The role of diffuse correlation spectroscopy and frequency-domain near-infrared spectroscopy in monitoring cerebral hemodynamics during hypothermic circulatory arrests
| Autor: | Arminder S. Jassar, Thoralf M. Sundt, Alexander I. Zavriyev, Parya Farzam, Stefan A. Carp, Parisa Farzam, Jason Z. Qu, Kutlu Kaya, Maria Angela Franceschini, John Sunwoo |
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| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
hypothermic circulatory arrest medicine.medical_specialty near-infrared spectroscopy DCS diffuse correlation spectroscopy cerebral blood flow brain imaging SO2 hemoglobin oxygen saturation law.invention Neuroimaging law ACP antegrade cerebral perfusion Internal medicine RCP retrograde cerebral perfusion medicine Cardiopulmonary bypass antegrade cerebral perfusion Cerebral perfusion pressure FDNIRS frequency-domain near-infrared spectroscopy rSO2 regional oxygen saturation diffuse correlation spectroscopy HCA hypothermic circulatory arrest business.industry NIRS near-infrared spectroscopy CBFi cerebral blood flow (index) CPB cardiopulmonary bypass CMRO2i cerebral metabolic rate of oxygen (index) Cardiac surgery Transcranial Doppler medicine.anatomical_structure Cerebral blood flow Adult: Mechanical Circulatory Support retrograde cerebral perfusion Cerebral cortex Circulatory system Cardiology TCD transcranial Doppler ultrasound Surgery business EEG electroencephalography |
| Zdroj: | JTCVS Techniques |
| ISSN: | 2666-2507 |
| Popis: | Objectives Real-time noninvasive monitoring of cerebral blood flow (CBF) during surgery is key to reducing mortality rates associated with adult cardiac surgeries requiring hypothermic circulatory arrest (HCA). We explored a method to monitor cerebral blood flow during different brain protection techniques using diffuse correlation spectroscopy (DCS), a noninvasive optical technique which, combined with frequency-domain near-infrared spectroscopy (FDNIRS), also provides a measure of oxygen metabolism. Methods We used DCS in combination with FDNIRS to simultaneously measure hemoglobin oxygen saturation (SO2), an index of cerebral blood flow (CBFi), and an index of cerebral metabolic rate of oxygen (CMRO2i) in 12 patients undergoing cardiac surgery with HCA. Results Our measurements revealed that a negligible amount of blood is delivered to the cerebral cortex during HCA with retrograde cerebral perfusion, indistinguishable from HCA-only cases (median CBFi drops of 93% and 95%, respectively) with consequent similar decreases in SO2 (mean decrease of 0.6 ± 0.1% and 0.9 ± 0.2% per minute, respectively); CBFi and SO2 are mostly maintained with antegrade cerebral perfusion; the relationship of CMRO2i to temperature is given by CMRO2i = 0.052e0.079T. Conclusions FDNIRS-DCS is able to detect changes in CBFi, SO2, and CMRO2i with intervention and can become a valuable tool for optimizing cerebral protection during HCA. Graphical abstract Real-time noninvasive cerebral blood flow monitoring during cardiac surgery could help optimize neuroprotective measures and hence decrease rates of neurologic injury associated with hypothermic circulatory arrests (HCAs). We used combined frequency-domain near-infrared spectroscopy and diffuse correlation spectroscopy (FDNIRS-DCS) to measure hemoglobin oxygen saturation (SO2), cerebral blood flow index (CBFi), and cerebral metabolic rate of oxygen (CMRO2i) in 12 adults undergoing HCA (4 HCA-only, 3 retrograde cerebral perfusion [RCP], 5 antegrade cerebral perfusion [ACP]). We coacquired regional oxygen saturation (rSO2) from a hospital oximeter (INVOS), mean arterial blood pressure (MAP), and nasopharyngeal temperature. Our measurements revealed that during HCA with RCP CBFi drops to almost zero and overshoots above baseline when circulation is restarted, similar to the CBFi behavior found during HCA-only. As a consequence of the low perfusion, with RCP and HCA-only SO2 decreases during HCA; in contrast, both CBFi and SO2 are mostly maintained with ACP. |
| Databáze: | OpenAIRE |
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