Perfusion indices revisited

Hasanin, Ahmed; Mukhtar, Ahmed; Nassar, Heba

doi:10.1186/s40560-017-0220-5

Cited by 105 publications

(103 citation statements)

References 71 publications

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“…Also, there could be multiple pathophysiological factors, e.g., arterial or venous occlusion, peripheral arterial disease, circulatory shock, or melanoma that can cause changes in peripheral perfusion. To disambiguate these diverse factors of blood perfusion variations using only one-dimensional temporal information of perfusion obtained using a contact-based sensor such as NIRS or a PulseOx or an LDF sensor is challenging, and therefore these point modalities are generally used only as a trend monitoring tool 9,44 in clinical practice. Instead, PulseCam provides high dimensional spatial and temporal blood perfusion information, and thus potentially opens up the opportunity to combine and collate both spatial as well as temporal dependence to disambiguate diverse factors of blood perfusion variations.…”

Section: Discussionmentioning

confidence: 99%

“…Popular clinical markers of local or peripheral perfusion such as center-to-toe temperature difference, skin mottling and capillary refill time are subjective indicators that lack the required sensitivity and specificity to identify patients with compromised peripheral perfusion 9 . In the last few decades, non-invasive contact-based optical techniques have increasingly been adopted in clinical settings for quantitative and qualitative assessment of blood perfusion in peripheral tissue.…”

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confidence: 99%

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PulseCam: a camera-based, motion-robust and highly sensitive blood perfusion imaging modality

Kumar

Suliburk

Veeraraghavan

et al. 2020

Sci Rep

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Blood carries oxygen and nutrients to the trillions of cells in our body to sustain vital life processes. Lack of blood perfusion can cause irreversible cell damage. therefore, blood perfusion measurement has widespread clinical applications. in this paper, we develop pulsecam -a new camera-based, motionrobust, and highly sensitive blood perfusion imaging modality with 1 mm spatial resolution and 1 frame-per-second temporal resolution. Existing camera-only blood perfusion imaging modality suffers from two core challenges: (i) motion artifact, and (ii) small signal recovery in the presence of large surface reflection and measurement noise. PulseCam addresses these challenges by robustly combining the video recording from the camera with a pulse waveform measured using a conventional pulse oximeter to obtain reliable blood perfusion maps in the presence of motion artifacts and outliers in the video recordings. For video stabilization, we adopt a novel brightness-invariant optical flow algorithm that helps us reduce error in blood perfusion estimate below 10% in different motion scenarios compared to 20-30% error when using current approaches. PulseCam can detect subtle changes in blood perfusion below the skin with at least two times better sensitivity, three times better response time, and is significantly cheaper compared to infrared thermography. PulseCam can also detect venous or partial blood flow occlusion that is difficult to identify using existing modalities such as the perfusion index measured using a pulse oximeter. With the help of a pilot clinical study, we also demonstrate that pulsecam is robust and reliable in an operationally challenging surgery room setting. We anticipate that pulsecam will be used both at the bedside as well as a point-of-care blood perfusion imaging device to visualize and analyze blood perfusion in an easy-to-use and cost-effective manner. open Scientific RepoRtS | (2020) 10:4825 | https://doi.comparing pulsecam with an infrared thermal camera. To compare PulseCam and infrared thermography, we perform incremental vascular occlusion experiment on 9 participants (5 male and 4 female) of varying skin tones (Fitzpatrick Scale I to VI) and record their palm videos using both a color camera as well as Scientific RepoRtS | (2020) 10:4825 | https://doi.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

PulseCam: a camera-based, motion-robust and highly sensitive blood perfusion imaging modality

Kumar

Suliburk

Veeraraghavan

et al. 2020

Sci Rep

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“…pulse pressure [10, 11] and stroke volume [12, 13] variations – both indicators of fluid responsiveness, have been promoted. The currently available options for volume assessment include capillary refill, peripheral temperature, skin color, mean arterial pressure, urine output, creatinine, lactate, lung sounds, chest X ray, edema, weight changes, central venous oxygen saturation, and cardiac output monitoring [9, 14-17]. All of these parameters are surrogate markers of the adequacy of the circulating blood volume (BV) [14, 15].…”

Section: Introductionmentioning

confidence: 99%

“…The currently available options for volume assessment include capillary refill, peripheral temperature, skin color, mean arterial pressure, urine output, creatinine, lactate, lung sounds, chest X ray, edema, weight changes, central venous oxygen saturation, and cardiac output monitoring [9, 14-17]. All of these parameters are surrogate markers of the adequacy of the circulating blood volume (BV) [14, 15]. Ultimately, the decision to administer or remove volume is almost always predicated on an assessment of volume status in the absence of a direct measurement .…”

Section: Introductionmentioning

confidence: 99%

A Novel Fluorescent Clinical Method to Rapidly Quantify Plasma Volume

Molitoris¹,

George²,

Murray³

et al. 2019

Cardiorenal Med

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Objectives: To determine the performance of a rapid fluorescent indicator technique for measuring plasma volume (PV). Methods: This was an open-label, observational evaluation of a two-component intravenous visible fluorescent dye technique to rapidly measure PV in 16 healthy subjects and 16 subjects with chronic kidney disease (8 stage 3 and 8 stage 4 CKD), at 2 clinical research sites. The method consisted of a single intravenous injection of 12 mg of a large 150-kDa carboxy-methyl dextran conjugated to a fluorescent rhodamine-derived dye as the PV marker (PVM), and 35 mg of a small 5-kDa carboxy-methyl dextran conjugated to fluorescein, the renal clearance marker. Dye concentrations were quantified 15 min after the injections for initial PV measurements using the indicator-dilution principle. Additional samples were taken over 8 h to evaluate the stability of the PVM as a determinant of PV. Blood volumes (BV) were calculated based on PV and the subject’s hematocrit. Pharmacokinetic parameters were calculated from the plasma concentration data taken over several days using noncompartmental methods (Phoenix WinNonlin®). Linear correlation and Bland-Altman plots were used to compare visible fluorescent injectate-measured PV compared to Nadler’s formula for estimating PV. Finally, 8 healthy subjects received 350 mL infusion of a 5% albumin solution in normal saline over 30 min and a repeat PV determination was then carried out. Results: PV and BV varied according to weight and body surface area, with PV ranging from 2,115 to 6,234 mL and 28.6 to 41.9 mL/kg when weight adjusted. Both parameters were stable for > 6 h with repeated plasma measurements of the PVM. There was no difference between healthy subjects and CKD subjects. Overall, there was general agreement with Nadler’s estimation formula for the mean PV in subjects. A 24-h repeat dose measurement in 8 healthy subjects showed PV variability of 98 ± 121 mL (mean = 3.8%). Additionally, following an intravenous bolus of 350 mL of a 5% albumin solution in normal saline in 8 healthy subjects, the mean (SD) measured increase in PV was 356 (±50.0) mL post-infusion. There were no serious adverse events reported during the study. Conclusions: This minimally invasive fluorescent dye approach safely allowed for rapid, accurate, and reproducible determination of PV, BV, and dynamic monitoring of changes following fluid administration.

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“…The serum lactate level is considered a surrogate of tissue perfusion because the lactate level increases in states of low peripheral perfusion. [16] Although the SV and CO can be measured intraoperatively with several devices such as esophageal Doppler or pulse contour analysis, the cost of these devices may impede widespread use of SV/CO measurement. [17] The anesthetic monitor Life Scope J (Nihon Kohden, Tokyo, Japan) provides PI and 4 PPV measurements without any other devices.…”

mentioning

confidence: 99%

The effects of hemodynamic management using the trend of the perfusion index and pulse pressure variation on tissue perfusion: a randomized clinical trial

Godai

Matsunaga

Kanmura

2019

Preprint

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Background: Intraoperative hemodynamic management is challenging because precise assessment of the adequacy of the intravascular volume is difficult during surgery. Perfusion index (PI) has been shown to reflect changes in peripheral circulation perfusion. Pulse pressure variation (PPV) reflects the preload responsiveness. The hypothesis of this study was that hemodynamic management using the trend of the PI and PPV would improve tissue perfusion. Methods: This was a prospective, randomized, parallel design, single-blind, single-center clinical trial. Patients undergoing elective open gynecological surgery requiring a direct arterial line were included. The patients were randomly allocated to two groups. The intervention group received hemodynamic management using the trend of the PI and PPV in an effort to improve tissue perfusion when the mean arterial pressure was <60 mmHg. The control group received hemodynamic management at the discretion of the anesthesia care provider. The primary outcome was the peak lactate level during surgery. The secondary outcomes were the duration of hypotension, intraoperative fluid balance, intraoperative urine output, and postoperative complication rate. Statistical analysis was performed using Student’s t-test and Fisher’s exact test. A P value of <0.05 was considered statistically significant. Results: Although the intervention significantly decreased the duration of hypotension and intraoperative fluid balance, the peak lactate level was not different between the intervention group and the control group. Intraoperative urine output and postoperative complication rate were not different between the groups. Conclusion: Hemodynamic management using the trend of the PI and PPV does not improve tissue perfusion in patients undergoing open gynecological surgery. Trial registration: This trial was prospectively registered on a publicly accessible database (UMIN Clinical Trials Registry ID: UMIN 000026957).

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Perfusion indices revisited

Cited by 105 publications

References 71 publications

PulseCam: a camera-based, motion-robust and highly sensitive blood perfusion imaging modality

PulseCam: a camera-based, motion-robust and highly sensitive blood perfusion imaging modality

A Novel Fluorescent Clinical Method to Rapidly Quantify Plasma Volume

The effects of hemodynamic management using the trend of the perfusion index and pulse pressure variation on tissue perfusion: a randomized clinical trial

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