Continuous Monitoring of Cerebral Autoregulation in Children Supported by Extracorporeal Membrane Oxygenation: A Pilot Study

Joram, Nicolas; Beqiri, Erta; Pezzato, Stefano; Moscatelli, Andrea; Robba, Chiara; Liet, Jean-Michel; Chenouard, Alexis; Bourgoin, Pierre; Czosnyka, Marek; Léger, Pierre-Louis; Smielewski, Peter

doi:10.1007/s12028-020-01111-1

Cited by 33 publications

(33 citation statements)

References 33 publications

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“…Although NIRS has been previously used as surrogate of cerebral blood flow in the dynamic measurement of autoregulation ( 15 , 16 ), its use is importantly limited by the fact that it takes into account both arterial and venous cerebral compartments, which do not take part in the same way for CBF regulation. Moreover, it has been mainly used in the paediatric population ( 15 , 16 ), and data on patients with COVID-19 are lacking.…”

Section: Discussionmentioning

confidence: 99%

The Use of Different Components of Brain Oxygenation for the Assessment of Cerebral Haemodynamics: A Prospective Observational Study on COVID-19 Patients

et al. 2021

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Introduction: The role of near-infrared spectroscopy (NIRS) for the evaluation of cerebral haemodynamics is gaining increasing popularity because of its noninvasive nature. The aim of this study was to evaluate the role of the integral components of regional cerebral oxygenation (rSO2) measured by NIRS [i.e., arterial-oxyhemoglobin (O2Hbi) and venous-deoxyhemoglobin (HHbi)-components], as indirect surrogates of cerebral blood flow (CBF) in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19). We compared these findings to the gold standard technique for noninvasive CBF assessment, Transcranial Doppler (TCD).Methods: Mechanically ventilated patients with COVID-19 admitted to the Intensive Care Unit (ICU) of Policlinico San Martino Hospital, Genova, Italy, who underwent multimodal neuromonitoring (including NIRS and TCD), were included. rSO2 and its components [relative changes in O2Hbi, HHbi, and total haemoglobin (cHbi)] were compared with TCD (cerebral blood flow velocity, CBFV). Changes (Δ) in CBFV and rSO2, ΔO2Hbi, ΔHHbi, and ΔcHbi after systemic arterial blood pressure (MAP) modifications induced by different manoeuvres (e.g., rescue therapies and haemodynamic manipulation) were assessed using mixed-effect linear regression analysis and repeated measures correlation coefficients. All values were normalised as percentage changes from the baseline (Δ%).Results: One hundred and four measurements from 25 patients were included. Significant effects of Δ%MAP on Δ%CBF were observed after rescue manoeuvres for CBFV, ΔcHbi, and ΔO2Hbi. The highest correlation was found between ΔCBFV and ΔΔO2Hbi (R = 0.88, p < 0.0001), and the poorest between ΔCBFV and ΔΔHHbi (R = 0.34, p = 0.002).Conclusions: ΔO2Hbi had the highest accuracy to assess CBF changes, reflecting its role as the main component for vasomotor response after changes in MAP. The use of indexes derived from the different components of rSO2 can be useful for the bedside evaluation of cerebral haemodynamics in mechanically ventilated patients with COVID-19.

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Section: Discussionmentioning

confidence: 99%

The Use of Different Components of Brain Oxygenation for the Assessment of Cerebral Haemodynamics: A Prospective Observational Study on COVID-19 Patients

et al. 2021

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“… 435 Optical oxygen delivery and autoregulation metrics may also individualize extracorporeal perfusion management. 432 , 433 , 438 – 441 In a related vein, modifications in diffuse optical hardware have accelerated the use of NIRS and DCS to monitor local spinal cord hemodynamics intraoperatively. This approach has been tested in ovine 442 – 444 and porcine 445 , 446 models so far, showing the feasibility and safety of using optical spectroscopy to monitor different sites of the spinal cord and identify early ischemia that can result in paralysis and paraparesis.…”

Section: Clinical Applications Of Optical Spectroscopy and Imagingmentioning

confidence: 99%

Optical imaging and spectroscopy for the study of the human brain: status report

et al. 2022

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. This report is the second part of a comprehensive two-part series aimed at reviewing an extensive and diverse toolkit of novel methods to explore brain health and function. While the first report focused on neurophotonic tools mostly applicable to animal studies, here, we highlight optical spectroscopy and imaging methods relevant to noninvasive human brain studies. We outline current state-of-the-art technologies and software advances, explore the most recent impact of these technologies on neuroscience and clinical applications, identify the areas where innovation is needed, and provide an outlook for the future directions.

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“…The right cerebral blood flow decreased during ECMO and was more susceptible to the interference of autoregulatory function, which seemed to explain the susceptibility to ANI in the right cerebral hemisphere. Additional studies showed that decreased cerebral oxygenation was associated with adverse short-term neurological outcomes and death (50)(51)(52)(53). In addition, a high rScO2 (>80%) was a protective factor that might predict a lower in-hospital mortality (54).…”

Section: Assessment Of Cerebral Oxygenationmentioning

confidence: 99%

ECMO in neonates: The association between cerebral hemodynamics with neurological function

Mao

et al. 2022

Front. Pediatr.

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Extracorporeal membrane oxygenation (ECMO) is a superior life support technology, commonly employed in critical patients with severe respiratory or hemodynamic failure to provide effective respiratory and circulatory support, which is especially recommended for the treatment of critical neonates. However, the vascular management of neonates with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is still under controversy. Reconstruction or ligation for the right common carotid artery (RCCA) after ECMO is inconclusive. This review summarized the existed studies on hemodynamics and neurological function after vascular ligation or reconstruction hoping to provide better strategies for vessel management in newborns after ECMO. After reconstruction, the right cerebral blood flow can increase immediately, and the normal blood supply can be restored rapidly. But the reconstructed vessel may be occluded and stenotic in long-term follow-ups. Ligation may cause lateralization damage, but there could be no significant effect owing to the establishment of collateral circulation. The completion of the circle of Willis, the congenital anomalies of cerebral or cervical vasculature, the duration of ECMO, and the vascular condition at the site of arterial catheterization should be assessed carefully before making the decision. It is also necessary to follow up on the reconstructed vessel sustainability, and the association between cerebral hemodynamics and neurological function requires further large-scale multi-center studies.

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Continuous Monitoring of Cerebral Autoregulation in Children Supported by Extracorporeal Membrane Oxygenation: A Pilot Study

Cited by 33 publications

References 33 publications

The Use of Different Components of Brain Oxygenation for the Assessment of Cerebral Haemodynamics: A Prospective Observational Study on COVID-19 Patients

The Use of Different Components of Brain Oxygenation for the Assessment of Cerebral Haemodynamics: A Prospective Observational Study on COVID-19 Patients

Optical imaging and spectroscopy for the study of the human brain: status report

ECMO in neonates: The association between cerebral hemodynamics with neurological function

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