Continuous monitoring of regional cerebral blood flow: experimental and clinical validation of a novel thermal diffusion microprobe

Vajkoczy, Peter; Roth, Harry; Horn, Peter A.; Lücke, Thomas; Thomé, Claudius; Hübner, Ulrich; Martín, Germán Valencia; Zappletal, Christina; Klar, E.; Schilling, Lothar; Schmiedek, Peter

doi:10.3171/jns.2000.93.2.0265

Cited by 205 publications

(102 citation statements)

References 41 publications

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“…Thermal diffusion flowmetry is so far the only technique, which allows for CBF monitoring in a feasible and user-friendly way directly at the bedside and there is evidence that symptomatic vasospasm after aSAH can be detected by the method 7,8 . However, its clinical application is limited because measurement drifts have been reported over the 30-minute measurement cycle and between automatically performed recalibrations 23 .…”

Section: Discussionmentioning

confidence: 99%

“…In 2000, thermal diffusion flowmetry for continuous bedside assessment of CBF was introduced and potential clinical benefits were demonstrated in patients with symptomatic vasospasm after aSAH 7,8 . However, the clinical application remains limited because of reduced reliability of CBF measurements in patients with fever and hemodynamic instability 9 .…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage

et al. 2016

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Objective: To evaluate a brain tissue probe for intracranial pressure (ICP) and temperature (TEMP) monitoring as well as determination of cerebral hemodynamics using a near infrared spectroscopy (NIRS) and indocyanine green (ICG) dye dilution method (NIRS-ICP probe). Methods: The NIRS-ICP probe was applied after aneurysmal subarachnoid hemorrhage if multimodal monitoring was established due to poor neurological condition. ICP and TEMP values were obtained from ventricular catheters and systemic temperature sensors. Repeated NIRS-ICG measurements (2 injections within 30 minutes) were performed daily for determination of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time of ICG (mttICG). Delayed cerebral ischemia was defined as brain tissue oxygen tension <20 mmHg and/or lactate-pyruvate-ratio >35. Results: A total of 128 NIRS-ICG measurements were performed in 10 patients. The correlation coefficient between ICP and TEMP values obtained with the NIRS-ICP probe and values from routine monitoring was r=0.72 and r=0.96, respectively. The mean value was 30.3 ± 13.6 ml/100g/min for CBF, 3.3 ± 1.2 ml/100g for CBV, and 6.8 ± 1.6 sec for mttICG. The coefficient of variation from repeated NIRS-ICG measurements was 10.9% for CBF, 11.7% for CBV, and 3.8% for mttICG. The sensitivity for delayed cerebral ischemia detection was 85% and the specificity 83% using a CBFthreshold of 25 ml/100g/min. Conclusion: Multimodal monitoring using the NIRS-ICP probe is feasible with high reproducibility of measurement values and the ability to detect delayed cerebral ischemia. No safety concerns exist for the routine clinical use of the NIRS-ICP probe. monitoring as well as determination of cerebral hemodynamics using a near infrared spectroscopy (NIRS) and indocyanine green (ICG) dye dilution method (NIRS-ICP probe). Methods:The NIRS-ICP probe was applied after aneurysmal subarachnoid hemorrhage if multimodal monitoring was established due to poor neurological condition. ICP and TEMP values were obtained from ventricular catheters and systemic temperature sensors. Repeated NIRS-ICG measurements (2 injections within 30 minutes) were performed daily for determination of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time of ICG (mttICG). Delayed cerebral ischemia was defined as brain tissue oxygen tension <20 mmHg and/or lactate-pyruvate-ratio >35.Results: A total of 128 NIRS-ICG measurements were performed in 10 patients. The correlation coefficient between ICP and TEMP values obtained with the NIRS-ICP probe and values from routine monitoring was r=0.72 and r=0.96, respectively. The mean value was 30.3 ± 13.6 ml/100g/min for CBF, 3.3 ± 1.2 ml/100g for CBV, and 6.8 ± 1.6 sec for mttICG. The coefficient of variation from repeated NIRS-ICG measurements was 10.9% for CBF, 11.7% for CBV, and 3.8% for mttICG. The sensitivity for delayed cerebral ischemia detection was 85% and the specificity 83% using a CBFthreshold of 25 ml/100g/min. Conclusion:Multimodal monitoring using the NIRS-ICP...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage

et al. 2016

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“…Laser Doppler flowmetry uses the same principle as TCD but has the probe placed intracranially through a burr hole and measures the concentration of red blood cells and their velocity generating a flow signal to provide a qualitative estimate of regional cerebral blood flow but has a limited sample volume [46]. The thermal diffusion method utilizes an intraparenchymal probe with a thermistor and a temperature sensor and measures the thermal gradient between the distal thermistor that his heated by 2°C and the proximal temperature sensor and provides a quantified regional cerebral blood flow measurement in ml/100 g/min [47]. CBF monitoring has been studies in traumatic brain injury, and thresholds of injury and ischemia have been found to correlate with regional brain tissue oxygenation.…”

Section: Cerebral Blood Flowmentioning

confidence: 99%

The Role of Invasive Monitoring in Traumatic Brain Injury

Carandang

2015

Curr Trauma Rep

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Severe traumatic brain injury is a complex disease that involves physical injury and distortion of tissues and cell membranes, gross hemodynamic changes including loss of autoregulation, cerebral edema and tissue shifts, changes in pressure and perfusion and multiple secondary cellular processes including electrolyte fluxes, inflammatory mediator release, neurotransmitter mediated excitotoxicity, apoptosis, mitochondrial dysfunction, and alterations in cellular metabolism. The optimal treatment of these patients who have severe neurological dysfunction or require sedation that compromises neurological functional assessment by physical examination requires the monitoring and management of multiple aspects of brain physiology including pressure, perfusion, oxygenation, cellular metabolism, and electrical activity. Invasive monitoring techniques, while still in various stages of development, can and will provide real-time trackable data that informs the management of these patients as well as contributes to our understanding of the pathophysiological processes that contribute to it.

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“…A probe that is placed in the brain parenchyma and allows stable CBF readings based on the principles of thermodilution in perfused tissues has now been cleared by the Food and Drug Administration (FDA) recently (Q flow 500 probe, Bowman Perfusion Monitor, Hemedex, Cambridge, MA). A good correlation has been shown with stable Xenon-CT. 91 It is expected that this method will face critical clinical testing during the next few years.…”

Section: Traumatic Head Injurymentioning

confidence: 99%

Current Concepts in Diagnosis and Treatment of Traumatic Brain Injury: Implications for Healthcare in Nepal

Sakowitz

Sharma

Kiening³

2005

Nep J Neurosci

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Taumatic brain injury (TBI) is a leading cause of disability and death in the industrialized and in the developing world. With an incidence of 200-400 cases per 100.000, head injuries are a major contributor to socio-economic costs. The 20% suffering from severe head injury (SHI) requiring prolonged intensive care and/or neurosurgical intervention are of particular interest to specialist practitioners from multiple disciplines.This review covers the current concepts of diagnosis and treatment in these patients in the Western world, i.e. mainly the US and Western Europe. Special emphasis is laid upon evidence-based guidelines established during the last decade. Comparison is drawn to the current status of trauma care in Nepal.Management strategies for TBI can not be applied to Nepalese healthcare entirely. Effective management of head injured persons in Nepal is affected by its difficult geographical location, unavailability of trained personnel in the field, and difficulty in transporting the patients due to the lack of motorable roads. While some of the equipment for the treatment of TBI victims is readily available (e.g. ventricular drainage), others are scarce (e.g. operating room capacity, intensive care facilities) or completely unavailable (e.g. emergency medical service providers, specialized monitoring equipment). Realistic proposals for improvement of the current situation are made. Nepal Journal of Neuroscience, Volume 2, Number 1, 2005, page: 29-51

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Continuous monitoring of regional cerebral blood flow: experimental and clinical validation of a novel thermal diffusion microprobe

Cited by 205 publications

References 41 publications

Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage

Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage

The Role of Invasive Monitoring in Traumatic Brain Injury

Current Concepts in Diagnosis and Treatment of Traumatic Brain Injury: Implications for Healthcare in Nepal

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