NIRS improves hemodynamic monitoring and detection of risk for cerebral injury: cases in the neonatal intensive care nursery

Chock, Valerie Y.; Variane, Gabriel Fernando Todeschi; Netto, Alexandre; Meurs, Krisa P. Van

doi:10.1080/14767058.2018.1528223

Cited by 20 publications

(28 citation statements)

References 43 publications

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“…To quantify chromophore concentrations, while accounting for the contribution of light scatter, a derivative approach was utilized [ 18 , 30 , 31 ]. First and second derivatives of R ( λ ) were calculated and fit to the solution of the diffusion approximation for a semi-infinite homogeneous medium [ 19 ]. Light absorption (Equation (2)) and scattering (Equation (3)) parameters were input into the solution as follows [ 30 ]:

where WF is the tissue water fraction, Hb b and HbO 2 b are baseline concentrations of deoxyhemoglobin and oxyhemoglobin in µM, and ε refers to the unique extinction coefficient for each chromophore.…”

Section: Methodsmentioning

confidence: 99%

“…To quantify chromophore concentrations, while accounting for the contribution of light scatter, a derivative approach was utilized [18,30,31]. First and second derivatives of R(λ) were calculated and fit to the solution of the diffusion approximation for a semi-infinite homogeneous medium [19]. Light absorption (Equation 2) and scattering (Equation 3) parameters were input into the solution as follows [30]:…”

Section: Instrumentationmentioning

confidence: 99%

“…Measurements of CBF by transcranial doppler (TCD) have proven robust in premature infants; however, continuous monitoring is not ideal as TCD is operator-dependent and only measures macrovascular changes in blood flow [16,17]. Biomedical optics instead provide a safe, non-invasive technique ideal for longitudinal brain monitoring at the bedside [3,[18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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Perfusion and Metabolic Neuromonitoring during Ventricular Taps in Infants with Post-Hemorrhagic Ventricular Dilatation

et al. 2020

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Post-hemorrhagic ventricular dilatation (PHVD) is characterized by a build-up of cerebral spinal fluid (CSF) in the ventricles, which increases intracranial pressure and compresses brain tissue. Clinical interventions (i.e., ventricular taps, VT) work to mitigate these complications through CSF drainage; however, the timing of these procedures remains imprecise. This study presents Neonatal NeuroMonitor (NNeMo), a portable optical device that combines broadband near-infrared spectroscopy (B-NIRS) and diffuse correlation spectroscopy (DCS) to provide simultaneous assessments of cerebral blood flow (CBF), tissue saturation (StO2), and the oxidation state of cytochrome c oxidase (oxCCO). In this study, NNeMo was used to monitor cerebral hemodynamics and metabolism in PHVD patients selected for a VT. Across multiple VTs in four patients, no significant changes were found in any of the three parameters: CBF increased by 14.6 ± 37.6% (p = 0.09), StO2 by 1.9 ± 4.9% (p = 0.2), and oxCCO by 0.4 ± 0.6 µM (p = 0.09). However, removing outliers resulted in significant, but small, increases in CBF (6.0 ± 7.7%) and oxCCO (0.1 ± 0.1 µM). The results of this study demonstrate NNeMo’s ability to provide safe, non-invasive measurements of cerebral perfusion and metabolism for neuromonitoring applications in the neonatal intensive care unit.

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Section: Methodsmentioning

confidence: 99%

“…To quantify chromophore concentrations, while accounting for the contribution of light scatter, a derivative approach was utilized [18,30,31]. First and second derivatives of R(λ) were calculated and fit to the solution of the diffusion approximation for a semi-infinite homogeneous medium [19]. Light absorption (Equation 2) and scattering (Equation 3) parameters were input into the solution as follows [30]:…”

Section: Instrumentationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perfusion and Metabolic Neuromonitoring during Ventricular Taps in Infants with Post-Hemorrhagic Ventricular Dilatation

et al. 2020

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“…Recent work in neonates undergoing NIRS monitoring during initial resuscitation has shown that infants who do not reach target arterial oxygen saturations have lower regional cerebral tissue oxygenation levels that do not reach established norms. Thus, NIRS is becoming more widely used as an adjunct marker of hemodynamics and can detect an increased risk for cerebral injury in this population 56,57 . It has also been shown to be more sensitive to acute changes in cerebral blood flow patterns in children undergoing Blalock‐Taussig shunt placement than traditional oximetry readings 58 .…”

Section: Intensive Care Monitoring Of Patients With Rvfmentioning

confidence: 99%

Intensive care management of right ventricular failure and pulmonary hypertension crises

Coleman

Chartan

Mourani

2021

Pediatric Pulmonology

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Pulmonary hypertension (PH), an often unrelenting disease that carries with it significant morbidity and mortality, affects not only the pulmonary vasculature but, in turn, the right ventricle as well. The survival of patients with PH is closely related to the right ventricular function. Therefore, having an understanding of how to manage right ventricular failure (RVF) and acute pulmonary hypertensive crises is imperative for clinicians who encounter these patients. This review addresses the management of these patients in detail, addressing: (a) the pathophysiology of RVF, (b) intensive care monitoring of these patients in the intensive care unit, (c) imaging of the right ventricle, (d) intubation and mechanical ventilation, (e) inotrope and vasopressor selection, (f) pulmonary vasodilator use, (g) interventional and surgical procedures for the acutely failing right ventricle, and (h) mechanical support for RVF.

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“…We measured cerebral oxygen saturation using an INVOS 5100C NIRS monitor (Somanetics, Troy, MI). Cerebral oxygen saturation measured with NIRS reflects tissue oxygenation in the capillary, venous, and arterial vasculature, which is weighted to the venous blood (roughly 70-80%) [12][13][14]. We also measured pulse oximetry, which requires pulsatile flow and therefore estimates arterial oxygenation [15].…”

Section: Cerebral Oxygen Saturation Measuresmentioning

confidence: 99%

Cerebral oxygen saturation and cerebrovascular instability in newborn infants with congenital heart disease compared to healthy controls

et al. 2021

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Objective Infants with Congenital Heart Disease (CHD) are at risk for developmental delays, though the mechanisms of brain injury that impair development are unknown. Potential causes could include cerebral hypoxia and cerebrovascular instability. We hypothesized that we would detect significantly reduced cerebral oxygen saturation and greater cerebrovascular instability in CHD infants compared to the healthy controls. Methods We performed a secondary analysis on a sample of 43 term infants (28 CHD, 15 healthy controls) that assessed prospectively in temporal cross-section before or at 12 days of age. CHD infants were assessed prior to open-heart surgery. Cerebral oxygen saturation levels were estimated using Near-Infrared Spectroscopy, and cerebrovascular stability was assessed with the response of cerebral oxygen saturation after a postural change (supine to sitting). Results Cerebral oxygen saturation was 9 points lower in CHD than control infants in both postures (β = -9.3; 95%CI = -17.68, -1.00; p = 0.028), even after controlling for differences in peripheral oxygen saturation. Cerebrovascular stability was significantly impaired in CHD compared to healthy infants (β = -2.4; 95%CI = -4.12, -.61; p = 0.008), and in CHD infants with single ventricle compared with biventricular defects (β = -1.5; 95%CI = -2.95, -0.05; p = 0.04). Conclusion CHD infants had cerebral hypoxia and decreased cerebral oxygen saturation values following a postural change, suggesting cerebrovascular instability. Future longitudinal studies should assess the associations of cerebral hypoxia and cerebrovascular instability with long-term neurodevelopmental outcomes in CHD infants.

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NIRS improves hemodynamic monitoring and detection of risk for cerebral injury: cases in the neonatal intensive care nursery

Cited by 20 publications

References 43 publications

Perfusion and Metabolic Neuromonitoring during Ventricular Taps in Infants with Post-Hemorrhagic Ventricular Dilatation

Perfusion and Metabolic Neuromonitoring during Ventricular Taps in Infants with Post-Hemorrhagic Ventricular Dilatation

Intensive care management of right ventricular failure and pulmonary hypertension crises

Cerebral oxygen saturation and cerebrovascular instability in newborn infants with congenital heart disease compared to healthy controls

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