
- Elisabeth Dewhirst
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Hina Walia
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Walter P Samora
- Department of Orthopedic Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Allan C Beebe
- Department of Orthopedic Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Jan E Klamar
- Department of Orthopedic Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH, USA
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Cardim D, Griesdale DE. Near-infrared spectroscopy: unfulfilled promises. Br J Anaesth 2018; 121:523-526. [PMID: 30115246 DOI: 10.1016/j.bja.2018.05.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/28/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- D Cardim
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver BC, Canada
| | - D E Griesdale
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver BC, Canada; Department of Medicine, Divisions of Critical Care Medicine and Neurology, University of British Columbia, Vancouver BC, Canada.
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Different ventilation techniques and hemodynamic optimization to maintain regional cerebral oxygen saturation (rScO 2) during laparoscopic bariatric surgery: a prospective randomized interventional study. J Anesth 2018; 32:394-402. [PMID: 29626267 DOI: 10.1007/s00540-018-2493-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of this study was to assess the changes in regional cerebral oxygen saturation (rScO2) in response to different ventilation strategies: inspired oxygen concentration (FiO2), end-tidal carbon dioxide (EtCO2), and positive end expiratory pressure (PEEP) in addition to optimizing mean arterial pressure (MAP) in obese patients subjected to laparoscopic bariatric surgery in the reverse trendelenburg position. METHODS 50 obese patients were randomly assigned into one of two groups. Each group is 25 patients. Control patients subjected to a ventilation strategy aimed to maintain FiO2 0.4 and EtCO2 30 mmHg without PEEP. Study patients were assigned to specific protocol; T0, baseline rScO2; T1, 5 min following induction; T2, PP/RTP (10 min after pneumoperitoneum and reverse trendelenburg position); T3, PEEP 10 cmH2O; T4, FiO2 1.0; T5, EtCO2 40 mmHg and T6, MAP/BL; MAP back to baseline in both groups. MAIN RESULTS 10 min after PP/RTP, there was a significant decrease in rScO2 in both groups. At T4, with FiO2 1.0, there was significant improvement in rScO2 when compared to T2. At T5, with EtCO2 40 mmHg, rScO2 significantly enhanced when compared to EtCO2 30 mmHg. At T4 and T5, we observed highly significance difference between both groups. At the end of the procedure and when MAP increased back to baseline (T6) in both groups, rScO2 statistically increased in both groups when compared to T2. CONCLUSION In obese patients, subjected to laparoscopic bariatric surgery in reverse trendelenburg position, adjustment of ventilation strategies and hemodynamic optimization succeeded to improve rScO2.
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Hawkins KA, Fox EJ, Daly JJ, Rose DK, Christou EA, McGuirk TE, Otzel DM, Butera KA, Chatterjee SA, Clark DJ. Prefrontal over-activation during walking in people with mobility deficits: Interpretation and functional implications. Hum Mov Sci 2018; 59:46-55. [PMID: 29604488 DOI: 10.1016/j.humov.2018.03.010] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 03/02/2018] [Accepted: 03/20/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Control of walking by the central nervous system includes contributions from executive control mechanisms, such as attention and motor planning resources. Executive control of walking can be estimated objectively by recording prefrontal cortical activity using functional near infrared spectroscopy (fNIRS). OBJECTIVE The primary objective of this study was to investigate group differences in prefrontal/executive control of walking among young adults, older adults, and adults post-stroke. Also assessed was the extent to which walking-related prefrontal activity fits existing cognitive frameworks of prefrontal over-activation. METHODS Participants included 24 adults post-stroke with moderate to severe walking deficits, 15 older adults with mild gait deficits, and 9 young healthy adults. Executive control of walking was quantified as oxygenated hemoglobin concentration in the prefrontal cortex measured by fNIRS. Three walking tasks were assessed: typical walking, walking over obstacles, and walking while performing a verbal fluency task. Walking performance was assessed by walking speed. RESULTS There was a significant effect of group for prefrontal activity (p < 0.001) during typical and obstacles walking tasks, with young adults exhibiting the lowest level of prefrontal activity, followed by older adults, and then adults post-stroke. In young adults the prefrontal activity during typical walking was much lower than for the verbal fluency dual-task, suggesting substantial remaining prefrontal resources during typical walking. However, in older and post-stroke adults these remaining resources were significantly less (p < 0.01). Cumulatively, these results are consistent with prefrontal over-activation in the older and stroke groups, which was accompanied by a steeper drop in walking speed as task complexity increased to include obstacles (p < 0.05). CONCLUSIONS There is a heightened use of prefrontal/executive control resources in older adults and post-stroke adults during walking. The level of prefrontal resource utilization, particularly during complex walking tasks like obstacle crossing, may approach the ceiling of available resources for people who have walking deficits. Prior cognitive research has revealed that prefrontal over-activation combined with limited prefrontal resources can lead to poor cognitive performance. The present study suggests a similar situation influences walking performance. Future research should further investigate the extent to which prefrontal over-activation during walking is linked to adverse mobility outcomes.
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Affiliation(s)
- Kelly A Hawkins
- Department of Physical Therapy, University of Florida, PO Box 100154, Gainesville, FL 32610, USA.
| | - Emily J Fox
- Department of Physical Therapy, University of Florida, PO Box 100154, Gainesville, FL 32610, USA; Brooks Rehabilitation, 3901 University Blvd S, Jacksonville, FL 32216, USA.
| | - Janis J Daly
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, USA; Department of Neurology, University of Florida, PO Box 100383, Gainesville, FL 32610, USA.
| | - Dorian K Rose
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, USA; Department of Physical Therapy, University of Florida, PO Box 100154, Gainesville, FL 32610, USA.
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118205, Gainesville, FL 32611, USA.
| | - Theresa E McGuirk
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, USA.
| | - Dana M Otzel
- VA Geriatric Research, Education and Clinical Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, USA.
| | - Katie A Butera
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, USA; Department of Physical Therapy, University of Florida, PO Box 100154, Gainesville, FL 32610, USA.
| | - Sudeshna A Chatterjee
- Department of Physical Therapy, University of Florida, PO Box 100154, Gainesville, FL 32610, USA.
| | - David J Clark
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, USA; Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Rd, Gainesville, FL 32603, USA.
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Herold F, Wiegel P, Scholkmann F, Thiers A, Hamacher D, Schega L. Functional near-infrared spectroscopy in movement science: a systematic review on cortical activity in postural and walking tasks. NEUROPHOTONICS 2017; 4:041403. [PMID: 28924563 PMCID: PMC5538329 DOI: 10.1117/1.nph.4.4.041403] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 06/23/2017] [Indexed: 05/07/2023]
Abstract
Safe locomotion is a crucial aspect of human daily living that requires well-functioning motor control processes. The human neuromotor control of daily activities such as walking relies on the complex interaction of subcortical and cortical areas. Technical developments in neuroimaging systems allow the quantification of cortical activation during the execution of motor tasks. Functional near-infrared spectroscopy (fNIRS) seems to be a promising tool to monitor motor control processes in cortical areas in freely moving subjects. However, so far, there is no established standardized protocol regarding the application and data processing of fNIRS signals that limits the comparability among studies. Hence, this systematic review aimed to summarize the current knowledge about application and data processing in fNIRS studies dealing with walking or postural tasks. Fifty-six articles of an initial yield of 1420 publications were reviewed and information about methodology, data processing, and findings were extracted. Based on our results, we outline the recommendations with respect to the design and data processing of fNIRS studies. Future perspectives of measuring fNIRS signals in movement science are discussed.
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Affiliation(s)
- Fabian Herold
- Otto von Guericke University Magdeburg, Institute III, Department of Sport Science, Magdeburg, Germany
- Address all correspondence to: Fabian Herold, E-mail:
| | - Patrick Wiegel
- University of Freiburg, Department of Sport Science, Freiburg, Germany
| | - Felix Scholkmann
- University of Zurich, University Hospital Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zurich, Switzerland
| | - Angelina Thiers
- Otto von Guericke University Magdeburg, Institute III, Department of Sport Science, Magdeburg, Germany
| | - Dennis Hamacher
- Otto von Guericke University Magdeburg, Institute III, Department of Sport Science, Magdeburg, Germany
| | - Lutz Schega
- Otto von Guericke University Magdeburg, Institute III, Department of Sport Science, Magdeburg, Germany
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Investigating the role of temporal lobe activation in speech perception accuracy with normal hearing adults: An event-related fNIRS study. Neuropsychologia 2017; 106:31-41. [PMID: 28888891 DOI: 10.1016/j.neuropsychologia.2017.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/29/2017] [Accepted: 09/04/2017] [Indexed: 12/14/2022]
Abstract
Functional near infrared spectroscopy (fNIRS) is a safe, non-invasive, relatively quiet imaging technique that is tolerant of movement artifact making it uniquely ideal for the assessment of hearing mechanisms. Previous research demonstrates the capacity for fNIRS to detect cortical changes to varying speech intelligibility, revealing a positive relationship between cortical activation amplitude and speech perception score. In the present study, we use an event-related design to investigate the hemodynamic response in the temporal lobe across different listening conditions. We presented participants with a speech recognition task using sentences in quiet, sentences in noise, and vocoded sentences. Hemodynamic responses were examined across conditions and then compared when speech perception was accurate compared to when speech perception was inaccurate in the context of noisy speech. Repeated measures, two-way ANOVAs revealed that the speech in noise condition (-2.8dB signal-to-noise ratio/SNR) demonstrated significantly greater activation than the easier listening conditions on multiple channels bilaterally. Further analyses comparing correct recognition trials to incorrect recognition trials (during the presentation phase of the trial) revealed that activation was significantly greater during correct trials. Lastly, during the repetition phase of the trial, where participants correctly repeated the sentence, the hemodynamic response demonstrated significantly higher deoxyhemoglobin than oxyhemoglobin, indicating a difference between the effects of perception and production on the cortical response. Using fNIRS, the present study adds meaningful evidence to the body of knowledge that describes the brain/behavior relationship related to speech perception.
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Antunes A, Montgomery D, Addison P, Borg U. Correction of tissue oxygen saturations using arterial oxygen levels for cerebrovascular autoregulation analysis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:4005-4008. [PMID: 29060775 DOI: 10.1109/embc.2017.8037734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Adequate perfusion of blood is fundamental to brain tissue viability, and failure to appropriately regulate cerebral blood flow is related to neurological damage. Cerebral tissue oxygenation is commonly used as a surrogate of cerebral blood flow for non-invasive measures of autoregulation, but may only be valid during periods of constant oxygen delivery. We present a new algorithm to correct for supply oxygen-induced variations in cerebral tissue oxygenation, and we validate it by measuring the improved correlation of the corrected tissue oxygenation with blood flow. The algorithm corrects tissue oxygenation by calculating its linear dependence with arterial oxygen saturation below a baseline level. A porcine model (N=8) of hypoxia is used to test the algorithm and compare the tissue oxygen correction with a blood flow reference signal. The correction provides significant improvement in the correlation between flow and tissue oxygenation (Wilcoxon signed rank, p<;0.01), and for the root mean square distance between the corrected hypoxic periods and the rSO2-flow regression line (Wilcoxon signed rank, p<;0.01). This method allows the correction of tissue oxygenation levels used in the non-invasive monitoring of autoregulation.
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Li Q, Zhang X, Wu J, Xu M. Two-minute disconnection technique with a double-lumen tube to speed the collapse of the non-ventilated lung for one-lung ventilation in thoracoscopic surgery. BMC Anesthesiol 2017; 17:80. [PMID: 28619111 PMCID: PMC5472948 DOI: 10.1186/s12871-017-0371-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/31/2017] [Indexed: 12/13/2022] Open
Abstract
Background Thoracic surgery requires the effective collapse of the non-ventilated lung. In the majority of cases, we accomplished, accelerated lung collapse using a double-lumen tube (DLT). We hypothesized that using the two-minute disconnection technique with a DLT would improve lung collapse during subsequent one-lung ventilation. Methods Fifty patients undergoing thoracoscopic surgery with physical classification I or II according to the American Society of Anesthesiologists were randomly divided into two groups for respiratory management of one-lung ventilation (OLV). In group N, OLV was initiated after the DLT was disconnected for 2 min; the initiation time began when the surgeon made the skin incision. In group C, OLV was initiated when the surgeon commenced the skin incision and scored the quality of lung collapse (using a four-point ordinal scale). The surgeon’s satisfaction or comfort with the surgical conditions was assessed using a visual analogue scale. rSO2 level, mean arterial pressure, pulse oxygen saturation, arterial blood gas analysis, intraoperative hypoxaemia, intraoperative use of CPAP during OLV, and awakening time were determined in patients at the following time points: while inhaling air (T0), after anaesthesia induction andinhaling 100% oxygen in the supine position under double lung ventilation for five mins (T1), at two mins after skin incision (T2), at ten mins after skin incision (T3), and after the lung recruitment manoeuvres and inhaling 50% oxygen for five mins (T4). Results The two-minute disconnection technique was associated with a significantly shorter time to total lung collapse compared to that of the conventional OLV ventilation method (15 mins vs 22 mins, respectively; P < 0.001), and the overall surgeon’s satisfaction was higher (9 vs 7, respectively; P < 0.001). At T2, the PaCO2, left rSO2 and right rSO2 were higher in group N than in group C. There were no statistically significant differences between the incidence of intraoperative hypoxaemia and intraoperative use of CPAP during OLV (10% vs 5%, respectively; P = 1.000), duration of awakening (18 mins vs 19 mins, respectively; P = 0.616). Conclusions A two-minute disconnection technique using a double-lumen tube was used to speed the collapse of the non-ventilated lung during one-lung ventilation for thoracoscopic surgery. The surgeon was satisfied with the surgical conditions. Trial registration Chinese Clinical Trial Registry number, ChiCTR-IPR-17010352. Registered on Jan, 7, 2017.
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Affiliation(s)
- Qiongzhen Li
- Department of Anesthesiology of Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Xiaofeng Zhang
- Department of Anesthesiology of Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Jingxiang Wu
- Department of Anesthesiology of Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Meiying Xu
- Department of Anesthesiology of Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China.
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Olmo Arroyo J, Khirani S, Amaddeo A, Griffon L, De Sanctis L, Pouard P, Fauroux B. A comparison of pulse oximetry and cerebral oxygenation in children with severe sleep apnea-hypopnea syndrome: a pilot study. J Sleep Res 2017; 26:799-808. [DOI: 10.1111/jsr.12561] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jorge Olmo Arroyo
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
- ASV Santé; Gennevilliers France
| | - Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
- Paris Descartes University; Paris France
- Research Unit INSERM U 955; Team 13; Créteil France
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
| | - Livio De Sanctis
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
| | - Philippe Pouard
- Pediatric Cardiac Intensive Care and Anaesthesia Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit; AP-HP; Hôpital Necker Enfants-Malades; Paris France
- Paris Descartes University; Paris France
- Research Unit INSERM U 955; Team 13; Créteil France
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Predictors of Outcome With Cerebral Autoregulation Monitoring: A Systematic Review and Meta-Analysis. Crit Care Med 2017; 45:695-704. [PMID: 28291094 DOI: 10.1097/ccm.0000000000002251] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare cerebral autoregulation indices as predictors of patient outcome and their dependence on duration of monitoring. DATA SOURCES Systematic literature search and meta-analysis using PubMed, EMBASE, and the Cochrane Library from January 1990 to October 2015. STUDY SELECTION We chose articles that assessed the association between cerebral autoregulation indices and dichotomized or continuous outcomes reported as standardized mean differences or correlation coefficients (R), respectively. Animal and validation studies were excluded. DATA EXTRACTION Two authors collected and assessed the data independently. The studies were grouped into two sets according to the type of analysis used to assess the relationship between cerebral autoregulation indices and predictors of outcome (standardized mean differences or R). DATA SYNTHESIS Thirty-three studies compared cerebral autoregulation indices and patient outcomes using standardized mean differences, and 20 used Rs. The only data available for meta-analysis were from patients with traumatic brain injury or subarachnoid hemorrhage. Based on z score analysis, the best three cerebral autoregulation index predictors of mortality or Glasgow Outcome Scale for patients with traumatic brain injury were the pressure reactivity index, transcranial Doppler-derived mean velocity index based on cerebral perfusion pressure, and autoregulation reactivity index (z scores: 8.97, 6.01, 3.94, respectively). Mean velocity index based on arterial blood pressure did not reach statistical significance for predicting outcome measured as a continuous variable (p = 0.07) for patients with traumatic brain injury. For patients with subarachnoid hemorrhage, autoregulation reactivity index was the only cerebral autoregulation index that predicted patient outcome measured with the Glasgow Outcome Scale as a continuous outcome (R = 0.82; p = 0.001; z score, 3.39). We found a significant correlation between the duration of monitoring and predictive value for mortality (R = 0.78; p < 0.001). CONCLUSIONS Three cerebral autoregulation indices, pressure reactivity index, mean velocity index based on cerebral perfusion pressure, and autoregulation reactivity index were the best outcome predictors for patients with traumatic brain injury. For patients with subarachnoid hemorrhage, autoregulation reactivity index was the only cerebral autoregulation index predictor of Glasgow Outcome Scale. Continuous assessment of cerebral autoregulation predicted outcome better than intermittent monitoring.
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Benni PB, MacLeod D, Ikeda K, Lin HM. A validation method for near-infrared spectroscopy based tissue oximeters for cerebral and somatic tissue oxygen saturation measurements. J Clin Monit Comput 2017; 32:269-284. [PMID: 28374103 PMCID: PMC5838152 DOI: 10.1007/s10877-017-0015-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 03/23/2017] [Indexed: 12/19/2022]
Abstract
We describe the validation methodology for the NIRS based FORE-SIGHT ELITE® (CAS Medical Systems, Inc., Branford, CT, USA) tissue oximeter for cerebral and somatic tissue oxygen saturation (StO2) measurements for adult subjects submitted to the United States Food and Drug Administration (FDA) to obtain clearance for clinical use. This validation methodology evolved from a history of NIRS validations in the literature and FDA recommended use of Deming regression and bootstrapping statistical validation methods. For cerebral validation, forehead cerebral StO2 measurements were compared to a weighted 70:30 reference (REF CXB) of co-oximeter internal jugular venous and arterial blood saturation of healthy adult subjects during a controlled hypoxia sequence, with a sensor placed on the forehead. For somatic validation, somatic StO2 measurements were compared to a weighted 70:30 reference (REF CXS) of co-oximetry central venous and arterial saturation values following a similar protocol, with sensors place on the flank, quadriceps muscle, and calf muscle. With informed consent, 25 subjects successfully completed the cerebral validation study. The bias and precision (1 SD) of cerebral StO2 compared to REF CXB was −0.14 ± 3.07%. With informed consent, 24 subjects successfully completed the somatic validation study. The bias and precision of somatic StO2 compared to REF CXS was 0.04 ± 4.22% from the average of flank, quadriceps, and calf StO2 measurements to best represent the global whole body REF CXS. The NIRS validation methods presented potentially provide a reliable means to test NIRS monitors and qualify them for clinical use.
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Affiliation(s)
- Paul B Benni
- CAS Medical Systems (CASMED), Inc., Branford, CT, USA.
| | - David MacLeod
- Human Pharmacology & Physiology Lab, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Keita Ikeda
- Human Pharmacology & Physiology Lab, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.,Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Hung-Mo Lin
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kietaibl C, Engel A, Horvat Menih I, Huepfl M, Erdoes G, Kubista B, Ullrich R, Windhager R, Markstaller K, Klein K. Detection and differentiation of cerebral microemboli in patients undergoing major orthopaedic surgery using transcranial Doppler ultrasound. Br J Anaesth 2017; 118:400-406. [DOI: 10.1093/bja/aex001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 01/28/2023] Open
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Teng F, Cormier T, Sauer-Budge A, Chaudhury R, Pera V, Istfan R, Chargin D, Brookfield S, Ko NY, Roblyer DM. Wearable near-infrared optical probe for continuous monitoring during breast cancer neoadjuvant chemotherapy infusions. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:14001. [PMID: 28114449 PMCID: PMC5289133 DOI: 10.1117/1.jbo.22.1.014001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/21/2016] [Indexed: 05/04/2023]
Abstract
We present a new continuous-wave wearable diffuse optical probe aimed at investigating the hemodynamic response of locally advanced breast cancer patients during neoadjuvant chemotherapy infusions. The system consists of a flexible printed circuit board that supports an array of six dual wavelength surface-mount LED and photodiode pairs. The probe is encased in a soft silicone housing that conforms to natural breast shape. Probe performance was evaluated using tissue-simulating phantoms and in vivo normal volunteer measurements. High SNR (71 dB), low source-detector crosstalk ( ? 60 ?? dB ), high measurement precision (0.17%), and good thermal stability (0.22% V rms / ° C ) were achieved in phantom studies. A cuff occlusion experiment was performed on the forearm of a healthy volunteer to demonstrate the ability to track rapid hemodynamic changes. Proof-of-principle normal volunteer measurements were taken to demonstrate the ability to collect continuous in vivo breast measurements. This wearable probe is a first of its kind tool to explore prognostic hemodynamic changes during chemotherapy in breast cancer patients.
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Affiliation(s)
- Fei Teng
- Boston University, Department of Electrical and Computer Engineering and Photonics Center, 8 Saint Mary’s Street, Boston, Massachusetts 02215, United States
| | - Timothy Cormier
- Boston University, Fraunhofer Center for Manufacturing Innovation, 15 Saint Mary’s Street, Brookline, Massachusetts 02446, United States
| | - Alexis Sauer-Budge
- Boston University, Fraunhofer Center for Manufacturing Innovation, 15 Saint Mary’s Street, Brookline, Massachusetts 02446, United States
| | - Rachita Chaudhury
- Boston University, Department of Biomedical Engineering, 44 Cummington Mall, Boston, Massachusetts 02215, United States
| | - Vivian Pera
- Boston University, Department of Biomedical Engineering, 44 Cummington Mall, Boston, Massachusetts 02215, United States
| | - Raeef Istfan
- Boston University, Department of Biomedical Engineering, 44 Cummington Mall, Boston, Massachusetts 02215, United States
| | - David Chargin
- Boston University, Fraunhofer Center for Manufacturing Innovation, 15 Saint Mary’s Street, Brookline, Massachusetts 02446, United States
| | - Samuel Brookfield
- Boston University, Fraunhofer Center for Manufacturing Innovation, 15 Saint Mary’s Street, Brookline, Massachusetts 02446, United States
| | - Naomi Yu Ko
- Boston Medical Center, Section of Hematology and Oncology, Women’s Health Unit, 801 Massachusetts Avenue, First Floor, Boston, Massachusetts 02118, United States
| | - Darren M. Roblyer
- Boston University, Department of Biomedical Engineering, 44 Cummington Mall, Boston, Massachusetts 02215, United States
- Address all correspondence to: Darren M. Roblyer, E-mail:
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Tachtsidis I, Scholkmann F. False positives and false negatives in functional near-infrared spectroscopy: issues, challenges, and the way forward. NEUROPHOTONICS 2016; 3:031405. [PMID: 27054143 PMCID: PMC4791590 DOI: 10.1117/1.nph.3.3.031405] [Citation(s) in RCA: 272] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/05/2016] [Indexed: 05/20/2023]
Abstract
We highlight a significant problem that needs to be considered and addressed when performing functional near-infrared spectroscopy (fNIRS) studies, namely the possibility of inadvertently measuring fNIRS hemodynamic responses that are not due to neurovascular coupling. These can be misinterpreted as brain activity, i.e., "false positives" (errors caused by wrongly assigning a detected hemodynamic response to functional brain activity), or mask brain activity, i.e., "false negatives" (errors caused by wrongly assigning a not observed hemodynamic response in the presence of functional brain activity). Here, we summarize the possible physiological origins of these issues and suggest ways to avoid and remove them.
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Affiliation(s)
- Ilias Tachtsidis
- University College London, Department of Medical Physics and Biomedical Engineering, Gower Street, Malet Place Engineering Building, WC1E 6BT, London, United Kingdom
| | - Felix Scholkmann
- University Hospital Zurich, University of Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Frauenklinikstr. 10, 8091 Zurich, Switzerland
- Address all correspondence to: Felix Scholkmann, E-mail:
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Tachtsidis I, Scholkmann F. False positives and false negatives in functional near-infrared spectroscopy: issues, challenges, and the way forward. NEUROPHOTONICS 2016. [PMID: 27054143 DOI: 10.1117/1.nph.3.3.030401] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
We highlight a significant problem that needs to be considered and addressed when performing functional near-infrared spectroscopy (fNIRS) studies, namely the possibility of inadvertently measuring fNIRS hemodynamic responses that are not due to neurovascular coupling. These can be misinterpreted as brain activity, i.e., "false positives" (errors caused by wrongly assigning a detected hemodynamic response to functional brain activity), or mask brain activity, i.e., "false negatives" (errors caused by wrongly assigning a not observed hemodynamic response in the presence of functional brain activity). Here, we summarize the possible physiological origins of these issues and suggest ways to avoid and remove them.
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Affiliation(s)
- Ilias Tachtsidis
- University College London , Department of Medical Physics and Biomedical Engineering, Gower Street, Malet Place Engineering Building, WC1E 6BT, London, United Kingdom
| | - Felix Scholkmann
- University Hospital Zurich, University of Zurich , Department of Neonatology, Biomedical Optics Research Laboratory, Frauenklinikstr. 10, 8091 Zurich, Switzerland
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Davranche K, Casini L, Arnal PJ, Rupp T, Perrey S, Verges S. Cognitive functions and cerebral oxygenation changes during acute and prolonged hypoxic exposure. Physiol Behav 2016; 164:189-97. [PMID: 27262217 DOI: 10.1016/j.physbeh.2016.06.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 11/26/2022]
Abstract
The present study aimed to assess specific cognitive processes (cognitive control and time perception) and hemodynamic correlates using functional near-infrared spectroscopy (fNIRS) during acute and prolonged high-altitude exposure. Eleven male subjects were transported via helicopter and dropped at 14 272 ft (4 350 meters) of altitude where they stayed for 4 days. Cognitive tasks, involving a conflict task and temporal bisection task, were performed at sea level the week before ascending to high altitude, the day of arrival (D0), the second (D2) and fourth (D4) day at high altitude. Cortical hemodynamic changes in the prefrontal cortex (PFC) area were monitored with fNIRS at rest and during the conflict task. Results showed that high altitude impacts information processing in terms of speed and accuracy. In the early hours of exposure (D0), participants displayed slower reaction times (RT) and decision errors were twice as high. While error rate for simple spontaneous responses remained twice that at sea level, the slow-down of RT was not detectable after 2 days at high-altitude. The larger fNIRS responses from D0 to D2 suggest that higher prefrontal activity partially counteracted cognitive performance decrements. Cognitive control, assessed through the build-up of a top-down response suppression mechanism, the early automatic response activation and the post-error adjustment were not impacted by hypoxia. However, during prolonged hypoxic exposure the temporal judgments were underestimated suggesting a slowdown of the internal clock. A decrease in cortical arousal level induced by hypoxia could consistently explain both the slowdown of the internal clock and the persistence of a higher number of errors after several days of exposure.
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Affiliation(s)
- Karen Davranche
- Laboratoire de Psychologie Cognitive (LPC), UMR 7290, CNRS, Aix-Marseille Université, FR, 3C FR, 3512, Marseille, France.
| | - Laurence Casini
- Laboratoire de Neurosciences Cognitives (LNC), UMR 7291, CNRS, Aix Marseille Université, FR, 3C FR, 3512, Marseille, France.
| | - Pierrick J Arnal
- Université de Lyon, Laboratoire de Physiologie de l'Exercice, EA4338, Saint-Étienne, France.
| | - Thomas Rupp
- HP2 Laboratory, Grenoble Alpes Université, Grenoble, France; U1042, INSERM, Grenoble, France.
| | | | - Samuel Verges
- HP2 Laboratory, Grenoble Alpes Université, Grenoble, France; U1042, INSERM, Grenoble, France.
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Noninvasive Vascular Methods for Detection of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage. J Clin Neurophysiol 2016; 33:260-7. [DOI: 10.1097/wnp.0000000000000271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kurita T, Morita K, Sato S. Impact of a β-blocker and/or acute hemodilution on cerebral oxygenation during apneic hypoxia. Acta Anaesthesiol Scand 2016; 60:343-53. [PMID: 26806957 DOI: 10.1111/aas.12637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 09/09/2015] [Accepted: 09/11/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND β-blockers reduce the tolerance for acute hemodilution by decreasing cerebral oxygenation and may contribute to the incidence of stroke. We hypothesized that β-blockers also increase the risk for cerebral hypoxia when apneic hypoxia occurs. METHODS After induction of isoflurane, 14 swine (mean ± SD =25.3 ± 0.8 kg) were studied using 200 μg/kg/min of landiolol or saline (control group) in three sequential stages: before, during, and after landiolol (saline) infusion. In each stage, after 5 min of mechanical ventilation with 100% oxygen, apnea was induced until the time to < 70% oxygen saturation. Hemodynamic and blood gas variables were measured, and the cerebral tissue oxygenation index (TOI) was recorded by near infrared spectroscopy (apnea experiment). After these steps, hemodilution was induced by hemorrhage of 600 ml and infusion of the same volume of hydroxyethylstarch, and the apnea experiments were then conducted before, during, and after landiolol (saline) infusion similarly to before hemodilution. RESULTS Landiolol decreased TOI at 1 min after apnea and at SpO2 < 70% by 3.3% and 7.0% from each corresponding value at baseline, and by 13.1% and 20.3% during hemodilution. Landiolol shifted the relationship between TOI and arterial hemoglobin oxygen saturation (SaO2 ) or arterial partial pressure of oxygen (PaO2 ) to the left; and reduced TOI at similar arterial blood oxygenation. This phenomenon was marked during hemodilution. CONCLUSIONS Landiolol reduces cerebral tissue oxygenation during apneic hypoxia. β-blockers increase the risk for cerebral hypoxia when apneic hypoxia occurs, especially during acute hemodilution.
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Affiliation(s)
- T. Kurita
- Department of Anesthesiology and Intensive Care; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - K. Morita
- Department of Anesthesiology and Intensive Care; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - S. Sato
- Department of Anesthesiology and Intensive Care; Hamamatsu University School of Medicine; Hamamatsu Japan
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Kim SY, Chae DW, Chun YM, Jeong KH, Park K, Han DW. Modelling of the Effect of End-Tidal Carbon Dioxide on Cerebral Oxygen Saturation in Beach Chair Position under General Anaesthesia. Basic Clin Pharmacol Toxicol 2016; 119:85-92. [DOI: 10.1111/bcpt.12549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 12/09/2015] [Indexed: 01/01/2023]
Affiliation(s)
- So Yeon Kim
- Department of Anesthesiology and Pain Medicine; Anesthesia and Pain Research Institute; Seoul Korea
| | - Dong Woo Chae
- Department of Pharmacology; Yonsei University College of Medicine; Seoul Korea
| | - Yong-Min Chun
- Department of Orthopedic Surgery; Yonsei University College of Medicine; Seoul Korea
| | - Kyu Hee Jeong
- Department of Anesthesiology and Pain Medicine; Anesthesia and Pain Research Institute; Seoul Korea
| | - Kyungsoo Park
- Department of Pharmacology; Yonsei University College of Medicine; Seoul Korea
| | - Dong Woo Han
- Department of Anesthesiology and Pain Medicine; Anesthesia and Pain Research Institute; Seoul Korea
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Influence of Ventilation Strategies and Anesthetic Techniques on Regional Cerebral Oximetry in the Beach Chair Position: A Prospective Interventional Study with a Randomized Comparison of Two Anesthetics. Anesthesiology 2015; 123:765-74. [PMID: 26244887 DOI: 10.1097/aln.0000000000000798] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Beach chair positioning during general anesthesia is associated with cerebral oxygen desaturation. Changes in cerebral oxygenation resulting from the interaction of inspired oxygen fraction (FIO2), end-tidal carbon dioxide (PETCO2), and anesthetic choice have not been fully evaluated in anesthetized patients in the beach chair position. METHODS This is a prospective interventional within-group study of patients undergoing shoulder surgery in the beach chair position that incorporated a randomized comparison between two anesthetics. Fifty-six patients were randomized to receive desflurane or total intravenous anesthesia with propofol. Following induction of anesthesia and positioning, FIO2 and minute ventilation were sequentially adjusted for all patients. Regional cerebral oxygenation (rSO2) was the primary outcome and was recorded at each of five set points. RESULTS While maintaining FIO2 at 0.3 and PETCO2 at 30 mmHg, there was a decrease in rSO2 from 68% (SD, 12) to 61% (SD, 12) (P < 0.001) following beach chair positioning. The combined interventions of increasing FIO2 to 1.0 and increasing PETCO2 to 45 mmHg resulted in a 14% point improvement in rSO2 to 75% (SD, 12) (P <0.001) for patients anesthetized in the beach chair position. There was no significant interaction effect of the anesthetic at the study intervention points. CONCLUSIONS Increasing FIO2 and PETCO2 resulted in a significant increase in rSO2 that overcomes desaturation in patients anesthetized in the beach chair position and that appears independent of anesthetic choice.
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Pinti P, Aichelburg C, Lind F, Power S, Swingler E, Merla A, Hamilton A, Gilbert S, Burgess P, Tachtsidis I. Using Fiberless, Wearable fNIRS to Monitor Brain Activity in Real-world Cognitive Tasks. J Vis Exp 2015:53336. [PMID: 26651025 PMCID: PMC4692764 DOI: 10.3791/53336] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Functional Near Infrared Spectroscopy (fNIRS) is a neuroimaging technique that uses near-infrared light to monitor brain activity. Based on neurovascular coupling, fNIRS is able to measure the haemoglobin concentration changes secondary to neuronal activity. Compared to other neuroimaging techniques, fNIRS represents a good compromise in terms of spatial and temporal resolution. Moreover, it is portable, lightweight, less sensitive to motion artifacts and does not impose significant physical restraints. It is therefore appropriate to monitor a wide range of cognitive tasks (e.g., auditory, gait analysis, social interaction) and different age populations (e.g., new-borns, adults, elderly people). The recent development of fiberless fNIRS devices has opened the way to new applications in neuroscience research. This represents a unique opportunity to study functional activity during real-world tests, which can be more sensitive and accurate in assessing cognitive function and dysfunction than lab-based tests. This study explored the use of fiberless fNIRS to monitor brain activity during a real-world prospective memory task. This protocol is performed outside the lab and brain haemoglobin concentration changes are continuously measured over the prefrontal cortex while the subject walks around in order to accomplish several different tasks.
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Affiliation(s)
- Paola Pinti
- Department of Medical Physics and Biomedical Engineering, Malet Place Engineering Building, University College London; Infrared Imaging Lab, Institute for Advanced Biomedical Technology (ITAB), Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara
| | - Clarisse Aichelburg
- Institute of Cognitive Neuroscience, Alexandra House, University College London
| | - Frida Lind
- Institute of Cognitive Neuroscience, Alexandra House, University College London
| | - Sarah Power
- Department of Medical Physics and Biomedical Engineering, Malet Place Engineering Building, University College London
| | - Elizabeth Swingler
- Institute of Cognitive Neuroscience, Alexandra House, University College London
| | - Arcangelo Merla
- Infrared Imaging Lab, Institute for Advanced Biomedical Technology (ITAB), Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara
| | - Antonia Hamilton
- Institute of Cognitive Neuroscience, Alexandra House, University College London
| | - Sam Gilbert
- Institute of Cognitive Neuroscience, Alexandra House, University College London
| | - Paul Burgess
- Institute of Cognitive Neuroscience, Alexandra House, University College London
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, Malet Place Engineering Building, University College London;
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Clark DJ, Rose DK, Ring SA, Porges EC. Utilization of central nervous system resources for preparation and performance of complex walking tasks in older adults. Front Aging Neurosci 2014; 6:217. [PMID: 25202270 PMCID: PMC4142860 DOI: 10.3389/fnagi.2014.00217] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/04/2014] [Indexed: 11/13/2022] Open
Abstract
Introduction: Walking in the home and community often involves performance of complex walking tasks. Understanding the control of such tasks is crucial to preserving independence and quality of life in older adults. However, very little research has been conducted in this area. Here, we assess the extent to which two measures of central nervous system (CNS) activity are responsive to the challenges posed by preparation and performance of complex walking tasks. Prefrontal cortical activity was measured by functional near-infrared spectroscopy (fNIRS) and sympathetic nervous system arousal was measured by skin conductance level (SCL). Materials and methods: Sixteen older men and women (age: 77.2 ± 5.6 years) with mild mobility deficits participated in this study. Participants walked at their preferred speed without distractions along an unobstructed, well-lit course (control task) and also walked on the same course under five separate challenging conditions: performing a cognitive verbal fluency task (verbal task), dim lighting (dim task), carrying a tray (carry task), negotiating obstacles (obstacles task) and wearing a weighted vest (vest task). Mean prefrontal activation and SCL were calculated during the preparation and performance phases of each task. Gait spatiotemporal measurements were acquired by an instrumented gait mat. Results: Prefrontal cortical activity and SCL were elevated during the preparation phase of complex walking tasks relative to the control task. During the performance phase, prefrontal activity remained elevated to a similar level as during task preparation. In contrast, SCL continued to increase beyond the level observed during task preparation. A larger increase in prefrontal activity was found to be linked to preserved quality of gait during complex walking tasks. Discussion: These findings indicate that availability and utilization of CNS resources are important for optimizing performance of complex walking tasks in older adults.
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Affiliation(s)
- David J Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System Gainesville, FL, USA ; Department of Aging and Geriatric Research, University of Florida Gainesville, FL, USA
| | - Dorian K Rose
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System Gainesville, FL, USA ; Department of Physical Therapy, University of Florida Gainesville, FL, USA
| | - Sarah A Ring
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System Gainesville, FL, USA ; Department of Aging and Geriatric Research, University of Florida Gainesville, FL, USA
| | - Eric C Porges
- Department of Aging and Geriatric Research, University of Florida Gainesville, FL, USA
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Clark DJ, Christou EA, Ring SA, Williamson JB, Doty L. Enhanced somatosensory feedback reduces prefrontal cortical activity during walking in older adults. J Gerontol A Biol Sci Med Sci 2014; 69:1422-8. [PMID: 25112494 DOI: 10.1093/gerona/glu125] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The coordination of steady state walking is relatively automatic in healthy humans, such that active attention to the details of task execution and performance (controlled processing) is low. Somatosensation is a crucial input to the spinal and brainstem circuits that facilitate this automaticity. Impaired somatosensation in older adults may reduce automaticity and increase controlled processing, thereby contributing to deficits in walking function. The primary objective of this study was to determine if enhancing somatosensory feedback can reduce controlled processing during walking, as assessed by prefrontal cortical activation. METHODS Fourteen older adults (age 77.1±5.56 years) with mild mobility deficits and mild somatosensory deficits participated in this study. Functional near-infrared spectroscopy was used to quantify metabolic activity (tissue oxygenation index, TOI) in the prefrontal cortex. Prefrontal activity and gait spatiotemporal data were measured during treadmill walking and overground walking while participants wore normal shoes and under two conditions of enhanced somatosensation: wearing textured insoles and no shoes. RESULTS Relative to walking with normal shoes, textured insoles yielded a bilateral reduction of prefrontal cortical activity for treadmill walking (ΔTOI = -0.85 and -1.19 for left and right hemispheres, respectively) and for overground walking (ΔTOI = -0.51 and -0.66 for left and right hemispheres, respectively). Relative to walking with normal shoes, no shoes yielded lower prefrontal cortical activity for treadmill walking (ΔTOI = -0.69 and -1.13 for left and right hemispheres, respectively), but not overground walking. CONCLUSIONS Enhanced somatosensation reduces prefrontal activity during walking in older adults. This suggests a less intensive utilization of controlled processing during walking.
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Affiliation(s)
- David J Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida. Department of Aging and Geriatric Research,
| | | | - Sarah A Ring
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - John B Williamson
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida. Department of Neurology, University of Florida, Gainesville
| | - Leilani Doty
- Department of Neurology, University of Florida, Gainesville
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Iwata S, Tachtsidis I, Takashima S, Matsuishi T, Robertson NJ, Iwata O. Dual role of cerebral blood flow in regional brain temperature control in the healthy newborn infant. Int J Dev Neurosci 2014; 37:1-7. [DOI: 10.1016/j.ijdevneu.2014.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 05/21/2014] [Accepted: 05/27/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sachiko Iwata
- Centre for Developmental and Cognitive NeuroscienceDepartment of Paediatrics and Child HealthKurume University School of MedicineKurumeFukuokaJapan
- Institute for Women's HealthUniversity College LondonLondonUK
| | - Ilias Tachtsidis
- Department of Medical Physics and BioengineeringUniversity College LondonLondonUK
| | - Sachio Takashima
- Yanagawa Institute for Developmental DisabilitiesInternational University of Health and WelfareFukuokaJapan
| | - Toyojiro Matsuishi
- Centre for Developmental and Cognitive NeuroscienceDepartment of Paediatrics and Child HealthKurume University School of MedicineKurumeFukuokaJapan
| | | | - Osuke Iwata
- Centre for Developmental and Cognitive NeuroscienceDepartment of Paediatrics and Child HealthKurume University School of MedicineKurumeFukuokaJapan
- Institute for Women's HealthUniversity College LondonLondonUK
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Murphy GS, Szokol JW, Avram MJ, Greenberg SB, Shear TD, Vender JS, Levin SD, Koh JL, Parikh KN, Patel SS. Effect of ventilation on cerebral oxygenation in patients undergoing surgery in the beach chair position: a randomized controlled trial. Br J Anaesth 2014; 113:618-27. [PMID: 24860157 DOI: 10.1093/bja/aeu109] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Surgery in the beach chair position (BCP) may reduce cerebral blood flow and oxygenation, resulting in neurological injuries. The authors tested the hypothesis that a ventilation strategy designed to achieve end-tidal carbon dioxide (E'(CO₂)) values of 40-42 mm Hg would increase cerebral oxygenation (Sct(O₂)) during BCP shoulder surgery compared with a ventilation strategy designed to achieve E'(CO₂) values of 30-32 mm Hg. METHODS Seventy patients undergoing shoulder surgery in the BCP with general anaesthesia were enrolled in this randomized controlled trial. Mechanical ventilation was adjusted to maintain an E'(CO₂) of 30-32 mm Hg in the control group and an E'(CO₂) of 40-42 mm Hg in the study group. Cerebral oxygenation was monitored continuously in the operating theatre using near-infrared spectroscopy. Baseline haemodynamics and Sct(O₂) were obtained before induction of anaesthesia, and these values were then measured and recorded continuously from induction of anaesthesia until tracheal extubation. The number of cerebral desaturation events (CDEs) (defined as a ≥20% reduction in Sct(O₂) from baseline values) was recorded. RESULTS No significant differences between the groups were observed in haemodynamic variables or phenylephrine interventions during the surgical procedure. Sct(O₂) values were significantly higher in the study 40-42 group throughout the intraoperative period (P<0.01). In addition, the incidence of CDEs was lower in the study 40-42 group (8.8%) compared with the control 30-32 group (55.6%, P<0.0001). CONCLUSIONS Cerebral oxygenation is significantly improved during BCP surgery when ventilation is adjusted to maintain E'(CO₂) at 40-42 mm Hg compared with 30-32 mm Hg. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01546636.
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Affiliation(s)
| | | | - M J Avram
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E Huron Street F5-704, Chicago, IL 60611, USA
| | | | | | | | - S D Levin
- Department of Surgery, NorthShore University HealthSystem (an affiliate of University of Chicago Pritzker School of Medicine), 2650 Ridge Ave., Evanston, IL 60201, USA
| | - J L Koh
- Department of Surgery, NorthShore University HealthSystem (an affiliate of University of Chicago Pritzker School of Medicine), 2650 Ridge Ave., Evanston, IL 60201, USA
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Menke J, Möller G. Cerebral near-infrared spectroscopy correlates to vital parameters during cardiopulmonary bypass surgery in children. Pediatr Cardiol 2014; 35:155-63. [PMID: 23852460 DOI: 10.1007/s00246-013-0754-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
Near-infrared spectroscopy (NIRS) can monitor changes in cerebral regional oxygen saturation (rSO2) and tissue hemoglobin content (HbT). The relation between cerebral NIRS readings and vital parameters has not been analyzed before at a fine temporal scale. This study analyzed this relation during cardiopulmonary bypass (CPB) surgery in 10 children (0-9 years, 1,770 min of data records) by using a novel random-coefficient model. The analysis indicated that a small number of patients is sufficient for obtaining significant results with this model. Changes of vital parameters explained 84.7 % of rSO2 changes and 90.7 % of HbT changes. Cerebral rSO2 correlated positively with perfusion pressure and inversely with body temperature (P < 0.05). Cerebral HbT correlated positively with perfusion pressure, central venous pressure, and temperature and inversely with arterial oxygen saturation (P < 0.05). During hypothermic circulatory arrest, the half-life of the exponential rSO2 decay correlated to the rSO2 reserve (P = 0.016). In conclusion, NIRS readings of cerebral hemoglobin content and tissue oxygen saturation correlate well to vital parameters during CPB surgery in children. NIRS may therefore become a monitoring device for the neuroprotective optimization of those vital parameters.
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Affiliation(s)
- Jan Menke
- Department of Pediatrics, University Hospital Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany,
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Végh T, Szatmári S, Juhász M, László I, Vaskó A, Takács I, Szegedi L, Fülesdi B. One-lung ventilation does not result in cerebral desaturation during application of lung protective strategy if normocapnia is maintained. ACTA ACUST UNITED AC 2013; 100:163-72. [DOI: 10.1556/aphysiol.100.2013.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kolyva C, Ghosh A, Tachtsidis I, Highton D, Cooper CE, Smith M, Elwell CE. Cytochrome c oxidase response to changes in cerebral oxygen delivery in the adult brain shows higher brain-specificity than haemoglobin. Neuroimage 2013; 85 Pt 1:234-44. [PMID: 23707584 PMCID: PMC3898943 DOI: 10.1016/j.neuroimage.2013.05.070] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 05/05/2013] [Accepted: 05/13/2013] [Indexed: 11/19/2022] Open
Abstract
The redox state of cerebral mitochondrial cytochrome c oxidase monitored with near-infrared spectroscopy (Δ[oxCCO]) is a signal with strong potential as a non-invasive, bedside biomarker of cerebral metabolic status. We hypothesised that the higher mitochondrial density of brain compared to skin and skull would lead to evidence of brain-specificity of the Δ[oxCCO] signal when measured with a multi-distance near-infrared spectroscopy (NIRS) system. Measurements of Δ[oxCCO] as well as of concentration changes in oxygenated (Δ[HbO2]) and deoxygenated haemoglobin (Δ[HHb]) were taken at multiple source-detector distances during systemic hypoxia and hypocapnia (decrease in cerebral oxygen delivery), and hyperoxia and hypercapnia (increase in cerebral oxygen delivery) from 15 adult healthy volunteers. Increasing source-detector spacing is associated with increasing light penetration depth and thus higher sensitivity to cerebral changes. An increase in Δ[oxCCO] was observed during the challenges that increased cerebral oxygen delivery and the opposite was observed when cerebral oxygen delivery decreased. A consistent pattern of statistically significant increasing amplitude of the Δ[oxCCO] response with increasing light penetration depth was observed in all four challenges, a behaviour that was distinctly different from that of the haemoglobin chromophores, which did not show this statistically significant depth gradient. This depth-dependence of the Δ[oxCCO] signal corroborates the notion of higher concentrations of CCO being present in cerebral tissue compared to extracranial components and highlights the value of NIRS-derived Δ[oxCCO] as a brain-specific signal of cerebral metabolism, superior in this aspect to haemoglobin. NIRS was used to measure oxidised cytochrome c oxidase (Δ[oxCCO]) in healthy brain. Δ[oxCCO] changed in the same direction as changes in cerebral oxygen delivery. Magnitude of Δ[oxCCO] response increased with increasing light penetration depth. Corresponding haemoglobin changes showed no dependence on light penetration depth. NIRS-measured Δ[oxCCO] has higher brain specificity than haemoglobin.
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Affiliation(s)
- Christina Kolyva
- Dept. of Medical Physics and Bioengineering, University College London, London, UK.
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45
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Wintermark P, Hansen A, Warfield SK, Dukhovny D, Soul JS. Near-infrared spectroscopy versus magnetic resonance imaging to study brain perfusion in newborns with hypoxic-ischemic encephalopathy treated with hypothermia. Neuroimage 2013; 85 Pt 1:287-93. [PMID: 23631990 DOI: 10.1016/j.neuroimage.2013.04.072] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/17/2013] [Accepted: 04/18/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The measurement of brain perfusion may provide valuable information for assessment and treatment of newborns with hypoxic-ischemic encephalopathy (HIE). While arterial spin labeled perfusion (ASL) magnetic resonance imaging (MRI) provides noninvasive and direct measurements of regional cerebral blood flow (CBF) values, it is logistically challenging to obtain. Near-infrared spectroscopy (NIRS) might be an alternative, as it permits noninvasive and continuous monitoring of cerebral hemodynamics and oxygenation at the bedside. OBJECTIVE The purpose of this study is to determine the correlation between measurements of brain perfusion by NIRS and by MRI in term newborns with HIE treated with hypothermia. DESIGN/METHODS In this prospective cohort study, ASL-MRI and NIRS performed during hypothermia were used to assess brain perfusion in these newborns. Regional cerebral blood flow (CBF) values, measured from 1-2 MRI scans for each patient, were compared to mixed venous saturation values (SctO2) recorded by NIRS just before and after each MRI. Analysis included groupings into moderate versus severe HIE based on their initial background pattern of amplitude-integrated electroencephalogram. RESULTS Twelve concomitant recordings were obtained of seven neonates. Strong correlation was found between SctO2 and CBF in asphyxiated newborns with severe HIE (r=0.88; p value=0.0085). Moreover, newborns with severe HIE had lower CBF (likely lower oxygen supply) and extracted less oxygen (likely lower oxygen demand or utilization) when comparing SctO2 and CBF to those with moderate HIE. CONCLUSIONS NIRS is an effective bedside tool to monitor and understand brain perfusion changes in term asphyxiated newborns, which in conjunction with precise measurements of CBF obtained by MRI at particular times, may help tailor neuroprotective strategies in term newborns with HIE.
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Affiliation(s)
- P Wintermark
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, 2300 Tupper Street, Montreal, QC H3H 1P3, Canada; Division of Newborn Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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Abstract
Cerebral oximetry allows continuous real-time and non-invasive monitoring of cerebral oxygen saturation (cSO(2)), by measuring oxyhaemoglobin and deoxyhaemoglobin near infrared light absorption, similarly to pulse oximetry. cSO(2) measurement predominantly reflects brain venous compartment, and is correlated with jugular venous saturation. As jugular venous saturation, cSO(2) must therefore be interpreted as a measure of balance between transport and consumption of O(2) in the brain. Cerebral oximetry should be used as a trend monitoring, because its accuracy is insufficient to be considered as reliable measure of absolute value of ScO(2). In adult, correction of intraoperative cerebral desaturation reduces hospital stay, heavy morbidity and mortality, and serious postoperative neurocognitive impairment after cardiac and major abdominal surgery. In children, the occurrence of intra- and postoperative cerebral desaturations during congenital heart surgery is associated with increased neurological morbi-mortality. Cerebral oximetry could be a useful monitoring during anaesthesia of (ex) preterm neonates, due to the risk of impaired cerebral blood flow autoregulation in these patients.
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Caicedo A, Papademetriou MD, Elwell CE, Hoskote A, Elliott MJ, Van Huffel S, Tachtsidis I. Canonical correlation analysis in the study of cerebral and peripheral haemodynamics interrelations with systemic variables in neonates supported on ECMO. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 765:23-29. [PMID: 22879010 PMCID: PMC4038010 DOI: 10.1007/978-1-4614-4989-8_4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Neonates supported on extracorporeal membrane oxygenation (ECMO) are at high risk
of brain injury due to haemodynamic instability. In order to monitor cerebral and
peripheral (muscle) haemodynamic and oxygenation changes in this population we used a
dual-channel near-infrared spectroscopy (NIRS) system. In addition, to assess
interrelations between NIRS and systemic variables, collected simultaneously,
canonical correlation analysis (CCA) was employed. CCA can quantify the relationship
between a set of variables and assess levels of dependency. In four out of five
patients, systemic variables were found to be less inter-related with cerebral rather
than peripheral NIRS measurements. Moreover, during ECMO flow manipulations, we found
that the interrelation between the systemic and the NIRS cerebral/peripheral variables
changed. The CCA method presented here can be used to assess differences between NIRS
cerebral and NIRS peripheral responses due to systemic variations which may be
indicative of physiological differences in the mechanisms that regulate oxygenation
and/or haemodynamics of the brain and the muscle.
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Affiliation(s)
- Alexander Caicedo
- ESAT/SCD, Department of Electrical Engineering & IBBT Future Health Department, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Maria D Papademetriou
- Department of Medical Physics and Bioengineering, University College London, 18 Dickensons Lane, London, WC1E 6BT, UK
| | - Clare E Elwell
- Department of Medical Physics and Bioengineering, University College London, 18 Dickensons Lane, London, WC1E 6BT, UK
| | | | | | - Sabine Van Huffel
- ESAT/SCD, Department of Electrical Engineering & IBBT Future Health Department, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ilias Tachtsidis
- Department of Medical Physics and Bioengineering, University College London, 18 Dickensons Lane, London, WC1E 6BT, UK.
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Abstract
The standard flight level for commercial airliners is ∼12 km (40 kft; air pressure: ∼ 200 hPa), the maximum certification altitude of modern airliners may be as high as 43-45 kft. Loss of structural integrity of an airplane may result in sudden depressurization of the cabin potentially leading to hypoxia with loss of consciousness of the pilots. Specialized breathing masks supply the pilots with oxygen. The aim of this study was to experimentally simulate such sudden depressurization to maximum design altitude in a pressure chamber while measuring the arterial and brain oxygenation saturation (SaO(2) and StO(2)) of the pilots. Ten healthy subjects with a median age of 50 (range 29-70) years were placed in a pressure chamber, breathing air from a cockpit mask. Pressure was reduced from 753 to 148 hPa within 20 s, and the test mask was switched to pure O(2) within 2 s after initiation of depressurization. During the whole procedure SaO(2) and StO(2) were measured by pulse oximetry, respectively near-infrared spectroscopy (NIRS; in-house built prototype) of the left frontal cortex. During the depressurization the SaO(2) dropped from median 93% (range 91-98%) to 78% (62-92%) by 16% (6-30%), while StO(2) decreased from 62% (47-67%) to 57% (43-62%) by 5% (3-14%). Considerable drops in oxygenation were observed during sudden depressurization. The inter-subject variability was high, for SaO(2) depending on the subjects' ability to preoxygenate before the depressurization. The drop in StO(2) was lower than the one in SaO(2) maybe due to compensation in blood flow.
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Scholkmann F, Gerber U, Wolf M, Wolf U. End-tidal CO2: an important parameter for a correct interpretation in functional brain studies using speech tasks. Neuroimage 2012; 66:71-9. [PMID: 23099101 DOI: 10.1016/j.neuroimage.2012.10.025] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/21/2012] [Accepted: 10/16/2012] [Indexed: 12/30/2022] Open
Abstract
The aim was to investigate the effect of different speech tasks, i.e. recitation of prose (PR), alliteration (AR) and hexameter (HR) verses and a control task (mental arithmetic (MA) with voicing of the result on end-tidal CO2 (PETCO2), cerebral hemodynamics and oxygenation. CO2 levels in the blood are known to strongly affect cerebral blood flow. Speech changes breathing pattern and may affect CO2 levels. Measurements were performed on 24 healthy adult volunteers during the performance of the 4 tasks. Tissue oxygen saturation (StO2) and absolute concentrations of oxyhemoglobin ([O2Hb]), deoxyhemoglobin ([HHb]) and total hemoglobin ([tHb]) were measured by functional near-infrared spectroscopy (fNIRS) and PETCO2 by a gas analyzer. Statistical analysis was applied to the difference between baseline before the task, 2 recitation and 5 baseline periods after the task. The 2 brain hemispheres and 4 tasks were tested separately. A significant decrease in PETCO2 was found during all 4 tasks with the smallest decrease during the MA task. During the recitation tasks (PR, AR and HR) a statistically significant (p<0.05) decrease occurred for StO2 during PR and AR in the right prefrontal cortex (PFC) and during AR and HR in the left PFC. [O2Hb] decreased significantly during PR, AR and HR in both hemispheres. [HHb] increased significantly during the AR task in the right PFC. [tHb] decreased significantly during HR in the right PFC and during PR, AR and HR in the left PFC. During the MA task, StO2 increased and [HHb] decreased significantly during the MA task. We conclude that changes in breathing (hyperventilation) during the tasks led to lower CO2 pressure in the blood (hypocapnia), predominantly responsible for the measured changes in cerebral hemodynamics and oxygenation. In conclusion, our findings demonstrate that PETCO2 should be monitored during functional brain studies investigating speech using neuroimaging modalities, such as fNIRS, fMRI to ensure a correct interpretation of changes in hemodynamics and oxygenation.
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Affiliation(s)
- F Scholkmann
- Institute of Complementary Medicine KIKOM, University of Bern, 3010 Bern, Switzerland; Biomedical Optics Research Laboratory, Division of Neonatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - U Gerber
- Institute of Complementary Medicine KIKOM, University of Bern, 3010 Bern, Switzerland
| | - M Wolf
- Biomedical Optics Research Laboratory, Division of Neonatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - U Wolf
- Institute of Complementary Medicine KIKOM, University of Bern, 3010 Bern, Switzerland.
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Picton P, Dering A, Miller B, Shanks A, Mashour GA. The influence of basic ventilation strategies and anesthetic techniques on cerebral oxygenation in the beach chair position: study protocol. BMC Anesthesiol 2012; 12:23. [PMID: 22994896 PMCID: PMC3499238 DOI: 10.1186/1471-2253-12-23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 09/17/2012] [Indexed: 11/28/2022] Open
Abstract
Background Beach chair positioning during general anesthesia is associated with a high incidence of cerebral desaturation; poor neurological outcome is a growing concern. There are no published data pertaining to changes in cerebral oxygenation seen with increases in the inspired oxygen fraction or end-tidal carbon dioxide in patients anesthetized in the beach chair position. Furthermore, the effect anesthetic agents have has not been thoroughly investigated in this context. We plan to test the hypothesis that changes in inspired oxygen fraction or end-tidal carbon dioxide correlate to a significant change in regional cerebral oxygenation in anesthetized patients in beach chair position. We will also compare the effects that inhaled and intravenous anesthetics have on this process. Methods/design This is a prospective within-group study of patients undergoing shoulder arthroscopy in the beach chair position which incorporates a randomized comparison between two anesthetics, approved by the Institutional Review Board of the University of Michigan, Ann Arbor. The primary outcome measure is the change in regional cerebral oxygenation due to sequential changes in oxygenation and ventilation. A sample size of 48 will have greater than 80% power to detect an absolute 4-5% difference in regional cerebral oxygenation caused by changes in ventilation strategy. The secondary outcome is the effect of anesthetic choice on cerebral desaturation in the beach chair position or response to changes in ventilation strategy. Fifty-four patients will be recruited, allowing for drop out, targeting 24 patients in each group randomized to an anesthetic. Regional cerebral oxygenation will be measured using the INVOS 5100C monitor (Covidien, Boulder, CO). Following induction of anesthesia, intubation and positioning, inspired oxygen fraction and minute ventilation will be sequentially adjusted. At each set point, regional cerebral oxygenation will be recorded and venous blood gas analysis performed. The overall statistical analysis will use a repeated measures analysis of variance with Tukey’s HSD procedure for post hoc contrasts. Discussion If simple maneuvers of ventilation or anesthetic technique can prevent cerebral hypoxia, patient outcome may be improved. This is the first study to investigate the effects of ventilation strategies on cerebral oxygenation in patients anesthetized in beach chair position. Trial registration NCT01535274
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Affiliation(s)
- Paul Picton
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
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