The effect of changes in tPCO2 on the fractional tissue oxygen extraction – as measured by near-infrared spectroscopy – in neonates during the first days of life

Vanderhaegen, Joke; Naulaers, Gunnar; Vanhole, Christine; Smet, Dominique De; Huffel, Sabine Van; Vanhaesebrouck, Sophie; Devlieger, Hugo

doi:10.1016/j.ejpn.2008.02.012

Cited by 50 publications

(42 citation statements)

References 48 publications

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“…HV induces transient arterial hypocapnia and alkalosis provoking a rapid cerebral vasoconstriction, cerebral blood flow reduction (21,30), and increased cerebral oxygen extraction (48). This results, as also observed in the present study, in both a marked reduction of V MCA (7,39) and a decrease in cerebral oxygenation (TOIi; Refs.…”

Section: Hvsupporting

confidence: 75%

Inconsistent detection of changes in cerebral blood volume by near infrared spectroscopy in standard clinical tests

Canova

Roatta

Bosone³

et al. 2011

Journal of Applied Physiology

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The attractive possibility of near infrared spectroscopy (NIRS) to noninvasively assess cerebral blood volume and oxygenation is challenged by the possible interference from extracranial tissues. However, to what extent this may affect cerebral NIRS monitoring during standard clinical tests is ignored. To address this issue, 29 healthy subjects underwent a randomized sequence of three maneuvers that differently affect intra- and extracranial circulation: Valsalva maneuver (VM), hyperventilation (HV), and head-up tilt (HUT). Putative intracranial (“i”) and extracranial (“e”) NIRS signals were collected from the forehead and from the cheek, respectively, and acquired together with cutaneous plethysmography at the forehead (PPG), cerebral blood velocity from the middle cerebral artery, and arterial blood pressure. Extracranial contribution to cerebral NIRS monitoring was investigated by comparing Beer-Lambert (BL) and spatially resolved spectroscopy (SRS) blood volume indicators [the total hemoglobin concentration (tHb) and the total hemoglobin index, (THI)] and by correlating their changes with changes in extracranial circulation. While THIe and tHbe generally provided concordant indications, tHbi and THIi exhibited opposite-sign changes in a high percentage of cases (VM: 46%; HV: 31%; HUT: 40%). Moreover, tHbi was correlated with THIi only during HV ( P < 0.05), not during VM and HUT, while it correlated with PPG in all three maneuvers ( P < 0.01). These results evidence that extracranial circulation may markedly affect BL parameters in a high percentage of cases, even during standard clinical tests. Surface plethysmography at the forehead is suggested as complementary monitoring helpful in the interpretation of cerebral NIRS parameters.

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Section: Hvsupporting

confidence: 75%

Inconsistent detection of changes in cerebral blood volume by near infrared spectroscopy in standard clinical tests

Canova

Roatta

Bosone³

et al. 2011

Journal of Applied Physiology

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“…Decreased cerebral blood flow may result in increased FTOE. A recent study reported a negative correlation between transcutaneous PCO 2 and FTOE (22). By contrast, we found no correlation between FTOE and PaCO 2 level.…”

Section: Discussioncontrasting

confidence: 55%

The Relationship Between Electrocerebral Activity and Cerebral Fractional Tissue Oxygen Extraction in Preterm Infants

et al. 2011

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Impaired cerebral oxygen delivery may cause cerebral damage in preterm infants. At lower levels of cerebral perfusion and oxygen concentration, electrocerebral activity is disturbed. The balance between cerebral oxygen delivery and oxygen use can be measured by near-infrared spectroscopy (NIRS), and electrocerebral activity can be measured by amplitude-integrated EEG (aEEG). Our aim was to determine the relationship between regional cerebral tissue oxygen saturation (r c SO 2 ), fractional tissue oxygen extraction (FTOE), and aEEG. We recorded longitudinal digital aEEG and r c SO 2 prospectively in 46 preterm infants (mean GA 29.5 wk, SD 1.7) for 2 hr on the 1st to 5th, 8th, and 15th d after birth. We excluded infants with germinal matrix hemorrhage exceeding grade I and recordings of infants receiving inotropes. FTOE was calculated using transcutaneous arterial oxygen saturation (tcSaO 2 ) and r c SO 2 values: (tcSaO 2 Ϫ r c SO 2 )/tcSaO 2 . aEEG was assessed by calculating the mean values of the 5th, 50th, and 95th centiles of the aEEG amplitudes. The aEEG amplitude centiles changed with increasing GA. FTOE and aEEG amplitude centiles increased significantly with postnatal age. More mature electrocerebral activity was accompanied by increased FTOE. FTOE also increased with increasing postnatal age and decreasing Hb levels. (Pediatr Res 70: 384-388, 2011)

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“…It is crucial, because inadvertent hyperventilation may occur as a result of mechanical ventilation during the acute phase of respiratory distress syndrome. If P CO 2 is below the normal range or low, even in the normal range, we recommend considering to decrease minute ventilation in case of low rSt O 2 [63,67,68,69]. Since the effect of manipulating minute ventilation on rSt O 2 has not been tested in a randomised trial, the evidence level in this guideline is only II.…”

Section: Interventions That Affect Oxygen Delivery To the Brainmentioning

confidence: 99%

“…One of the most important determinants of CBF and cerebral oxygen dynamics is partial pressure of carbon dioxide (P CO 2 ) [46,63,67,68,69,70]. It is crucial, because inadvertent hyperventilation may occur as a result of mechanical ventilation during the acute phase of respiratory distress syndrome.…”

Section: Interventions That Affect Oxygen Delivery To the Brainmentioning

confidence: 99%

The SafeBoosC Phase II Randomised Clinical Trial: A Treatment Guideline for Targeted Near-Infrared-Derived Cerebral Tissue Oxygenation versus Standard Treatment in Extremely Preterm Infants

et al. 2013

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Near-infrared spectroscopy-derived regional tissue oxygen saturation of haemoglobin (rStO₂) reflects venous oxygen saturation. If cerebral metabolism is stable, rStO₂ can be used as an estimate of cerebral oxygen delivery. The SafeBoosC phase II randomised clinical trial hypothesises that the burden of hypo- and hyperoxia can be reduced by the combined use of close monitoring of the cerebral rStO₂ and a treatment guideline to correct deviations in rStO₂ outside a predefined target range. Aims: To describe the rationale for and content of this treatment guideline. Methods: Review of the literature and assessment of the quality of evidence and the grade of recommendation for each of the interventions. Results and Conclusions: A clinical intervention algorithm based on the main determinants of cerebral perfusion-oxygenation changes during the first hours after birth was generated. The treatment guideline is presented to assist neonatologists in making decisions in relation to cerebral oximetry readings in preterm infants within the SafeBoosC phase II randomised clinical trial. The evidence grades were relatively low and the guideline cannot be recommended outside a research setting.

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The effect of changes in tPCO2 on the fractional tissue oxygen extraction – as measured by near-infrared spectroscopy – in neonates during the first days of life

Cited by 50 publications

References 48 publications

Inconsistent detection of changes in cerebral blood volume by near infrared spectroscopy in standard clinical tests

Inconsistent detection of changes in cerebral blood volume by near infrared spectroscopy in standard clinical tests

The Relationship Between Electrocerebral Activity and Cerebral Fractional Tissue Oxygen Extraction in Preterm Infants

The SafeBoosC Phase II Randomised Clinical Trial: A Treatment Guideline for Targeted Near-Infrared-Derived Cerebral Tissue Oxygenation versus Standard Treatment in Extremely Preterm Infants

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