Transcranial Cerebral Oximetry Related to Transcranial Doppler After Aneurysmal Subarachnoid Haemorrhage

Ekelund, Anders; Kongstad, Poul; Säveland, Hans; Romner, Bertil; Reinstrup, Peter; Kristiansson, K-A; Brandt, Lennart

doi:10.1007/s007010050211

Cited by 25 publications

(18 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…On the other hand, there are also reports suggesting that rSO 2 may enhance reliability in detecting cerebral ischemia [29,30] or be useful for assessing the therapeutic effectiveness in angiographic and interventional procedures for severe symptomatic vasospasm after SAH [31]. Evidence for the latter was also observed in this study in the detection of significant rSO 2 responsiveness to DOB-induced APCO augmentation in the vascular territory corresponding to clinical signs and symptoms.…”

Section: Discussionsupporting

confidence: 57%

Continuous Cardiac Output and Near-Infrared Spectroscopy Monitoring to Assist in Management of Symptomatic Cerebral Vasospasm After Subarachnoid Hemorrhage

et al. 2010

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 57%

Continuous Cardiac Output and Near-Infrared Spectroscopy Monitoring to Assist in Management of Symptomatic Cerebral Vasospasm After Subarachnoid Hemorrhage

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Some studies indicate a correlation between data from NIRS and TCD and suggest that NIRS may be more sensitive than TCD for detecting compromised cerebral oxygenation. 37,38 In patients with a new focal neurological deficit, NIRS detected decreased cerebral oxygenation in the affected region and a rise in oxygenation after treatment with an inotrope. 39,40 However, others have found no such correlation.…”

Section: Jugular Bulb Oximetrymentioning

confidence: 99%

Multimodal Monitoring in Subarachnoid Hemorrhage

Sandsmark

Kumar

Park

et al. 2012

Stroke

View full text Add to dashboard Cite

In severely injured patients, the immediate goal of resuscitation is restoration and maintenance of adequate tissue metabolism by ensuring sufficient delivery of fuel, typically oxygen and glucose, to meet cellular metabolic demands. In neurocritical care, traditional goals of resuscitation-intracranial pressure (ICP), cerebral perfusion pressure (CPP), and the clinical examination-have been extrapolated from those of general critical care. These variables are analogous to central venous pressure, mean arterial pressure, and urine output and are similarly crude. These distant surrogates for cerebral perfusion do not account for dynamic changes in cerebral autoregulation, tissue metabolic rate, cellular fuel use, and microcirculatory dysfunction, all of which impact tissue metabolic health. Although standard, it seems intuitively obvious that a uniform approach of maintaining ICP Ͻ20 mm Hg and CPP Ͼ60 mm Hg is overly simplistic. This approach does not address either significant baseline differences in patient physiology nor the complex, dynamic, and variable pathophysiological changes that ensue after severe brain injury. A more tailored therapeutic strategy that responds to multiple simultaneously measured and more relevant physiological variables is logically appealing. Until recently, however, the requisite individual patient physiology was inaccessible at the bedside.The emergence of technology that allows for continuous real-time bedside monitoring of cerebral physiology marks a new era in neurocritical care. These monitors facilitate assessment of therapeutic efficacy and may provide more relevant physiological end points for resuscitation. Combining these monitors in a multimodal approach allows for the practice of goal-directed cerebral resuscitation that emphasizes the individual patient's unique neurological and systemic physiology.

show abstract

“…In case of development of cerebral vasospasm after SAH, the complex changes of cerebral hemodynamics and oxygenation pattern are underestimated if they are considered exclusively on basis of transcranial Doppler sonography (TCD) and angiography [11][12][13][14]. Radiographic vasospasm may occur in the absence of clinical deficit and vice-versa [15].…”

Section: Subarachnoid Hemorrhagementioning

confidence: 99%

Measurement of Cerebral Blood Flow with Near Infrared Spectroscopy and Indocyanine Green Dye Dilution

Keller¹,

Mudra

2007

CMIR

View full text Add to dashboard Cite

Early detection and treatment of cerebral ischemia to prevent further neurological damage in patients with severe brain injuries, such as in trauma and stroke patients, is one of the most important issues in Neurocritical Care. Our own clinical experiences in treatment of patients with severe ischemic stroke and subarachnoid hemorrhage have shown that the available methods to monitor cerebral hemodynamics and oxygenation are insufficient with regard to detection of secondary ischemic events. The established methods for bedside monitoring of cerebral blood flow (CBF) and cerebral oxygenation are difficult to perform clinically, involve radioactive radiation, are invasive or require the patient to be transported, thus involving potentially high risks. Transcranial Doppler sonography produces indices that can be related to changes in CBF and cerebral oxygenation but does not measure actual flow rates.During recent years, near infrared spectroscopy (NIRS) was further developed and supplemented with the indocyanine green (ICG) dye dilution mode for bedside monitoring of CBF. The NIRS ICG dye dilution technique is a promising method for serial bedside CBF measurements in the environment of the intensive care unit. The NIRS method with optodes on the skin has the advantage of being non invasive, does not require the patient to be transported and provides data at the bedside within minutes.Preliminary data in a limited number of volunteers indicate that CBF measurements obtained by NIRS ICG dye dilution technique are in agreement with corresponding values obtained by perfusion-weighted MRI. More patient-validated data by correlating the measurement values with clinical events and comparing them with standard methods are needed. For the accuracy of absolute measurements and in order to quantify the individual extracerebral pathlengths as well as to allow appropriate correction to be made for extracerebral dead space tissue further modelling based on patients data is required.New-generation NIRS instrumentation, implementing spatially resolved spectroscopy (SRS), depth-resolved technologies and invasive NIRS probes will give the opportunity to reduce or eliminate extracerebral contamination and will provide some unique physiological information for NIRS technology. To calculate the influence of extracerebral contamination comparative measurements can be performed using noninvasive NIRS probes on the scalp and invasive probes for NIRS and intracranial pressure (ICP) monitoring. Combined monitoring of ICP and NIRS will be of special clinical value in patients with severe stroke, subarachnoid hemorrhage and head trauma, already provided with ICP probes for treatment of intracranial hypertension and being especially at risk for secondary ischemic brain damage.

show abstract

Transcranial Cerebral Oximetry Related to Transcranial Doppler After Aneurysmal Subarachnoid Haemorrhage

Cited by 25 publications

References 38 publications

Continuous Cardiac Output and Near-Infrared Spectroscopy Monitoring to Assist in Management of Symptomatic Cerebral Vasospasm After Subarachnoid Hemorrhage

Continuous Cardiac Output and Near-Infrared Spectroscopy Monitoring to Assist in Management of Symptomatic Cerebral Vasospasm After Subarachnoid Hemorrhage

Multimodal Monitoring in Subarachnoid Hemorrhage

Measurement of Cerebral Blood Flow with Near Infrared Spectroscopy and Indocyanine Green Dye Dilution

Contact Info

Product

Resources

About