New approaches to bedside monitoring in stroke

Abstract

Stroke is a common, potentially devastating disease with potential high morbidity and mortality. Recognition at the onset of acute ischemic stroke is pivotal to changing outcomes such as intravenous thrombolysis. Stroke monitoring is a burgeoning field with various methods described and newer devices that aid in detecting acute or worsening ischemia that can lead to improved bedside and intensive care unit management. This article describes various methods of bedside stroke monitoring including newer techniques of intracranial pressure monitoring using the pressure reactivity index and compensatory reserve index to detect changes in autoregulatory states, noninvasive intracranial pressure monitoring, quantitative EEG with alpha-delta ratio, transcranial Doppler, methods of arteriovenous brain oxygen monitoring such as jugular venous oxygen and near-infrared spectroscopy, invasive brain oxygen probes such as Licox™ (brain tissue O₂), cerebral blood flow probe (CBF Hemedex™) and cerebral microdialysis.

Calibration-free quantification of absolute oxygen saturation based on the dynamics of photoacoustic signals

“…For instance, real-time monitoring of cerebral sO 2 is valuable in the diagnosis of cerebral desaturations and vasospasm in stroke patients [1], and tumor hypoxia is strongly associated with tumor propagation and malignant progression [2]. Many techniques have been developed to quantify sO 2 in vivo ; however, they all have limitations.…”

Role of Anesthesia for Endovascular Treatment of Ischemic Stroke

“…36 Measurement of SjvO 2 requires the insertion of a jugular venous catheter in patients, potentially with intravenous tPA, which not only delays the neuroendovascular procedure itself but can also be associated with complications such as internal carotid artery injury, immediate venous puncture bleeding or later thrombosis, and infection. NIRS uses near-infrared light between 600 and 1000 nm in length to penetrate the human scalp, skull, and brain tissue to 2.5 cm below the skin level.…”

“…36 The main advantage of TCD is that it can provide real-time measurement of large intracranial artery blood flow, blood vessel patency, microemboli, and recanalization status. Furthermore, TCD can also potentially augment the thrombolytic effects of intravenous tPA, known as sonothrombolysis to disrupt an intracranial arterial thrombus.…”

Early Clinical Results Using Normothermic Machine Liver Preservation

“…Metabolomic profiling of hepatic biomarkers by mass spectrometry obtained from tissue and perfusate samples presents a promising technique [54][55][56]. In addition, quantification of hepatic microcirculation [9] and evaluation of tissue oxygenation [57] offer valuable real-time information about the graft condition.…”