Effect of posture and extracranial contamination on results of cerebral oximetry by near-infrared spectroscopy

Kato, Shinya; Yoshitani, Kenji; Kubota, Yosuke; Inatomi, Yuzuru; Ohnishi, Yoshihiko

doi:10.1007/s00540-016-2275-1

Cited by 32 publications

(26 citation statements)

References 26 publications

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“…They also suggest that skin oxygen levels did not markedly contaminate the signal, as is an issue with conventional cerebral oximeters. 17,18 Other findings from this study, including the distinctive brain PPG waveform shape and timing relative to the skin PPG waveform, the large changes in brain oxygen saturations during systole and diastole and the 7-Hz oscillation in the brain PPG waveform during periods of hypoxia. These findings were consistent with the signal arising from the brain and were analogous with the findings from our earlier study in a sheep model of acute brain injury.…”

Section: Discussionmentioning

confidence: 61%

“…They also suggest that skin oxygen levels did not markedly contaminate the signal, as is an issue with conventional cerebral oximeters. 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

“…15,16 This approach provides a method to discriminate potential contamination of the brain signal by oxygen levels in the skin, which is a limitation of existing cerebral oximeters. 17,18 The aims of the study were to assess the temporal changes in brain and skin oxygen saturations during acute hypoxia and to measure the correlation between the brain oximeter and proximal internal jugular vein oxygen saturations.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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<p>Assessment of a Non Invasive Brain Oximeter in Volunteers Undergoing Acute Hypoxia</p>

Dixon¹,

MacLeod²

2020

MDER

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Introduction: Research in traumatic brain injury suggests better patient outcomes when invasive oxygen monitoring is used to detect and correct episodes of brain hypoxia. Invasive brain oxygen monitoring is, however, not routinely used due to the risks, costs and technical challengers. We are developing a non-invasive brain oximeter to address these limitations. The monitor uses the principles of pulse oximetry to record a brain photoplethysmographic waveform and oxygen saturations. We undertook a study in volunteers to assess the new monitor. Patients and Methods: We compared the temporal changes in the brain and skin oxygen saturations in six volunteers undergoing progressive hypoxia to reach arterial saturations of 70%. This approach provides a method to discriminate potential contamination of the brain signal by skin oxygen levels, as the responses in brain and skin oxygen saturations are distinct due to the auto-regulation of cerebral blood flow to compensate for hypoxia. Conventional pulse oximetry was used to assess skin oxygen levels. Blood was also collected from the internal jugular vein and correlated with the brain oximeter oxygen levels. Results: At baseline, a photoplethysmographic waveform consistent with that expected from the brain was obtained in five subjects. The signal was adequate to assess oxygen saturations in three subjects. During hypoxia, the brain's oximeter oxygen saturation fell to 74%, while skin saturation fell to 50% (P<0.0001). The brain photoplethysmographic waveform developed a high-frequency oscillation of~7 Hz, which was not present in the skin during hypoxia. A weak correlation between the brain oximeter and proximal internal jugular vein oxygen levels was demonstrated, R 2 =0.24, P=0.01. Conclusion: Brain oximeter oxygen saturations were relatively well preserved compared to the skin during hypoxia. These findings are consistent with the expected physiological responses and suggest skin oxygen levels did not markedly contaminate the brain oximeter signal.

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Section: Discussionmentioning

confidence: 61%

“…They also suggest that skin oxygen levels did not markedly contaminate the signal, as is an issue with conventional cerebral oximeters. 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

<p>Assessment of a Non Invasive Brain Oximeter in Volunteers Undergoing Acute Hypoxia</p>

Dixon¹,

MacLeod²

2020

MDER

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“…Device manufacturers claim that specific algorithms remove the effect of superficial tissue, referred to as extracerebral contamination. However, Kato et al and Davie and Grocott reported significant extracranial contamination in adults by several commercially available NIRS devices. Kurth et al found that extracranial contamination is unlikely in neonates, infants, and young children.…”

Section: A Practical Introduction To Near‐infrared Spectroscopy (Nirs)mentioning

confidence: 99%

A practical approach to cerebral near‐infrared spectroscopy (NIRS) directed hemodynamic management in noncardiac pediatric anesthesia

Weber

Scoones

2019

Pediatric Anesthesia

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Safeguarding cerebral function is of major importance during pediatric anesthesia. Premature, ex‐premature, and full‐term neonates can be vulnerable to physiological changes that occur during anesthesia and surgery. Data from studies performed during pediatric cardiac surgery and in neonatal/pediatric intensive care units have shown the benefits of near‐infrared spectroscopy (NIRS) monitoring of regional cerebral oxygenation (c‐rSO2). However, NIRS monitoring is seldom used during noncardiac pediatric anesthesia. Despite compelling evidence that blood pressure does not reflect end‐organ perfusion, it is still regarded as the most important determinant of cerebral perfusion and the most relevant hemodynamic management target parameter by most (pediatric) anesthetists. The principle of NIRS monitoring is not self‐explanatory and sometimes seems even counterintuitive, which may explain why many anesthesiologists are reserved regarding its use. The first part of this paper is dedicated to a clinical introduction to NIRS monitoring. Despite scientific efforts, it has not yet been possible to define individual lower limit c‐rSO2 values and it is unlikely this will succeed in the near future. Nonetheless, published treatment algorithms usually specify c‐rSO2 values which may be associated with cerebral hypoxia. Our treatment guideline for maintaining sufficient cerebral oxygenation differs fundamentally from all previously published approaches. We define a baseline c‐rSO2 value, registered in the awake child prior to anesthesia induction, as the lowest acceptable limit during anesthesia and surgery. The cerebral rSO2 is the single target parameter, while blood pressure, heart rate, PaCO2, and SaO2 are major parameters that determine the c‐rSO2. Cerebral NIRS monitoring, interpreted together with its continuously available contributing parameters, may help avoid potentially harmful episodes of cerebral desaturation in anesthetized pediatric patients.

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Supine Cycling Exercise Enhances Cerebral Oxygenation of Motor-Related Areas in Healthy Male Volunteers

Sato

Morishita

Hotta

et al. 2021

Advances in Experimental Medicine and Biology

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Effect of posture and extracranial contamination on results of cerebral oximetry by near-infrared spectroscopy

Abstract: Except when using NIRO-TRS, measurements of rSO in the forehead are significantly lower when measured in the upright position than in the supine position. All devices in this study were affected by extracranial contamination.

Cited by 32 publications

References 26 publications

<p>Assessment of a Non Invasive Brain Oximeter in Volunteers Undergoing Acute Hypoxia</p>

<p>Assessment of a Non Invasive Brain Oximeter in Volunteers Undergoing Acute Hypoxia</p>

A practical approach to cerebral near‐infrared spectroscopy (NIRS) directed hemodynamic management in noncardiac pediatric anesthesia

Supine Cycling Exercise Enhances Cerebral Oxygenation of Motor-Related Areas in Healthy Male Volunteers

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