Artículos de revistas
Continuous Optical Monitoring Of Cerebral Hemodynamics During Head-of-bed Manipulation In Brain-injured Adults
Registro en:
Neurocritical Care. Humana Press Inc., v. 20, n. 3, p. 443 - 453, 2014.
15416933
10.1007/s12028-013-9849-7
2-s2.0-84902330355
Autor
Kim M.N.
Edlow B.L.
Durduran T.
Frangos S.
Mesquita R.C.
Levine J.M.
Greenberg J.H.
Yodh A.G.
Detre J.A.
Institución
Resumen
Introduction: Head-of-bed manipulation is commonly performed in the neurocritical care unit to optimize cerebral blood flow (CBF), but its effects on CBF are rarely measured. This pilot study employs a novel, non-invasive instrument combining two techniques, diffuse correlation spectroscopy (DCS) for measurement of CBF and near-infrared spectroscopy (NIRS) for measurement of cerebral oxy- and deoxy-hemoglobin concentrations, to monitor patients during head-of-bed lowering. Methods: Ten brain-injured patients and ten control subjects were monitored continuously with DCS and NIRS while the head-of-bed was positioned first at 30° and then at 0°. Relative CBF (rCBF) and concurrent changes in oxy- (ΔHbO2), deoxy- (ΔHb), and total-hemoglobin concentrations (ΔTHC) from left/right frontal cortices were monitored for 5 min at each position. Patient and control response differences were assessed. Results: rCBF, ΔHbO2, and ΔTHC responses to head lowering differed significantly between brain-injured patients and healthy controls (P < 0.02). For patients, rCBF changes were heterogeneous, with no net change observed in the group average (0.3 ± 28.2 %, P = 0.938). rCBF increased in controls (18.6 ± 9.4 %, P < 0.001). ΔHbO2, ΔHb, and ΔTHC increased with head lowering in both groups, but to a larger degree in brain-injured patients. rCBF correlated moderately with changes in cerebral perfusion pressure (R = 0.40, P < 0.001), but not intracranial pressure. Conclusion: DCS/NIRS detected differences in CBF and oxygenation responses of brain-injured patients versus controls during head-of-bed manipulation. This pilot study supports the feasibility of continuous bedside measurement of cerebrovascular hemodynamics with DCS/NIRS and provides the rationale for further investigation in larger cohorts. © 2013 Springer Science+Business Media. 20 3 443 453 Durward, Q.J., Amachier, A.L., Del, M.R.F., Sibbald, W.J., Cerebral and cardiovascular responses to changes in head elevation in patients with intracranial hypertension (1983) Journal of Neurosurgery, 59 (6), pp. 938-944 Fan, J.Y., Effect of backrest position on intracranial pressure and cerebral perfusion pressure in individuals with brain injury: A systematic review (2004) J Neurosci Nurs, 36, pp. 278-288 Winkelman, C., Effect of backrest position on intracranial and cerebral perfusion pressures in traumatically brain-injured adults (2000) Am J Crit Care, 9 (6), pp. 373-380 Ropper, A.H., O'Rourke, D., Kennedy, S.K., Head position, intracranial pressure, and compliance (1982) Neurology, 32 (11), pp. 1288-1291 Moraine, J.-J., Berre, J., Melot, C., Is cerebral perfusion pressure a major determinant of cerebral blood flow during head elevation in comatose patients with severe intracranial lesions? (2000) Journal of Neurosurgery, 92 (4), pp. 606-614 Feldman, Z., Kanter, M.J., Robertson, C.S., Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients (1992) J Neurosurg, 76, pp. 207-211 Cruz, J., Jaggi, J.L., Hoffstad, O.J., Cerebral blood flow, vascular resistance, and oxygen metabolism in acute brain trauma: Redefining the role of cerebral perfusion pressure? (1995) Crit Care Med, 23, pp. 1412-1417 Vespa, P., What is the optimal threshold for cerebral perfusion pressure following traumatic brain injury? (2003) Neurosurg Focus, 15, pp. E4 Juul, N., Morris, G.F., Marshall, S.B., Marshall, L.F., Intracranial hypertension and cerebral perfusion pressure: Influence on neurological deterioration and outcome in severe head injury (2000) Journal of Neurosurgery, 92 (1), pp. 1-6 Chesnut, R.M., Temkin, N., Carney, N., A trial of intracranial-pressure monitoring in traumatic brain injury (2012) N Engl J Med, 367, pp. 2471-2481 Cremer, O.L., Van Dijk, G.W., Van Wensen, E., Brekelmans, G.J.F., Moons, K.G.M., Leenen, L.P.H., Kalkman, C.J., Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury (2005) Critical Care Medicine, 33 (10), pp. 2207-2213. , DOI 10.1097/01.CCM.0000181300.99078.B5 Overgaard, J., Mosdal, C., Tweed, W.A., Cerebral circulation after head injury. Part 3: Does reduced regional cerebral blood flow determine recovery of brain function after blunt head injury? (1981) Journal of Neurosurgery, 55 (1), pp. 63-74 Evans, D.H., McDicken, W.N., (2000) Doppler Ultrasound: Physics, Instrumentation, and Signal Processing. 2nd Ed., , Chichester: Wiley Vajkoczy, P., Roth, H., Horn, P., Lucke, T., Thome, C., Hubner, U., Martin, G.T., Schmiedek, P., Continuous monitoring of regional cerebral blood flow: Experimental and clinical validation of a novel thermal diffusion microprobe (2000) Journal of Neurosurgery, 93 (2), pp. 265-274 Kirkpatrick, P.J., Smielewski, P., Czosnyka, M., Pickard, J.D., Continuous monitoring of cortical perfusion by laser Doppler flowmetry in ventilated patients with head injury (1994) Journal of Neurology Neurosurgery and Psychiatry, 57 (11), pp. 1382-1388 Reinhard, M., Wehrle-Wieland, E., Grabiak, D., Roth, M., Guschlbauer, B., Timmer, J., Weiller, C., Hetzel, A., Oscillatory cerebral hemodynamics-the macro- vs. microvascular level (2006) Journal of the Neurological Sciences, 250 (1-2), pp. 103-109. , DOI 10.1016/j.jns.2006.07.011, PII S0022510X06003595 White, H., Venkatesh, B., Applications of transcranial Doppler in the ICU: A review (2006) Intensive Care Medicine, 32 (7), pp. 981-994. , DOI 10.1007/s00134-006-0173-y Menon, C., Polin, G.M., Prabakaran, I., Hsi, A., Cheung, C., Culver, J.P., Pingpank, J.F., Fraker, D.L., An Integrated Approach to Measuring Tumor Oxygen Status Using Human Melanoma Xenografts as a Model (2003) Cancer Research, 63 (21), pp. 7232-7240 Durduran, T., (2004) Non-invasive Measurements of Tissue Hemodynamics with Hybrid Diffuse Optical Methods, , PhD thesis, University of Pennsylvania Yu, G., Durduran, T., Zhou, C., Wang, H.-W., Putt, M.E., Saunders, H.M., Sehgal, C.M., Busch, T.M., Noninvasive monitoring of murine tumor blood flow during and after photodynamic therapy provides early assessment of therapeutic efficacy (2005) Clinical Cancer Research, 11 (9), pp. 3543-3552. , DOI 10.1158/1078-0432.CCR-04-2582 Sunar, U., Makonnen, S., Zhou, C., Durduran, T., Yu, G., Wang, H.-W., Lee, W.M.F., Yodh, A.G., Hemodynamic responses to antivascular therapy and ionizing radiation assessed by diffuse optical spectroscopies (2007) Optics Express, 15 (23), pp. 15507-15516. , http://www.opticsexpress.org/DirectPDFAccess/46973223-BDB9-137E- C3FB80936BC15692_144753.pdf?da=1&id=144753&seq=0&CFID= 6113484&CFTOKEN=93334823, DOI 10.1364/OE.15.015507 Zhou, C., Eucker, S.A., Durduran, T., Diffuse optical monitoring of hemodynamic changes in piglet brain with closed head injury (2009) J Biomed Opt, 14, p. 034015 Carp, S.A., Dai, G.P., Boas, D.A., Franceschini, M.A., Kim, Y.R., Validation of diffuse correlation spectroscopy measurements of rodent cerebral blood flow with simultaneous arterial spin labeling MRI towards MRI-optical continuous cerebral metabolic monitoring (2010) Biomed Opt Express, 1, pp. 553-565 Mesquita, R.C., Skuli, N., Kim, M.N., Hemodynamic and metabolic diffuse optical monitoring in a mouse model of hindlimb ischemia (2010) Biomed Opt Express, 1, pp. 1173-1187 Kim, M.N., Durduran, T., Frangos, S., Noninvasive measurement of cerebral blood flow and blood oxygenation using nearinfrared and diffuse correlation spectroscopies in critically braininjured adults (2010) Neurocrit Care, 12, pp. 173-180 Buckley, E.M., Cook, N.M., Durduran, T., Cerebral hemodynamics in preterm infants during positional intervention measured with diffuse correlation spectroscopy and transcranial Doppler ultrasound (2009) Opt Express, 17, pp. 12571-12581 Roche-Labarbe, N., Carp, S.A., Surova, A., Noninvasive optical measures of CBV, StO(2), CBF index, and rCMRO(2) in human premature neonates' brains in the first six weeks of life (2010) Hum Brain Mapp, 31, pp. 341-352 Durduran, T., Zhou, C.A., Buckley, E.M., Optical measurement of cerebral hemodynamics and oxygen metabolism in neonates with congenital heart defects (2010) J Biomed Opt, 15 (3), p. 037004 Yu, G., Floyd, T.F., Durduran, T., Zhou, C., Wang, J., Detre, J.A., Yodh, A.G., Validation of diffuse correlation spectroscopy for muscle blood flow with concurrent arterial spin labeled perfusion MRI (2007) Optics Express, 15 (3), pp. 1064-1075. , http://www.opticsexpress.org/DirectPDFAccess/950F9A3C-BDB9-137E- CA199955C8477E68_125690.pdf?da=1&id=125690&seq=0&CFID= 40563667&CFTOKEN=61765589, DOI 10.1364/OE.15.001064 Zirak, P., Delgado-Mederos, R., Marti-Fabregas, J., Durduran, T., Effects of acetazolamide on the micro- and macro-vascular cerebral hemodynamics: A diffuse optical and transcranial doppler ultrasound study (2010) Biomed Opt Express, 1, pp. 1443-1459 Edlow, B.L., Kim, M.N., Durduran, T., The effects of healthy aging on cerebral hemodynamic responses to posture change (2010) Physiol Meas, 31, pp. 477-495 Durduran, T., Zhou, C., Edlow, B.L., Transcranial optical monitoring of cerebrovascular hemodynamics in acute stroke patients (2009) Opt Express, 17, pp. 3884-3902 Mesquita, R.C., Schenkel, S.S., Durduran, T., Diffuse correlation spectroscopy for flow assessment and management of acute ischemic stroke (2012) Biomedical Optics, pp. BW4B. , Miami: Optical Society of America Durduran, T., Yu, G., Burnett, M., Diffuse optical measurement of blood flow, blood oxygenation, and metabolism in a human brain during sensorimotorcortex activation (2004) Opt Lett, 29, pp. 1766-1768 Durduran, T., Choe, R., Baker, W.B., Yodh, A.G., Diffuse optics for tissue monitoring and tomography (2010) Rep Prog Phys, 73, p. 076701 Mesquita, R.C., Yodh, A.G., Diffuse optics: Fundamentals and tissue applications Proceedings of the International School of Physics "Enrico Fermi" Course CLXXIII "Nano Optics and Atomics: Transport of Light and Matter Waves. 2011, 173, pp. 51-74 Mesquita, R.C., Durduran, T., Yu, G., Direct measurement of tissue blood flow and metabolism with diffuse optics (2011) Philos Trans R Soc A: Math Phys Eng Sci, 369, pp. 4390-4406 Boas, D.A., Yodh, A.G., Spatially varying dynamical properties of turbid media probed with diffusing temporal light correlation (1997) Journal of the Optical Society of America A: Optics and Image Science, and Vision, 14 (1), pp. 192-215 Cheung, C., Culver, J.P., Takahashi, K., Greenberg, J.H., Yodh, A.G., In vivo cerebrovascular measurement combining diffuse near-infrared absorption and correlation spectroscopies (2001) Physics in Medicine and Biology, 46 (8), pp. 2053-2065. , DOI 10.1088/0031-9155/46/8/302, PII S0031915501232023 Imholz, B.P.M., Wieling, W., Van Montfrans, G.A., Wesseling, K.H., Fifteen years experience with finger arterial pressure monitoring: Assessment of the technology (1998) Cardiovascular Research, 38 (3), pp. 605-616. , DOI 10.1016/S0008-6363(98)00067-4, PII S0008636398000674 Teasdale, G., Jennett, B., Assessment of coma and impaired consciousness. A practical scale (1974) Lancet, 2, pp. 81-84 Hunt, W.E., Hess, R.M., Surgical risk as related to time of intervention in the repair of intracranial aneurysms (1968) J Neurosurg, 28, pp. 14-20 Overgaard, J., Tweed, W.A., Cerebral circulation after head injury. 1. Cerebral blood flow and its regulation after closed head injury with emphasis on clinical correlations (1974) J Neurosurg, 41, pp. 531-541 Enevoldsen, E.M., Jensen, F.T., Autoregulation and CO2 responses of cerebral blood flow in patients with acute severe head injury (1978) J Neurosurg, 48, pp. 689-703 Czosnyka, M., Smielewski, P., Piechnik, S., Steiner, L.A., Pickard, J.D., Cerebral autoregulation following head injury (2001) Journal of Neurosurgery, 95 (5), pp. 756-763 Jaeger, M., Schuhmann, M.U., Soehle, M., Nagel, C., Meixensberger, J., Continuous monitoring of cerebrovascular autoregulation after subarachnoid hemorrhage by brain tissue oxygen pressure reactivity and its relation to delayed cerebral infarction (2007) Stroke, 38 (3), pp. 981-986. , DOI 10.1161/01.STR.0000257964.65743.99, PII 0000767020070300000034 Lang, E.W., Diehl, R.R., Mehdorn, H.M., Cerebral autoregulation testing after aneurysmal subarachnoid hemorrhage: The phase relationship between arterial blood pressure and cerebral blood flow velocity (2001) Critical Care Medicine, 29 (1), pp. 158-163 Ratsep, T., Asser, T., Cerebral hemodynamic impairment after aneurysmal subarachnoid hemorrhage as evaluated using transcranial Doppler ultrasonography: Relationship to delayed cerebral ischemia and clinical outcome (2001) Journal of Neurosurgery, 95 (3), pp. 393-401 Shenkin, H.A., Scheuerman, W.G., Effect of change of position upon the cerebral circulation of man (1949) J Appl Physiol, 2, pp. 317-326 Carey, B.J., Panerai, R.B., Potter, J.F., Effect of aging on dynamic cerebral autoregulation during head-up tilt (2003) Stroke, 34 (8), pp. 1871-1875. , DOI 10.1161/01.STR.0000081981.99908.F3 Alperin, N., Lee, S.H., Sivaramakrishnan, A., Hushek, S.G., Quantifying the effect of posture on intracranial physiology in humans by MRI flow studies (2005) Journal of Magnetic Resonance Imaging, 22 (5), pp. 591-596. , DOI 10.1002/jmri.20427 Young, J.S., Blow, O., Turrentine, F., Claridge, J.A., Schulman, A., Is there an upper limit of intracranial pressure in patients with severe head injury if cerebral perfusion pressure is maintained? (2003) Neurosurg Focus, 15, pp. E2 Mesquita, R.C., Schenkel, S.S., Minkoff, D.L., Influence of probe pressure on the diffuse correlation spectroscopy blood flow signal: Extra-cerebral contributions (2013) Biomed Opt Express, , submitted