Near-infrared spectroscopy for monitoring cerebral ischemia during selective cerebral perfusion

Orihashi, Kazumasa; Sueda, Taijiro; Okada, Kenji; Imai, Kyoichi

doi:10.1016/j.ejcts.2004.06.014

Cited by 118 publications

(61 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In adults, normal TOI values have been reported to range from 65% to 85%. 14,36 -41 Although a number of authors have compared NIRS with other techniques such as jugular bulb oxygen saturation (SjO 2 ), transcranial Doppler ultrasonography and somatosensory-evoked potential 15,37,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] or with neurologic events, few have attempted to define an absolute threshold for ischemia. 13,14,16,17,46,[57][58][59] Most studies of this type using NIRS make no attempt to correct for extracranial contributions to signal changes.…”

Section: Discussionmentioning

confidence: 99%

Tissue Oxygen Index

Al-Rawi

Kirkpatrick

2006

Stroke

148

View full text Add to dashboard Cite

Background and Purpose-To date, the clinical application of near infrared spectroscopy in the adult brain has been limited. The NIRO 300 (Hamamatsu Photonics) provides a continuous measurement of tissue oxygen index (TOI) using spatially resolved spectroscopy. Although TOI reflects cerebral oxygenation to a high degree of sensitivity and specificity, to become a useful clinical tool, thresholds for cerebral ischemia need to be defined. This study has attempted to identify a quantifiable TOI threshold for ischemia in the adult brain. Methods-One hundred sixty-seven patients undergoing carotid endarterectomy were studied. The NIRO 300 was incorporated into an established multimodal monitoring system enabling observations of cerebral hemodynamic changes under highly controlled conditions. Changes in TOI (%⌬TOI) on clamping the internal carotid artery were compared with intracranial blood flow (middle cerebral artery flow velocity) and cerebral function monitoring to identify and quantify periods of cerebral ischemia. Results-Significant correlation was seen between changes in middle cerebral artery flow velocity and ⌬TOI on clamping (rϭ0.74, Pϭ0.0001). Thirty-one patients showed cerebral ischemia on internal carotid artery clamping as defined by a sustained fall in cerebral function monitoring. A threshold for %⌬TOI of Ϫ13 was identified, above which no patients showed any evidence of ischemia on clamping. This threshold provided 100% sensitivity and 93.2% specificity for patients satisfying the preset criteria for cerebral ischemia. Conclusions-These data demonstrate the potential to identify TOI-quantified thresholds for cerebral ischemia in the adult brain and thus improve the clinical use of near infrared spectroscopy. Our observations have defined a drop in TOI (13%) that can be adopted as a threshold for severe cerebral ischemia with high sensitivity and specificity. Key Words: carotid endarterectomy Ⅲ cerebral ischemia Ⅲ near infrared spectroscopy Ⅲ spatially resolved spectroscopy Ⅲ tissue oxygen index O ptical methods based on near-infrared spectroscopy (NIRS) can be used to monitor hemodynamic variables in the clinical setting. 1 Applications include monitors of fetal physiology, 2-4 during cardiac surgery, 5,6 muscle function, 7-10 and neonatal, 11 pediatric, 12 and adult brain. [13][14][15][16][17][18][19] A number of NIRS instruments are now available that detect changes in optical attenuation from several wavelengths of light, and although a variety of algorithms have been applied to attempt quantification, accuracy of these instruments remains a concern.The NIRO 300 (Hamamatsu Photonics) provides a continuous online measurement of tissue oxygen index (TOI) using spatially resolved spectroscopy. 20,21 We have previously determined that TOI reflects cerebral oxygenation to a high degree of sensitivity and specificity during carotid surgery, 20 an indication that NIRS can show clinically relevant estimations of cerebral hemodynamic and oxygen changes in the adult head (Figure 1). However, there are no da...

show abstract

Section: Discussionmentioning

confidence: 99%

Tissue Oxygen Index

Al-Rawi

Kirkpatrick

2006

Stroke

148

View full text Add to dashboard Cite

show abstract

“…14 This method that we used is simple, non-invasive, and can be achieved at real-time; therefore, 10 rSO 2 is measured during open heart surgery. 15,16 In the present study, rSO 2 changed quickly with mean blood pressure, especially when the heart was displaced. During anastomosis of the left circumflex artery, both the mean blood pressure and rSO 2 decreased.…”

Section: Discussionmentioning

confidence: 81%

Monitoring brain oxygen saturation during awake off-pump coronary artery bypass

Toda

Watanabe

Matsumoto

et al. 2013

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

Objective: To evaluate the changes in cerebral blood flow during awake off-pump coronary artery bypass grafting and compare with the changes during off-pump coronary artery bypass grafting under general anesthesia, using continuous monitoring of regional cerebral oxygen saturation.Methods: The study population comprised 3 groups of patients who had undergone off-pump coronary artery bypass grafting with thoracic epidural anesthesia, general anesthesia, or a combination of the two. Regional brain oxygen saturation, determined with a near-infrared oxygen monitor, and mean arterial pressure during surgery were calculated and compared among the 3 groups.Results: Patients who had undergone awake off-pump coronary artery bypass grafting with thoracic epidural anesthesia had a significantly higher cerebrovascular impairment ratio, and the EuroSCORE was high. No significant differences were observed among the 3 groups in terms of the relationship between mean arterial pressure during surgery and regional brain oxygen saturation. It is suggested that there were no differences in cerebral blood flow and mean arterial pressure changes among the 3 groups.Conclusions: Awake off-pump coronary artery bypass grafting is a safe surgical technique for patients with history of cerebral infarction or impaired cerebral blood flow. Awake off-pump coronary artery bypass grafting is a less invasive procedure that allows efficient management of intraoperative cerebral blood flow, and can be equally effective as a percutaneous coronary intervention.

show abstract

“…Нужно отметить, что метод церебральной окси метрии в настоящее время является единственной технологией, которая позволяет своевременно и неин вазивно диагностировать мозговую гипоксию и оце нивать результаты ее коррекции в режиме реального времени [28][29][30].…”

Section: параметрыunclassified

Cerebral Oximetry for the Prediction of Neurological Dysfunction in Cardiosurgical Patients

Шепелюк¹,

Клыпа²,

Никифоров³

2011

rmt

View full text Add to dashboard Cite

Цель исследования -оценить диагностическую значимость церебральной оксиметрии при кардиохирургических опе рациях и выработать принципы профилактики постперфузионной неврологической дисфункции. Материал и мето ды. Обследовали 461 пациента, оперированных в условиях ИК. Всем больным проводили мониторинг церебральной оксигенации (ЦО). Анализировали пред , интра и послеоперационные данные. Результаты. Выделили 2 группы па циентов -1 я -со снижением церебральной оксигенации (ЦО) ниже 45% (n=148) во время ИК и 2 я -без сниже ния ЦО (n=313). Выявили в 1 й группе более низкий уровень гемоглобина и гематокрита до операции, исходно сни женную ЦО с обеих сторон, более частые сопутствующие стенозы брахиоцефальных артерий (БЦА) более 50%, чаще выявляемую дисциркуляторную энцефалопатию (ДЭП) в анамнезе. Выявили отличия уровня гемоглобина и гемато крита, доставки кислорода и РаСО 2 в течение ИК в группах, а также зависимость частоты снижения ЦО от вида кар диоплегии. Выявили отличия в степени снижения ЦО в группах относительно исходных величин. В послеоперацион ном периоде проявления энцефалопатии имели место у 24 х (16,3%) пациентов 1 й группы и 12 и (3,8%) -во 2 й группе (р<0,05). У пациентов с послеоперационной ЭП снижение ЦО во время ИК отметили в 66,7%. Заключение. Мониторинг ЦО является целесообразным при операциях с ИК. Снижение ЦО менее 45%, а также снижение ЦО в те чение ИК более чем на 20% от исходных значений является достоверным предиктором развития послеоперационной энцефалопатии. В группу риска послеоперационных энцефалопатий отнесли пациентов с предоперационной анемией, сопутствующими стенозами БЦА более 50%, проявлениями ДЭП в анамнезе, а также больных с исходно сниженной ЦО (менее 70%). У данных пациентов следует избегать выраженной гемодилюции и гипокапнии во время ИК, также следует отдавать предпочтение проведению кровяной кардиоплегии. Ключевые слова: искусственное кровообраще ние, церебральная оксиметрия, неврологическая дисфункция, церебральная оксигенация.Objective: to estimate the diagnostic value of cerebral oximetry during cardiosurgical operations and to elaborate princi ples of the prevention of postperfusion neurological dysfunction. Subjects and methods. Four hundred and sixty one patients operated on under extracorporeal circulation (EC) were examined. Cerebral oxygenation (CO) was monitored in all the patients. Pre , intra , and postoperative data were analyzed. Results. Two groups of patients were identified: 1) 148 patients with a reduced CO of lower than 45% during EC and 2) 313 patients without reduced CO. Group 1 was found to have lower preoperative levels of hemoglobin and packed cell volume and baseline reduced bilateral CO, more frequent con comitant brachiocephalic artery (BCA) stenoses of more than 50%, more detectable dyscirculatory encephalopathy (DEP) in the history. Group differences were found in the level of hemoglobin and packed cell volume, oxygen delivery, and PaCO 2 during EC and there was a relationship of the rate of CO reductions to the type of cardioplegia. There were also...

show abstract

Near-infrared spectroscopy for monitoring cerebral ischemia during selective cerebral perfusion

Cited by 118 publications

References 12 publications

Tissue Oxygen Index

Tissue Oxygen Index

Monitoring brain oxygen saturation during awake off-pump coronary artery bypass

Cerebral Oximetry for the Prediction of Neurological Dysfunction in Cardiosurgical Patients

Contact Info

Product

Resources

About