Measurement of Cerebral Oxidative Metabolism with Near-Infrared Spectroscopy: A Validation Study

Tichauer, Kenneth M.; Hadway, Jennifer; Lee, Ting‐Yim; Lawrence, Keith St.

doi:10.1038/sj.jcbfm.9600230

Cited by 42 publications

(33 citation statements)

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“…By combining these measurements, our group has developed a bedside NIRS system capable of rapidly measuring the CMRO 2 that was validated in healthy piglets over a range of metabolic states (3,38). Furthermore, our group observed early, persistent reductions in the CMRO 2 of piglets subjected to transient hypoxia-ischemia (37).…”

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confidence: 99%

Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets

Tichauer¹,

Elliott²,

Hadway³

et al. 2009

Journal of Applied Physiology

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Tichauer KM, Elliott JT, Hadway JA, Lee T, St. Lawrence KS. Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets. J Appl Physiol 106: 1506 -1512. First published March 19, 2009 doi:10.1152/japplphysiol.91156.2008.-The therapeutic window following perinatal hypoxia-ischemia is brief, and early clinical signs of injury can be subtle. Electroencephalography (EEG) represents the most promising early diagnostic of hypoxia-ischemia; however, some studies have questioned the sensitivity and specificity of EEG. The present study investigated the use of both near-infrared spectroscopy (NIRS) measurements of the cerebral metabolic rate of oxygen (CMRO 2) and amplitude-integrated EEG (aEEG) to detect the severity of hypoxia-ischemia after 1 h of reperfusion in newborn piglets (10 insult, 3 control). The CMRO2 was measured before and after 1 h of reperfusion from hypoxia-ischemia, the duration of which was varied from piglet to piglet with a range of 3-24 min, under fentanyl/nitrous oxide anesthesia to mimic awake-like levels of cerebral metabolism. EEG data were collected throughout the study. On average, the CMRO2 and mean aEEG background signals were significantly depressed following the insult (P Ͻ 0.05). Mean CMRO 2 and mean aEEG background were 2.61 Ϯ 0.11 ml O2 ⅐ min Ϫ1 ⅐ 100 g Ϫ1 and 20.4 Ϯ 2.7 V before the insult and 1.58 Ϯ 0.09 ml O2⅐min Ϫ1 ⅐100 g Ϫ1 and 11.8 Ϯ 2.9 V after 1 h of reperfusion, respectively. Both CMRO2 and aEEG displayed statistically significant correlations with duration of ischemia (P Ͻ 0.05; r ϭ 0.71 and r ϭ 0.89, respectively); however, only CMRO2 was sensitive to milder injuries (Ͻ5 min). This study highlights the potential for combining NIRS measures of CMRO2 with EEG in the neonatal intensive care unit to improve early detection of perinatal hypoxia-ischemia. near-infrared spectroscopy; piglet; hypoxia-ischemia; electroencephalography PERINATAL HYPOXIC-ISCHEMIC encephalopathy is a substantial cause of infant mortality and morbidity. It remains a detrimental factor in roughly 1 of every 500 live term births in developed nations, leading to long-term neurological and developmental disabilities (20). Recent clinical trials have demonstrated that the incidence of death and disability from hypoxia-ischemia in newborns can be significantly reduced by initiating treatment strategies, hypothermia, for example, after birth and within a 6-h therapeutic window (9,11,14,32). Due to the brevity of the therapeutic window, early detection of injury and early determination of those infants who are likely candidates for treatment are crucial (15). In this regard, traditional early indicators of brain injury, including Apgar scores, umbilical artery acidosis, and fetal heart rate monitoring, suffer from poor specificity (7, 31), and more specific indicators of injury, such as magnetic resonance imaging and spectroscopy, are insensitive or difficult to implement within the therapeutic window (6, 21).To this point, the most...

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Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets

Tichauer¹,

Elliott²,

Hadway³

et al. 2009

Journal of Applied Physiology

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“…With continuouswave, broadband-spectrum NIRS, the absolute concentration of cerebral deoxy-Hb ([HHb]) (8) and cerebral blood flow (CBF) (9) can be accurately determined. By combining these measurements, we have developed a NIRS system capable of rapidly measuring CMRO 2 and have validated it in newborn piglets over a range of metabolic states (10,11).…”

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Assessing the Severity of Perinatal Hypoxia-Ischemia in Piglets Using Near-Infrared Spectroscopy to Measure the Cerebral Metabolic Rate of Oxygen

et al. 2009

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Reduced cerebral function after neonatal hypoxiaischemia is an early indicator of hypoxic-ischemic encephalopathy. Near-infrared spectroscopy offers a clinically relevant means of detecting impaired cerebral metabolism from the measurement of the cerebral metabolic rate of oxygen (CMRO 2 ). The purpose of this study was to determine the relationship between postinsult CMRO 2 and duration of hypoxia-ischemia in piglets. Twelve piglets were subjected to randomly selected durations of hypoxia-ischemia (5-28 min) and five animals served as controls. Measurements of CMRO 2 were taken before and for 24 h after hypoxia-ischemia. Histology was carried out in nine piglets (six insults, three controls) to estimate brain injury. In the first 4 h after the insult, average CMRO 2 of the insult group was significantly depressed (33 Ϯ 3% reduction compared with controls) and by 8 h, a significant correlation developed, which persisted for the remainder of the study, between CMRO 2 and the duration of ischemia. Histologic staining suggested little brain damage resulted from shorter insult durations and considerable damage from more prolonged insults. This study demonstrated that near-infrared spectroscopy could detect early changes in CMRO 2 after hypoxia-ischemia for a range of insult severities and CMRO 2 could be used to distinguish insult severity by 8 h after the insult. (Pediatr Res 65: 301-306, 2009) P erinatal hypoxia-ischemia continues to be a significant cause of neurodevelopmental impairment and disability in the term infant. Results from animal and newborn human studies suggest a significant portion of hypoxic-ischemic brain damage can be delayed by 6 -72 h after resuscitation (1). Long-term outcome could be improved if mechanisms leading to delayed cell death could be suppressed during the latent period between insult and injury-a period termed the "therapeutic window" (2). The exact duration of the therapeutic window is unknown; however, the success rate of treatment strategies depends on early administration. Unfortunately, the clinical signs of perinatal hypoxia-ischemia can be subtle and there are as yet no proven methods capable of reliably and accurately assessing the severity of injury within the confines of the therapeutic window (2).For nearly 30 y it has been known that cerebral ischemia can cause long-term depression of cerebral metabolism despite resuscitation (3). Studies conducted in neonatal lambs demonstrated that a reduction in cerebral energy metabolism can be seen within 4 h after resuscitation from hypoxiaischemia (4,5) and metabolic impairment has been similarly observed in newborns within 18 h of birth by proton magnetic resonance spectroscopy (6), while delayed energy failure, as quantified by phosphorous magnetic resonance spectroscopy, can be used to predict neurologic outcome (7). The results of these studies suggest that a noninvasive measure of the cerebral metabolic rate of oxygen (CMRO 2 ) may be of particular interest to the clinical prognosis of hypoxia-ischemia.Recent tech...

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“…There was also a strong correlation between concomitant CMRO 2 values obtained from the two techniques ( Fig. 3 in Tichauer et al, 2006b). Furthermore, repeated measurements obtained while maintaining constant CMRO 2 showed that the NIRS technique can measure CMRO 2 with a precision of 10.7%.…”

Section: Cmro 2 Validationmentioning

confidence: 75%

“…The NIRS CBF measurements can be used to determine CMRO 2 by applying the Fick Principle (Tichauer et al, 2006b):…”

Section: Measuring the Cerebral Metabolic Rate Of Oxygenmentioning

confidence: 99%

“…The cerebral metabolic rate of oxygen measured by the NIRS technique were compared to CMRO 2 determined from the product of CBF and the cerebral arterial-venous difference in oxygen (AVDO 2 ) measured from blood samples (Tichauer et al, 2006b). The experiments were conducted in newborn piglets subjected to five cerebral metabolic states created by varying the plane of anesthesia.…”

Section: Cmro 2 Validationmentioning

confidence: 99%

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Towards Non-Invasive Bedside Monitoring of Cerebral Blood Flow and Oxygen Metabolism in Brain-Injured Patients with Near-Infrared Spectroscopy

Diop¹,

Elliott²,

Lee³

et al. 2012

Brain Injury - Pathogenesis, Monitoring, Recovery and Management

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Measurement of Cerebral Oxidative Metabolism with Near-Infrared Spectroscopy: A Validation Study

Cited by 42 publications

References 40 publications

Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets

Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets

Assessing the Severity of Perinatal Hypoxia-Ischemia in Piglets Using Near-Infrared Spectroscopy to Measure the Cerebral Metabolic Rate of Oxygen

Towards Non-Invasive Bedside Monitoring of Cerebral Blood Flow and Oxygen Metabolism in Brain-Injured Patients with Near-Infrared Spectroscopy

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