Optical monitoring of various tissue physiological and biochemical parameters in real-time represents a significant new approach and a tool for better clinical diagnosis. The Tissue Spectroscope (TiSpec), developed and applied in experimental and clinical situations, is the first medical device that enables the real-time monitoring of three parameters representing the vitality of the tissue. Tissue vitality, which is correlated to the oxygen balance in the tissue, is defined as the ratio between O(2) supply and O(2) demand. The TiSpec enables the monitoring of microcirculatory blood flow (O(2) supply), mitochondrial NADH redox state (O(2) balance), and tissue reflectance, which correlates to blood volume. We describe in detail the theoretical basis for the monitoring of the three parameters and the technological aspects of the TiSpec. The comparison between the TiSpec and the existing single parameter monitoring instruments shows a statistically significant correlation as evaluated in vitro as well as in various in vivo animal models. The results presented originated in a pilot study performed in vivo in experimental animals. Further research is needed to apply this technology clinically. The clinical applications of the TiSpec include two situations where the knowledge of tissue vitality can improve clinical practice. The major application is the monitoring of "nonvital" organs of the body [i.e., the skin, gastrointestinal (G-I) tract, urethra] in emergency situations, such as in the operating rooms and intensive care units. Also, the monitoring of specific (vital) organs, such as the brain or the heart, during surgical procedure is of practical importance.
Real time Monitoring of mitochondrial function in vivo is a significant factor in the understanding of tissue vitality. Nevertheless a single parameter monitoring device is not appropriate and effective in clinical diagnosis of tissue vitality. Therefore we have developed a multiparameteric monitoring system that monitors, in addition to mitochondrial NADH redox state, tissue microcirculatory blood flow, tissue total back-scattered light as an indication of blood volume and blood oxygenation (Hb02). In the present communication a new device named "CritiView" is described. This device was developed in order to enable real time monitoring of the four parameters from various organs in the body. The main medical application of the CritiView is in critical care medicine of patients hospitalized in the Intensive Care Units (ICUs) and intraoperatively in operating rooms. The physiological basis for our clinical monitoring approach is based on the well known response to the development of body emergency situation, such as shock or trauma. Under such conditions a process of blood flow redistribution will give preference to vital organs (Brain, Heart) neglecting less vital organs (Skin, G-I tract or the urinary system). Under such condition the brain will be hyperperfused and 02 supply will increase to provide the need of the activated mitochondria. The non-vital organs will be hypoperfused and mitochondrial function will be inhibited leading to energy failure. This differentiation between the two types of organs could be used for the early detection of body deterioration by monitoring of the nonvital organ vitality. A fiber optic sensor was embedded in a Foley catheter, enabling the monitoring of Urethral wall vitality, to serve as an early warning signal ofbody deterioration.
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