Incongruous effect of phenylephrine on changes in cerebral blood volume measured by near-infrared spectroscopy (NIRS) indicating extracranial contamination

Moerman, Anneliese; Vandenheuvel, Michaël; Tuybens, Pieter-Jan; Gompel, Carla Van; Hert, S. G. De

doi:10.1007/s10877-021-00702-3

Cited by 8 publications

(7 citation statements)

References 24 publications

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“…In 66 sub-studies in 16 articles, no reference techniques were used, or NIRS measurements were compared with those from reference techniques only on a group level and not on an individual level [40,[45][46][47][48][49][50][51][52][52][53][54][55][56][57][58][59]. The results are described in detail in File S3.…”

Section: Studies Without Within-subject Comparisons With Reference Te...mentioning

confidence: 99%

The Influence of Extracerebral Tissue on Continuous Wave Near-Infrared Spectroscopy in Adults: A Systematic Review of In Vivo Studies

Eleveld

Esquivel-Franco

Drost

et al. 2023

JCM

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Near-infrared spectroscopy (NIRS) is a non-invasive technique for measuring regional tissue haemoglobin (Hb) concentrations and oxygen saturation (rSO2). It may be used to monitor cerebral perfusion and oxygenation in patients at risk of cerebral ischemia or hypoxia, for example, during cardiothoracic or carotid surgery. However, extracerebral tissue (mainly scalp and skull tissue) influences NIRS measurements, and the extent of this influence is not clear. Thus, before more widespread use of NIRS as an intraoperative monitoring modality is warranted, this issue needs to be better understood. We therefore conducted a systematic review of published in vivo studies of the influence of extracerebral tissue on NIRS measurements in the adult population. Studies that used reference techniques for the perfusion of the intra- and extracerebral tissues or that selectively altered the intra- or extracerebral perfusion were included. Thirty-four articles met the inclusion criteria and were of sufficient quality. In 14 articles, Hb concentrations were compared directly with measurements from reference techniques, using correlation coefficients. When the intracerebral perfusion was altered, the correlations between Hb concentrations and intracerebral reference technique measurements ranged between |r| = 0.45–0.88. When the extracerebral perfusion was altered, correlations between Hb concentrations and extracerebral reference technique measurements ranged between |r| = 0.22–0.93. In studies without selective perfusion modification, correlations of Hb with intra- and extracerebral reference technique measurements were generally lower (|r| < 0.52). Five articles studied rSO2. There were varying correlations of rSO2 with both intra- and extracerebral reference technique measurements (intracerebral: |r| = 0.18–0.77, extracerebral: |r| = 0.13–0.81). Regarding study quality, details on the domains, participant selection and flow and timing were often unclear. We conclude that extracerebral tissue indeed influences NIRS measurements, although the evidence (i.e., correlation) for this influence varies considerably across the assessed studies. These results are strongly affected by the study protocols and analysis techniques used. Studies employing multiple protocols and reference techniques for both intra- and extracerebral tissues are therefore needed. To quantitatively compare NIRS with intra- and extracerebral reference techniques, we recommend applying a complete regression analysis. The current uncertainty regarding the influence of extracerebral tissue remains a hurdle in the clinical implementation of NIRS for intraoperative monitoring. The protocol was pre-registered in PROSPERO (CRD42020199053).

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Section: Studies Without Within-subject Comparisons With Reference Te...mentioning

confidence: 99%

The Influence of Extracerebral Tissue on Continuous Wave Near-Infrared Spectroscopy in Adults: A Systematic Review of In Vivo Studies

Eleveld

Esquivel-Franco

Drost

et al. 2023

JCM

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“…A major limitation of classical NIRS measurement, based on the modified Beer–Lambert methodology is that the contribution from superficial cutaneous layers cannot be discriminated the contribution from deeper layers, e.g., brain or muscle. Spatially-resolved spectroscopy was proven to be particularly effective in focusing the measurement in deep layers as documented in several studies for both cerebral (Canova et al 2011 ; Moerman et al 2022 ) and muscle monitoring (Messere and Roatta 2013 ; Grassi and Quaresima 2016 ). In particular, we showed that contrary to standard NIRS, spatially-resolved spectroscopy was neither affected by local increases in cutaneous microcirculation (Messere and Roatta 2013 ) nor by increased blood flow in superficial veins (Messere and Roatta 2015 ), provoked by warming of local or remote distal areas, respectively.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic changes in the temporalis and masseter muscles during acute stress in healthy humans

Rashid,

Roatta

2023

Eur J Appl Physiol

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Purpose Autonomic control of orofacial areas is an integral part of the stress response, controlling functions such as pupil dilatation, salivation, and skin blood flow. However, the specific control of blood flow in head muscles during stress is unknown. This study aims to investigate the hemodynamic response of temporalis and masseter muscles in response to five different stressors. Methods Sixteen healthy individuals were subjected to a randomized series of stressors, including cold pressor test, mental arithmetic test, apnea, isometric handgrip, and post-handgrip muscle ischemia, while in the sitting posture. Finger-pulse photoplethysmography was used to measure arterial blood pressure, heart rate, and cardiac output. Near-infrared spectroscopy was used to measure changes in tissue oxygenation and hemoglobin indices from the temporalis and masseter muscles. Results All stressors effectively and significantly increased arterial blood pressure. Tissue oxygenation index significantly increased in both investigated head muscles during mental arithmetic test (temporalis: 4.22 ± 3.52%; masseter: 3.43 ± 3.63%) and isometric handgrip (temporalis: 3.45 ± 3.09%; masseter: 3.26 ± 3.07%), suggesting increased muscle blood flow. Neither the masseter nor the temporalis muscles evidenced a vasoconstrictive response to any of the stressors tested. Conclusion In the different conditions, temporalis and masseter muscles exhibited similar hemodynamic patterns of response, which do not include the marked vasoconstriction generally observed in limb muscles. The peculiar sympathetic control of head muscles is possibly related to the involvement of these muscles in aggressive/defensive reactions and/or to their unfavorable position with regard to hydrostatic blood levels.

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“…The influence of chromophores in the tissues surrounding the CNS, reflections, and scattering of the light wave spectrum has a very significant effect on the final result of cerebral saturation measurement. A very important argument for this statement is based on observations that have been repeatedly published from studies conducted on small groups of patients [4][5][6][7][8][9]. This is exemplified by the publication by Tatli and colleagues, who confirmed the lack of sensitivity of NIRS diagnosis for confirming brain death in patients [5].…”

Section: Discussionmentioning

confidence: 99%

“…This process is referred to as spatial resolution. [7] There are a number of publications in the literature that show a significant effect on the result of NIRS measurement through intermediate structures. These publications use the phenomenon of orthostatic changes in blood flow in craniofacial structures, the effect of the Valsalva maneuver [8].…”

Section: Preprintsmentioning

confidence: 99%

Near Infrared Spectroscopy (NIRS) in the Assessment of Cerebral Tissue Oxygenation (rSO2) - Methodological Issues and Dilemmas

Lukaszewski,

Nelke

2024

Preprint

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Introduction The monitoring of cerebral perfusion in patients with brain damage is a major clinical challenge. Monitoring cerebral oxygenation (rSO2) by NIRS was introduced at the turn of the 1980s, and many clinicians believed it was a valuable method for assessing cerebral perfusion and subsequent measures to optimize cerebral flow. The main problem of NIRS usage is the presence of the intermediate structures-skin, skull, meninges, cerebrospinal fluid-and their influence on the outcome of the test. Therefore, it seems that NIRS assessment performed on a patient during brain death attempts, can give an idea of the magnitude of the influence of these intermediate structures on the monitoring result. Case We present a retrospective analysis of cerebral oxygenation measurements of a patient undergoing a brain death diagnostic procedure. A clinical situation where the cerebral blood flow is stopped can give an idea of the specificity of the method, particularly the impact of the influence of intermediate structures on the monitoring outcome. In this case, the NIRS result is increased by the oxygenation of the patient before the apnoea test. The influence of chromophores in the tissues surrounding the CNS, reflections and scattering of the light wave spectrum have a very significant effect on the final result of cerebral saturation measurement. Discussion The majority of research observations describing changes in cerebral perfusion or its optimisation may be burdened by the problem described, i.e. the significant influence of measured oxygenation from intermediate structures. The specificity of NIRS to assess cerebral perfusion requires careful analysis. The therapeutic implications of monitoring cerebral oxygenation with NIRS are of great importance and, from the example presented and the literature provided, the method should be used with caution. It has been shown that in a patient with brain death, the result of NIRS oxygenation measurements depends on the surrounding structures of the brain.

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Incongruous effect of phenylephrine on changes in cerebral blood volume measured by near-infrared spectroscopy (NIRS) indicating extracranial contamination

Cited by 8 publications

References 24 publications

The Influence of Extracerebral Tissue on Continuous Wave Near-Infrared Spectroscopy in Adults: A Systematic Review of In Vivo Studies

The Influence of Extracerebral Tissue on Continuous Wave Near-Infrared Spectroscopy in Adults: A Systematic Review of In Vivo Studies

Hemodynamic changes in the temporalis and masseter muscles during acute stress in healthy humans

Near Infrared Spectroscopy (NIRS) in the Assessment of Cerebral Tissue Oxygenation (rSO2) - Methodological Issues and Dilemmas

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