Non-invasive optical neuromonitoring of the temperature-dependence of cerebral oxygen metabolism during deep hypothermic cardiopulmonary bypass in neonatal swine.

Autor: Ko TS; Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA.; Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, USA.; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Mavroudis CD; Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA., Baker WB; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Morano VC; Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, USA., Mensah-Brown K; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Boorady TW; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Schmidt AL; Department of Biology, James Madison University, Harrisonburg, VA, USA., Lynch JM; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Busch DR; Department of Anesthesiology & Pain Management, University of Texas Southwestern, Dallas, TX, USA.; Department of Neurology & Neurotherapeutics, University of Texas Southwestern, Dallas, TX, USA., Gentile J; Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Bratinov G; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Lin Y; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Jeong S; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Melchior RW; Department of Perfusion Services, Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Rosenthal TM; Department of Perfusion Services, Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Shade BC; Department of Perfusion Services, Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Schiavo KL; Department of Perfusion Services, Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Xiao R; Department of Pediatrics, Division of Biostatistics, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Gaynor JW; Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Yodh AG; Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, USA., Kilbaugh TJ; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Licht DJ; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Jazyk: angličtina
Zdroj: Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism [J Cereb Blood Flow Metab] 2020 Jan; Vol. 40 (1), pp. 187-203. Date of Electronic Publication: 2018 Oct 30.
DOI: 10.1177/0271678X18809828
Abstrakt: Management of deep hypothermic (DH) cardiopulmonary bypass (CPB), a critical neuroprotective strategy, currently relies on non-invasive temperature to guide cerebral metabolic suppression during complex cardiac surgery in neonates. Considerable inter-subject variability in temperature response and residual metabolism may contribute to the persisting risk for postoperative neurological injury. To characterize and mitigate this variability, we assess the sufficiency of conventional nasopharyngeal temperature (NPT) guidance, and in the process, validate combined non-invasive frequency-domain diffuse optical spectroscopy (FD-DOS) and diffuse correlation spectroscopy (DCS) for direct measurement of cerebral metabolic rate of oxygen ( CMRO 2 ). During CPB, n  = 8 neonatal swine underwent cooling from normothermia to 18℃, sustained DH perfusion for 40 min, and then rewarming to simulate cardiac surgery. Continuous non-invasive and invasive measurements of intracranial temperature (ICT) and CMRO 2 were acquired. Significant hysteresis ( p  < 0.001) between cooling and rewarming periods in the NPT versus ICT and NPT versus CMRO 2 relationships were found. Resolution of this hysteresis in the ICT versus CMRO 2 relationship identified a crucial insufficiency of conventional NPT guidance. Non-invasive CMRO 2 temperature coefficients with respect to NPT ( Q 10  = 2.0) and ICT ( Q 10  = 2.5) are consistent with previous reports and provide further validation of FD-DOS/DCS CMRO 2 monitoring during DH CPB to optimize management.
Databáze: MEDLINE