“Therapeutic Hypercapnia” after Ischemic Brain Injury

Brambrink, Ansgar M.; Orfanakis, Andrea

doi:10.1097/aln.0b013e3181ca8273

Cited by 10 publications

(3 citation statements)

References 12 publications

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“…However, the fundamental difference between gadolinium contrast and deoxyhemoglobin contrast may allow them to play complementary roles in perfusion imaging for these pathologies. For ischemic strokes in which the penumbra is under low oxygen delivery, CO 2 -induced modulations in CBF can lead to reperfusion of the damaged regions ( Brambrink and Orfanakis, 2010 ), which can yield a completely different perfusion distribution compared to gadolinium DSC. In brain tumors, gadolinium-based contrast extravasation through the disrupted blood-brain barrier can result in altered CBV measurements ( Ho et al, 2016 ); on the other hand, deoxygenation-based contrast remains purely intravascular.…”

Section: Discussionmentioning

confidence: 99%

Sinusoidal CO2 respiratory challenge for concurrent perfusion and cerebrovascular reactivity MRI

Xu²,

Gonzalez-Zacarias³

et al. 2023

Front. Physiol.

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Introduction: Deoxygenation-based dynamic susceptibility contrast (dDSC) has previously leveraged respiratory challenges to modulate blood oxygen content as an endogenous source of contrast alternative to gadolinium injection in perfusion-weighted MRI. This work proposed the use of sinusoidal modulation of end-tidal CO2 pressures (SineCO2), which has previously been used to measure cerebrovascular reactivity, to induce susceptibility-weighted gradient-echo signal loss to measure brain perfusion.Methods:SineCO2 was performed in 10 healthy volunteers (age 37 ± 11, 60% female), and tracer kinetics model was applied in the frequency domain to calculate cerebral blood flow, cerebral blood volume, mean transit time, and temporal delay. These perfusion estimates were compared against reference techniques, including gadolinium-based DSC, arterial spin labeling, and phase contrast.Results: Our results showed regional agreement between SineCO2 and the clinical comparators. SineCO2 was able to generate robust CVR maps in conjunction to baseline perfusion estimates.Discussion: Overall, this work demonstrated feasibility of using sinusoidal CO2 respiratory paradigm to simultaneously acquire both cerebral perfusion and cerebrovascular reactivity maps in one imaging sequence.

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Section: Discussionmentioning

confidence: 99%

Sinusoidal CO2 respiratory challenge for concurrent perfusion and cerebrovascular reactivity MRI

Xu²,

Gonzalez-Zacarias³

et al. 2023

Front. Physiol.

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“…Conversely, StcO 2 increased from 53% to 63% when PaCO 2 increased from 31 to 41 mmHg during cardiopulmonary bypass [27]. Thus, it is likely that, in the survivor group, an improvement in cerebral perfusion due to hypercapnia-induced arterial vasodilation may have reduced the ischemic process [28] during ECMO.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of cerebral tissue oxygen saturation during neonatal extracorporeal membrane oxygenation

et al. 2017

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ObjectivesExtracorporeal membrane oxygenation support is indicated in severe and refractory respiratory or circulatory failures. Neurological complications are typically represented by acute ischemic or hemorrhagic lesions, which induce higher morbidity and mortality. The primary goal of this study was to assess the prognostic value of cerebral tissue oxygen saturation (StcO2) on mortality in neonates and young infants treated with ECMO. A secondary objective was to evaluate the association between StcO2 and the occurrence of cerebral lesions.Study designThis was a prospective study in infants < 3 months of age admitted to a pediatric intensive care unit and requiring ECMO support.MeasurementsThe assessment of cerebral perfusion was made by continuous StcO2 monitoring using near-infrared spectroscopy (NIRS) sensors placed on the two temporo-parietal regions. Neurological lesions were identified by MRI or transfontanellar echography.ResultsThirty-four infants <3 months of age were included in the study over a period of 18 months. The ECMO duration was 10±7 days. The survival rate was 50% (17/34 patients), and the proportion of brain injuries was 20% (7/34 patients). The mean StcO2 during ECMO in the non-survivors was reduced in both hemispheres (p = 0.0008 right, p = 0.03 left) compared to the survivors. StcO2 was also reduced in deceased or brain-injured patients compared to the survivors without brain injury (p = 0.002).ConclusionStcO2 appears to be a strong prognostic factor of survival and of the presence of cerebral lesions in young infants during ECMO.

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“…Data in support of a correlation between surgery and subsequent neuro-physiological changes has accumulated over years. The use of a non-human primate model to decrease the uncertainty in extrapolating pre-clinical data (Slikker et al, 2007; Zou et al, 2009a; Brambrink et al, 2010) to the human condition (e.g., peri-operative neurotoxicity) continues to garner considerable interest among anesthesiologists and toxicologists, with growing recognition to be anticipated from surgeons and neonatologists. A host of mechanistic studies have been completed or are underway which have been helpful in providing rationale for the overall concern over anesthetic and sedative-induced neurotoxicity.…”

Section: Introductionmentioning

confidence: 99%

Advanced Pre-Clinical Research Approaches and Models to Studying Pediatric Anesthetic Neurotoxicity

Wang¹

2012

Front. Neur.

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Advances in pediatric and obstetric surgery have resulted in an increase in the duration and complexity of anesthetic procedures. A great deal of concern has recently arisen regarding the safety of anesthesia in infants and children. Because of obvious limitations, it is not possible to thoroughly explore the effects of anesthetic agents on neurons in vivo in human infants or children. However, the availability of some advanced pre-clinical research approaches and models, such as imaging technology both in vitro and in vivo, stem cells, and non-human primate experimental models, have provided potentially invaluable tools for examining the developmental effects of anesthetic agents. This review discusses the potential application of some sophisticated research approaches, e.g., calcium imaging, in stem cell-derived in vitro models, especially human embryonic neural stem cells, along with their capacity for proliferation and their potential for differentiation, to dissect relevant mechanisms underlying the etiology of the neurotoxicity associated with developmental exposures to anesthetic agents. Also, this review attempts to discuss several advantages for using the developing rhesus monkey model (in vivo), when combined with dynamic molecular imaging approaches, in addressing critical issues related to the topic of pediatric sedation/anesthesia. These include the relationships between anesthetic-induced neurotoxicity, dose response, time-course, and developmental stage at time of exposure (in vivo studies), serving to provide the most expeditious platform toward decreasing the uncertainty in extrapolating pre-clinical data to the human condition.

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“Therapeutic Hypercapnia” after Ischemic Brain Injury

Cited by 10 publications

References 12 publications

Sinusoidal CO2 respiratory challenge for concurrent perfusion and cerebrovascular reactivity MRI

Sinusoidal CO2 respiratory challenge for concurrent perfusion and cerebrovascular reactivity MRI

Prognostic value of cerebral tissue oxygen saturation during neonatal extracorporeal membrane oxygenation

Advanced Pre-Clinical Research Approaches and Models to Studying Pediatric Anesthetic Neurotoxicity

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