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Monitoring of Cerebral Oxygen Saturation in Interhospital Transport of Patients Receiving Extracorporeal Membrane Oxygenation. ASAIO J 2023; 69:185-190. [PMID: 35470305 DOI: 10.1097/mat.0000000000001754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) in acute respiratory distress syndrome (ARDS) is used to achieve oxygenation and protect lung ventilation. Near infrared spectroscopy (NIRS) measures cerebral regional tissue oxygenation (rSO 2 ) and may contribute to patient safety during interhospital transport under ECMO support. We evaluated 16 adult ARDS patients undergoing interhospital ECMO transport by measuring cerebral rSO 2 before and after initiation of ECMO support and continuously during transport. To compare peripheral oxygen saturation (SpO 2 ) measurement with rSO 2 , both parameters were analyzed. NIRS monitoring for initiation of ECMO and interhospital transport under ECMO support was feasible, and there was no significant difference in the percentage of achievable valid measurements over time between cerebral rSO 2 (88.4% [95% confidence interval {CI}, 81.3-95.0%]) and standard SpO 2 monitoring 91.7% (95% CI, 86.1-94.2%), p = 0.68. No change in cerebral rSO 2 was observed before 77% (73.5-81%) (median [interquartile range {IQR}]) and after initiation of ECMO support 78% (75-81%), p = 0.2. NIRS for cerebral rSO 2 measurement is feasible during ECMO initiation and interhospital transport. Achievement of valid measurements of cerebral rSO 2 was not superior to SpO 2 . In distinct patients ( e.g. , shock), measurement of cerebral rSO 2 may contribute to improvement of patient safety during interhospital ECMO transport.
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Cerebral oxygen saturation and autoregulation during hypotension in extremely preterm infants. Pediatr Res 2021; 90:373-380. [PMID: 33879849 DOI: 10.1038/s41390-021-01483-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The impact of the permissive hypotension approach in clinically well infants on regional cerebral oxygen saturation (rScO2) and autoregulatory capacity (CAR) remains unknown. METHODS Prospective cohort study of blinded rScO2 measurements within a randomized controlled trial of management of hypotension (HIP trial) in extremely preterm infants. rScO2, mean arterial blood pressure, duration of cerebral hypoxia, and transfer function (TF) gain inversely proportional to CAR, were compared between hypotensive infants randomized to receive dopamine or placebo and between hypotensive and non-hypotensive infants, and related to early intraventricular hemorrhage or death. RESULTS In 89 potentially eligible HIP trial patients with rScO2 measurements, the duration of cerebral hypoxia was significantly higher in 36 hypotensive compared to 53 non-hypotensive infants. In 29/36 hypotensive infants (mean GA 25 weeks, 69% males) receiving the study drug, no significant difference in rScO2 was observed after dopamine (n = 13) compared to placebo (n = 16). Duration of cerebral hypoxia was associated with early intraventricular hemorrhage or death. Calculated TF gain (n = 49/89) was significantly higher reflecting decreased CAR in 16 hypotensive compared to 33 non-hypotensive infants. CONCLUSIONS Dopamine had no effect on rScO2 compared to placebo in hypotensive infants. Hypotension and cerebral hypoxia are associated with early intraventricular hemorrhage or death. IMPACT Treatment of hypotension with dopamine in extremely preterm infants increases mean arterial blood pressure, but does not improve cerebral oxygenation. Hypotensive extremely preterm infants have increased duration of cerebral hypoxia and reduced cerebral autoregulatory capacity compared to non-hypotensive infants. Duration of cerebral hypoxia and hypotension are associated with early intraventricular hemorrhage or death in extremely preterm infants. Since systematic treatment of hypotension may not be associated with better outcomes, the diagnosis of cerebral hypoxia in hypotensive extremely preterm infants might guide treatment.
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Sanders ML, Elting JWJ, Panerai RB, Aries M, Bor-Seng-Shu E, Caicedo A, Chacon M, Gommer ED, Van Huffel S, Jara JL, Kostoglou K, Mahdi A, Marmarelis VZ, Mitsis GD, Müller M, Nikolic D, Nogueira RC, Payne SJ, Puppo C, Shin DC, Simpson DM, Tarumi T, Yelicich B, Zhang R, Claassen JAHR. Dynamic Cerebral Autoregulation Reproducibility Is Affected by Physiological Variability. Front Physiol 2019; 10:865. [PMID: 31354518 PMCID: PMC6634255 DOI: 10.3389/fphys.2019.00865] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/20/2019] [Indexed: 11/24/2022] Open
Abstract
Parameters describing dynamic cerebral autoregulation (DCA) have limited reproducibility. In an international, multi-center study, we evaluated the influence of multiple analytical methods on the reproducibility of DCA. Fourteen participating centers analyzed repeated measurements from 75 healthy subjects, consisting of 5 min of spontaneous fluctuations in blood pressure and cerebral blood flow velocity signals, based on their usual methods of analysis. DCA methods were grouped into three broad categories, depending on output types: (1) transfer function analysis (TFA); (2) autoregulation index (ARI); and (3) correlation coefficient. Only TFA gain in the low frequency (LF) band showed good reproducibility in approximately half of the estimates of gain, defined as an intraclass correlation coefficient (ICC) of >0.6. None of the other DCA metrics had good reproducibility. For TFA-like and ARI-like methods, ICCs were lower than values obtained with surrogate data (p < 0.05). For TFA-like methods, ICCs were lower for the very LF band (gain 0.38 ± 0.057, phase 0.17 ± 0.13) than for LF band (gain 0.59 ± 0.078, phase 0.39 ± 0.11, p ≤ 0.001 for both gain and phase). For ARI-like methods, the mean ICC was 0.30 ± 0.12 and for the correlation methods 0.24 ± 0.23. Based on comparisons with ICC estimates obtained from surrogate data, we conclude that physiological variability or non-stationarity is likely to be the main reason for the poor reproducibility of DCA parameters.
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Affiliation(s)
- Marit L Sanders
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jan Willem J Elting
- Department of Neurology, University Medical Center Groningen, Groningen, Netherlands
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Marcel Aries
- Department of Intensive Care, University of Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Edson Bor-Seng-Shu
- Department of Neurology, Faculty of Medicine, Hospital das Clinicas University of São Paulo, São Paulo, Brazil
| | - Alexander Caicedo
- Department of Applied Mathematics and Computer Science, Faculty of Natural Sciences and Mathematics, Universidad del Rosario, Bogotá, Colombia
| | - Max Chacon
- Department of Engineering Informatics, Institute of Biomedical Engineering, University of Santiago, Santiago, Chile
| | - Erik D Gommer
- Department of Clinical Neurophysiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Sabine Van Huffel
- Department of Electronic Engineering (ESAT), Stadius Center for Dynamical Systems, Signal Processing and Data Analytics, Katholieke Universiteit Leuven, Leuven, Belgium.,Interuniversity Microelectronics Centre, Leuven, Belgium
| | - José L Jara
- Department of Engineering Informatics, Institute of Biomedical Engineering, University of Santiago, Santiago, Chile
| | - Kyriaki Kostoglou
- Department of Electrical, Computer and Software Engineering, McGill University, Montreal, QC, Canada
| | - Adam Mahdi
- Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Vasilis Z Marmarelis
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Georgios D Mitsis
- Department of Bioengineering, McGill University, Montreal, QC, Canada
| | - Martin Müller
- Department of Neurology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Dragana Nikolic
- Faculty of Engineering and the Environment, Institute of Sound and Vibration Research, University of Southampton, Southampton, United Kingdom
| | - Ricardo C Nogueira
- Department of Neurology, Faculty of Medicine, Hospital das Clinicas University of São Paulo, São Paulo, Brazil
| | - Stephen J Payne
- Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Corina Puppo
- Departamento de Emergencia, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Dae C Shin
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - David M Simpson
- Faculty of Engineering and the Environment, Institute of Sound and Vibration Research, University of Southampton, Southampton, United Kingdom
| | - Takashi Tarumi
- Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Bernardo Yelicich
- Departamento de Emergencia, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jurgen A H R Claassen
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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Functional form estimation using oblique projection matrices for LS-SVM regression models. PLoS One 2019; 14:e0217967. [PMID: 31173619 PMCID: PMC6555528 DOI: 10.1371/journal.pone.0217967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 05/23/2019] [Indexed: 11/19/2022] Open
Abstract
Kernel regression models have been used as non-parametric methods for fitting experimental data. However, due to their non-parametric nature, they belong to the so-called "black box" models, indicating that the relation between the input variables and the output, depending on the kernel selection, is unknown. In this paper we propose a new methodology to retrieve the relation between each input regressor variable and the output in a least squares support vector machine (LS-SVM) regression model. The method is based on oblique subspace projectors (ObSP), which allows to decouple the influence of input regressors on the output by including the undesired variables in the null space of the projection matrix. Such functional relations are represented by the nonlinear transformation of the input regressors, and their subspaces are estimated using appropriate kernel evaluations. We exploit the properties of ObSP in order to decompose the output of the obtained regression model as a sum of the partial nonlinear contributions and interaction effects of the input variables, we called this methodology Nonlinear ObSP (NObSP). We compare the performance of the proposed algorithm with the component selection and smooth operator (COSSO) for smoothing spline ANOVA models. We use as benchmark 2 toy examples and a real life regression model using the concrete strength dataset from the UCI machine learning repository. We showed that NObSP is able to outperform COSSO, producing stable estimations of the functional relations between the input regressors and the output, without the use of prior-knowledge. This methodology can be used in order to understand the functional relations between the inputs and the output in a regression model, retrieving the physical interpretation of the regression models.
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Sanders ML, Claassen JAHR, Aries M, Bor-Seng-Shu E, Caicedo A, Chacon M, Gommer ED, Van Huffel S, Jara JL, Kostoglou K, Mahdi A, Marmarelis VZ, Mitsis GD, Müller M, Nikolic D, Nogueira RC, Payne SJ, Puppo C, Shin DC, Simpson DM, Tarumi T, Yelicich B, Zhang R, Panerai RB, Elting JWJ. Reproducibility of dynamic cerebral autoregulation parameters: a multi-centre, multi-method study. Physiol Meas 2018; 39:125002. [PMID: 30523976 DOI: 10.1088/1361-6579/aae9fd] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Different methods to calculate dynamic cerebral autoregulation (dCA) parameters are available. However, most of these methods demonstrate poor reproducibility that limit their reliability for clinical use. Inter-centre differences in study protocols, modelling approaches and default parameter settings have all led to a lack of standardisation and comparability between studies. We evaluated reproducibility of dCA parameters by assessing systematic errors in surrogate data resulting from different modelling techniques. APPROACH Fourteen centres analysed 22 datasets consisting of two repeated physiological blood pressure measurements with surrogate cerebral blood flow velocity signals, generated using Tiecks curves (autoregulation index, ARI 0-9) and added noise. For reproducibility, dCA methods were grouped in three broad categories: 1. Transfer function analysis (TFA)-like output; 2. ARI-like output; 3. Correlation coefficient-like output. For all methods, reproducibility was determined by one-way intraclass correlation coefficient analysis (ICC). MAIN RESULTS For TFA-like methods the mean (SD; [range]) ICC gain was 0.71 (0.10; [0.49-0.86]) and 0.80 (0.17; [0.36-0.94]) for VLF and LF (p = 0.003) respectively. For phase, ICC values were 0.53 (0.21; [0.09-0.80]) for VLF, and 0.92 (0.13; [0.44-1.00]) for LF (p < 0.001). Finally, ICC for ARI-like methods was equal to 0.84 (0.19; [0.41-0.94]), and for correlation-like methods, ICC was 0.21 (0.21; [0.056-0.35]). SIGNIFICANCE When applied to realistic surrogate data, free from the additional exogenous influences of physiological variability on cerebral blood flow, most methods of dCA modelling showed ICC values considerably higher than what has been reported for physiological data. This finding suggests that the poor reproducibility reported by previous studies may be mainly due to the inherent physiological variability of cerebral blood flow regulatory mechanisms rather than related to (stationary) random noise and the signal analysis methods.
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Affiliation(s)
- Marit L Sanders
- Department of Geriatric Medicine, Radboudumc Alzheimer Centre and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Varon C, Lazaro J, Bolea J, Hernando A, Aguilo J, Gil E, Van Huffel S, Bailon R. Unconstrained Estimation of HRV Indices After Removing Respiratory Influences From Heart Rate. IEEE J Biomed Health Inform 2018; 23:2386-2397. [PMID: 30507541 DOI: 10.1109/jbhi.2018.2884644] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This paper proposes an approach to better estimate the sympathovagal balance (SB) and the respiratory sinus arrhythmia (RSA) after separating respiratory influences from the heart rate (HR). METHODS The separation is performed using orthogonal subspace projections and the approach is first tested using simulated HR and respiratory signals with different spectral properties. Then, RSA and SB are estimated during autonomic blockade and stress using the proposed approach and the classical heart rate variability (HRV) analysis. Both real- and ECG-derived respiration (EDR) are used and the reliability of the EDR is evaluated. RESULTS Mean absolute percentage errors lower than [Formula: see text] were obtained after removing previously known respiratory signals from simulated HR. The proposed indices were able to improve the quantification of SB during autonomic withdrawal. In the stress data, differences ( ) among relaxed and stressful phases were found with the proposed approach, using both the real respiration and the EDR, but they disappeared when using the classical HRV. CONCLUSION A better assessment of the autonomic nervous system' response to pharmacological blockade and stress can be achieved after removing respiratory influences from HR, and this can be done using either the real respiration or the EDR. SIGNIFICANCE This work can be used to better identify vagal withdrawal and increased sympathetic activation when the classical HRV analysis fails due to the respiratory influences on HR. Furthermore, it can be computed using only the ECG, which is an advantage when developing wearable systems with limited number of sensors.
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Thewissen L, Caicedo A, Dereymaeker A, Van Huffel S, Naulaers G, Allegaert K, Smits A. Cerebral autoregulation and activity after propofol for endotracheal intubation in preterm neonates. Pediatr Res 2018; 84:719-725. [PMID: 30201953 DOI: 10.1038/s41390-018-0160-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/12/2018] [Accepted: 08/10/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite increasing use of propofol in neonates, observations on cerebral effects are limited. AIM To investigate cerebral autoregulation (CAR) and activity after propofol for endotracheal intubation in preterm neonates. METHODS Twenty-two neonates received propofol before intubation as part of a published dose-finding study. Mean arterial blood pressure (MABP), near-infrared spectroscopy-derived cerebral oxygenation (rScO2), and amplitude-integrated electroencephalography (aEEG) were analyzed until 180 min after propofol. CAR was expressed as transfer function (TF) gain, indicating % change in rScO2 per 1 mmHg change in MABP. Values exceeding mean TF gain + 2 standard deviations (SD) defined impaired CAR. RESULTS After intubation with a median propofol dose of 1 (0.5-4.5) mg/kg, rScO2 remained stable during decreasing MABP. Mean (±SD) TF gain was 0.8 (±0.3)%/mmHg. Impaired CAR was identified in 1 and 5 patient(s) during drug-related hypotension and normal to raised MABP, respectively. Suppressed aEEG was observed up to 60 min after propofol. CONCLUSIONS Drug-related hypotension and decreased cerebral activity after intubation with low propofol doses in preterm neonates were observed, without evidence of cerebral ischemic hypoxia. CAR remained intact during drug-related hypotension in 95.5% of patients. Cerebral monitoring including CAR clarifies the cerebral impact of MABP fluctuations.
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Affiliation(s)
- Liesbeth Thewissen
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium.
| | - Alexander Caicedo
- Department of Electrical Engineering, ESAT-Stadius, KU Leuven, Leuven, Belgium
| | | | - Sabine Van Huffel
- Department of Electrical Engineering, ESAT-Stadius, KU Leuven, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Anne Smits
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium
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Thewissen L, Caicedo A, Lemmers P, Van Bel F, Van Huffel S, Naulaers G. Measuring Near-Infrared Spectroscopy Derived Cerebral Autoregulation in Neonates: From Research Tool Toward Bedside Multimodal Monitoring. Front Pediatr 2018; 6:117. [PMID: 29868521 PMCID: PMC5960703 DOI: 10.3389/fped.2018.00117] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/11/2018] [Indexed: 12/30/2022] Open
Abstract
Introduction: Cerebral autoregulation (CAR), the ability of the human body to maintain cerebral blood flow (CBF) in a wide range of perfusion pressures, can be calculated by describing the relation between arterial blood pressure (ABP) and cerebral oxygen saturation measured by near-infrared spectroscopy (NIRS). In literature, disturbed CAR is described in different patient groups, using multiple measurement techniques and mathematical models. Furthermore, it is unclear to what extent cerebral pathology and outcome can be explained by impaired CAR. Aim and methods: In order to summarize CAR studies using NIRS in neonates, a systematic review was performed in the PUBMED and EMBASE database. To provide a general overview of the clinical framework used to study CAR, the different preprocessing methods and mathematical models are described and explained. Furthermore, patient characteristics, definition of impaired CAR and the outcome according to this definition is described organized for the different patient groups. Results: Forty-six articles were included in this review. Four patient groups were established: preterm infants during the transitional period, neonates receiving specific medication/treatment, neonates with congenital heart disease and neonates with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia. Correlation, coherence and transfer function (TF) gain are the mathematical models most frequently used to describe CAR. The definition of impaired CAR is depending on the mathematical model used. The incidence of intraventricular hemorrhage in preterm infants is the outcome variable most frequently correlated with impaired CAR. Hypotension, disease severity, dopamine treatment, injury on magnetic resonance imaging (MRI) and long term outcome are associated with impaired CAR. Prospective interventional studies are lacking in all research areas. Discussion and conclusion: NIRS derived CAR measurement is an important research tool to improve knowledge about central hemodynamic fluctuations during the transitional period, cerebral pharmacodynamics of frequently used medication (sedatives-inotropes) and cerebral effects of specific therapies in neonatology. Uniformity regarding measurement techniques and mathematical models is needed. Multimodal monitoring databases of neonatal intensive care patients of multiple centers, together with identical outcome parameters are needed to compare different techniques and make progress in this field. Real-time bedside monitoring of CAR, together with conventional monitoring, seems a promising technique to improve individual patient care.
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Affiliation(s)
- Liesbeth Thewissen
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Alexander Caicedo
- Department of Electrical Engineering, ESAT-Stadius, KU Leuven, Leuven, Belgium.,Interuniversity Microelectronics Centre, Leuven, Belgium
| | - Petra Lemmers
- Department of Neonatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Frank Van Bel
- Department of Neonatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sabine Van Huffel
- Department of Electrical Engineering, ESAT-Stadius, KU Leuven, Leuven, Belgium.,Interuniversity Microelectronics Centre, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Impact of Changes in Systemic Physiology on fNIRS/NIRS Signals: Analysis Based on Oblique Subspace Projections Decomposition. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1072:119-125. [PMID: 30178333 DOI: 10.1007/978-3-319-91287-5_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Measurements of cerebral and muscle oxygenation (StO2) and perfusion ([tHb]) with functional near-infrared spectroscopy (fNIRS) and near infrared spectroscopy (NIRS), respectively, can be influenced by changes in systemic physiology. The aim of our study was to apply the oblique subspace projections signal decomposition (OSPSD) to find the contribution from systemic physiology, i.e. heart rate (HR), electrocardiography (ECG)-derived respiration (EDR) and partial pressure of carbon dioxide (pCO2) to StO2 and [tHb] signals measured on the prefrontal cortex (PFC) and calf muscle. OSPSD was applied to two datasets (n1 = 42, n2 = 79 measurements) from two fNIRS/NIRS speech studies. We found that (i) all StO2 and [tHb] signals contained components related to changes in systemic physiology, (ii) the contribution from systemic physiology varied strongly between subjects, and (iii) changes in systemic physiology generally influenced fNIRS signals on the left and right PFC to a similar degree.
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Goltsov A, Anisimova AV, Zakharkina M, Krupatkin AI, Sidorov VV, Sokolovski SG, Rafailov E. Bifurcation in Blood Oscillatory Rhythms for Patients with Ischemic Stroke: A Small Scale Clinical Trial using Laser Doppler Flowmetry and Computational Modeling of Vasomotion. Front Physiol 2017; 8:160. [PMID: 28386231 PMCID: PMC5362641 DOI: 10.3389/fphys.2017.00160] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/02/2017] [Indexed: 11/18/2022] Open
Abstract
We describe application of spectral analysis of laser Doppler flowmetry (LDF) signals to investigation of cerebrovascular haemodynamics in patients with post-acute ischemic stroke (AIS) and cerebrovascular insufficiency. LDF was performed from 3 to 7 days after the onset of AIS on forehead in the right and left supraorbital regions in patients. Analysis of LDF signals showed that perfusion in the microvasculature in AIS patients was lower than that in patients with cerebrovascular insufficiency. As a result of wavelet analysis of the LDF signals we obtained activation of the vasomotion in the frequency range of myogenic oscillation of 0.1 Hz and predominantly nutritive regime microcirculation after systemic thrombolytic therapy of the AIS patients. In case of significant stroke size, myogenic activity, and nutritive pattern microhaemodynamics were reduced, in some cases non-nutritive pattern and/or venular stasis was revealed. Wavelet analysis of the LDF signals also showed asymmetry in wavelet spectra of the LDF signals obtained in stroke-affected and unaffected hemispheres in the AIS patients. A mechanism underlying the observed asymmetry was analyzed by computational modeling of vasomotion developed in Arciero and Secomb (2012). We applied this model to describe relaxation oscillation of arteriole diameter which is forced by myogenic oscillation induced by synchronous calcium oscillation in vascular smooth muscle cells. Calculation showed that vasomotion frequency spectrum at the low-frequency range (0.01 Hz) is reciprocally modulated by myogenic oscillation (0.1 Hz) that correlates with experimental observation of inter-hemispheric variation in the LDF spectrum.
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Affiliation(s)
- Alexey Goltsov
- Division of Science, School of Science, Engineering and Technology, Abertay University Dundee, UK
| | - Anastasia V Anisimova
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, First City Hospital Moscow, Russia
| | - Maria Zakharkina
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, First City Hospital Moscow, Russia
| | - Alexander I Krupatkin
- Department of Functional Diagnostics, Priorov's Central Institute of Traumatology and Orthopedics Moscow, Russia
| | | | - Sergei G Sokolovski
- Optoelectronics and Biomedical Photonics Group, Photonics and Nanoscience Group, Aston Institute of Photonic Technologies, Aston University Birmingham, UK
| | - Edik Rafailov
- Optoelectronics and Biomedical Photonics Group, Photonics and Nanoscience Group, Aston Institute of Photonic Technologies, Aston University Birmingham, UK
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