Total Hemoglobin Index Research Articles

A novel device to assess the oxygen saturation and congestion status of the gastric conduit in thoracic esophagectomy

BackgroundIn thoracic esophagectomy, anastomotic leakage is one of the most important surgical complications. Indocyanine green (ICG) is the most widely used method to assess tissue blood flow; however, this technique has been pointed out to have disadvantages such as difficulty in evaluating the degree of congestion, lack of objectivity in evaluating the degree of staining, and bias easily caused by ICG injection, camera distance, and other factors.Evaluating tissue oxygen saturation (StO2) overcomes these disadvantages and can be performed easily and repeatedly. It is also possible to measure objective values including the degree of congestion. We evaluate novel imaging technology to assess tissue oxygen saturation (StO2) in the gastric conduit during thoracic esophagectomy.MethodsFifty patients were enrolled, with seven excluded due to intraoperative findings, leaving 43 for analysis. These patients underwent thoracic esophagectomy for esophageal cancer. The device was used intraoperatively to evaluate tissue oxygen saturation (StO2) and total hemoglobin index (T-HbI), which guided the optimal site for gastric tube anastomosis. The efficacies of StO2 and T-HbI in relation to short-term outcomes were analyzed.ResultsStO2, indicating blood supply to the gastric tube, remained stable beyond the right gastroepiploic artery (RGEA) end but significantly decreased distally to the demarcation line (p < 0.05). T-HbI, indicative of congestion, significantly decreased past the RGEA (p < 0.05). Three patients experienced anastomotic leakage. These patients exhibited significantly lower StO2 (p < 0.01) and higher T-HbI (p < 0.01) at both the RGEA end and the demarcation line. Furthermore, the anastomotic site, usually within 3 cm of the RGEA’s anorectal side, also showed significantly lower StO2 (p < 0.01) and higher T-HbI (p < 0.01) in patients with anastomotic leakage.ConclusionsThe novel device provides real-time, objective evaluations of blood flow and congestion in the gastric tube. It proves useful for safer reconstruction during thoracic esophagectomy, particularly by identifying optimal anastomosis sites and predicting potential anastomotic leakage.

Partial Hepatic Vein Occlusion and Venous Congestion in Liver Exploration Using a Hyperspectral Camera: A Proposal for Monitoring Intraoperative Liver Perfusion

The changes occurring in the liver in cases of outflow deprivation have rarely been investigated, and no measurements of this phenomenon are available. This investigation explored outflow occlusion in a pig model using a hyperspectral camera. Six pigs were enrolled. The right hepatic vein was clamped for 30 min. The oxygen saturation (StO2%), deoxygenated hemoglobin level (de-Hb), near-infrared perfusion (NIR), and total hemoglobin index (THI) were investigated at different time points in four perfused lobes using a hyperspectral camera measuring light absorbance between 500 nm and 995 nm. Differences among lobes at different time points were estimated by mixed-effect linear regression. StO2% decreased over time in the right lateral lobe (RLL, totally occluded) when compared to the left lateral (LLL, outflow preserved) and the right medial (RML, partially occluded) lobes (p < 0.05). De-Hb significantly increased after clamping in RLL when compared to RML and LLL (p < 0.05). RML was further analyzed considering the right portion (totally occluded) and the left portion of the lobe (with an autonomous draining vein). StO2% decreased and de-Hb increased more smoothly when compared to the totally occluded RLL (p < 0.05). The variations of StO2% and deoxy-Hb could be considered good markers of venous liver congestion.

Hemodynamics and Vascular Histology of Keloid Tissues and Anatomy of Nearby Blood Vessels.

Background:Keloids are red‚ invasive scars that are driven by chronic inflammation in the reticular dermis. The role of blood vessels in keloid behavior remains poorly understood. In the present study with 32 keloid patients, we examined the hemodynamics of keloid tissue, the anatomy of the blood vessels feeding and draining the keloids, and the vascular histology of keloids.Methods:Ten patients with large anterior chest keloids underwent near-infrared spectroscopy, which measured regional saturation of oxygen and total hemoglobin index in the keloid and surrounding skin. Another 10 patients with large chest keloids and three healthy volunteers underwent multidetector-low computed tomography. The extirpated chest keloids of 12 patients were subjected to histology with optical, CD31 immunohistochemical, and electron microscopy.Results:All keloids had a low regional saturation of oxygen and a high total hemoglobin index, which is indicative of blood congestion. Multidetector-low computed tomography revealed dilation of the arteries and veins that were respectively feeding and draining the keloid leading edge. Hematoxylin-eosin staining and CD31 immunohistochemisty revealed considerable neovascularization in the keloid leading edge but not in the center. Electron microscopy showed that the lumens of many vessels in the keloid center appeared to be occluded or narrowed.Conclusions:Keloids seem to be congested because of increased neovascularization and arterial inflow at the leading edge and blocked outflow due to vascular destruction in the center. The surrounding veins seem to expand in response to this congested state. Methods that improve the blood circulation in keloids may be effective therapies.

The use of near-infrared spectroscopy for the evaluation of a 4-week rehabilitation program in patients with COPD.

Near-infrared spectroscopy (NIRS) technology can evaluate muscle metabolism and oxygenation. NIRS-based oximeters can measure skeletal muscle oxygen delivery and utilization during static and dynamic work non-invasively. Our goal was to assess the value and usability of NIRS technology in chronic obstructive pulmonary disease (COPD) rehabilitation program. Forty patients with COPD participated in a 4-week inpatient rehabilitation program that included breathing exercises and personalized cycle/treadmill training adjusted to the functional capacity, physical activity and comorbidities of the patients. A NIRS muscle oxygen monitor was used to measure tissue oxygenation and hemoglobin levels. Total hemoglobin index, average muscle oxygenation, minimal and maximal muscle oxygenation were recorded before and after the rehabilitation program. Rehabilitation resulted improvement in 6 min walking distance (6MWD:335.3 ± 110. vs. 398.3 ± 126.2 m; P < 0.01), maximal inspiratory pressure (MIP: 57.7 ± 22.7 vs. 63.6 ± 18.0 cmH2O; P < 0.01), chest wall expansion (CWE: 2.84 ± 1.26 vs, 4.00 ± 1.76 cm; P < 0.01), breath hold time (BHT: 25.8 ± 10.6 vs. 29.2 ± 11.6 s; P < 0.01) and grip strength (GS: 24.9 ± 11.9 vs. 27.0 ± 11.4 kg; P < 0.01). Quality of life improvement was monitored by COPD Assessment Test (CAT: 17.00 ± 8.49 vs. 11.89 ± 7.3, P < 0.05). Total hemoglobin index (tHb: 12.8 ± 1.3% vs. 12.8 ± 1.4), average muscle oxygenation (SmO2: 67.5 ± 14.4% vs. 65.2 ± 20.4%) showed a tendency for improvement. Maximal muscle oxygenation decreased (SmO2 max: 98.0 ± 20.5% vs. 90.1 ± 14.3%; P < 0.01). Minimal muscle oxygenation increased (SmO2 min: 42.6 ± 12.6% vs. 54.8 ± 14.3%; P < 0.01). NIRS results showed that muscle oxygenation and microcirculation can be described as a high-risk factor in COPD patients. The 4-week rehabilitation improves functional parameters, quality of life and tissue oxygenation levels in COPD patients.

A near-infrared spectroscopy (NIRS) device unveils oxygenation levels in skeletal muscle and brain of a conscious Harris\u2019s Hawk (Parabuteo unicinctus)

We measured the regional saturation of oxygen of hemoglobin (rSO2) and the total hemoglobin index (HbI) in the brain and skeletal muscles of a conscious Harris’s Hawk by a near-infrared spectroscopy device (NIRS). The oxygenation levels of the breast were significantly lower than the cerebral parts. A flight exercise significantly increased the rSO2 and HbI of the breast. The breast surface temperature significantly increased in response to flight training by a thermography. NIRS enabled us to measure changes in the oxygenation levels of brain and skeletal muscles in a conscious Harris’s Hawk before and after a moving task.

The evaluation of the hemodynamics of a gastric tube in esophagectomy using a new noninvasive blood flow evaluation device utilizing near-infrared spectroscopy.

We herein evaluated the hemodynamics of a gastric tube in esophagectomy using a new noninvasive blood flow evaluation device utilizing near-infrared spectroscopy. Thirty-two cases of subtotal esophagectomy and gastric tube reconstruction for esophageal cancer were studied. The new device measures the regional tissue saturation of oxygen (rSO2: 0-99%) and total hemoglobin index (T-HbI: 0-1.0) with a small sensor. We measured these values at the antrum (point A), final branch of the right gastroepiploic artery (point B) and planned anastomotic point (point C) before and after gastric tube formation. The values at the three points were compared, and the gradients at the three points from before to after gastric tube formation were compared. The mean values of rSO2 at point A, B, and C before gastric tube formation were 57.2%, 57.8% and 56.0%, and those after formation were 54.6%, 58.0% and 55.8%, respectively. There was no significant difference in the comparison of the rSO2 gradient before and after formation (p = 0.167). The mean values of T-HbI at point A, B, and C before formation were 0.126, 0.178 and 0.211, and those after formation were 0.167, 0.247 and 0.292, respectively. There was no significant difference in the gradient of the increase before and after formation (p = 0.461). A new device has shown that the gastric tube used in our facility is one that maintains tissue saturation of oxygen and does not cause excessive congestion at anastomosis.

P155 REAL-TIME EVALUATION OF THE GASTRIC CONDUIT BASED ON THE REGIONAL O2 SATURATION (%) AND TOTAL HEMOGLOBIN INDEX IN THORACIC ESOPHAGECTOMY

Abstract Aim Evaluation of blood supply of gastric conduit is one of the most importance parameter in thoracic esophagectomy. Evaluation with indocyanine green is the most popular evaluation method. However, indocyanine green does not objecctive values with Herein we introduce the new evaluation method based on the regional SO2(%) and Total hemoglobin index in thoracic esophagectomy. Background and methods: Between February to July 2018, we evaluated 56 patients underwent thoracic esophagectomy for esophageal cancer. Regional O2 saturation level (rSO%) and total hemoglobin indexes (T-HbI) of gastric conduit was evaluated using the ToccareTM (ASTEM Co. Ltd Tokyo, Japan) to determine the optimal site of anastomosis on gastric conduit. Results Fifty-two patients were eligible in this study. Mean value of the rSO2(%)/T-HbI were 57.6%/0.22 at the anal side of the gastric conduit where sufficient feeding arteries were existed from right gastroepiploic artery and vein. On the other hand, mean values of the rSO2(%)/T-HbI were 59.4%/0.28 (p&lt;0.05) at the distal side of the gastric conduit where direct feeding artery from right gastroepiploic vessel was terminated. Then, mean values of rSO2(%)/T-HbI were 46.3%/0.34 (p&lt;0.05) at the tip of the gastric conduit, which consisted to the gradual congestion was happened prior to the tissue oxygenation in the gastric conduit. There were 1 patient which found anastomotic leakage (1.9%) among 56 patients. Conclusion Evaluation of the regional SO2(%) and total hemoglobin index of the gastric conduit was non-invasiveness procedure and useful to easily determine the optimal site of anastomotic level to minimize the incidence of anastomotic leakage in thoracic esophagectomy.

Brain oxygenation declines in elite Kenyan runners during a maximal interval training session.

The purpose of this study was to characterise the cerebral oxygenation (Cox) response during a high-intensity interval training session in Kenyan runners, and to examine any relationship with running performance. 15 Kenyan runners completed a 5-km time trial (TT) and a Fatigue Training Test on a treadmill (repeated running bouts of 1-km at a pace 5% faster than their mean 5-km TT pace with a 30-s recovery until exhaustion). Changes in Cox were monitored via near-infrared spectroscopy through concentration changes in oxy- and deoxy-haemoglobin (Δ[O2Hb] and Δ[HHb]), tissue oxygenation index (TOI), and total hemoglobin index (nTHI). The number of 1-km repetitions achieved by the participants was 5.5 ± 1.2 repetitions at a mean pace of 20.5 ± 0.7kmh-1. Δ[O2Hb] measured at the end of each running repetition declined progressively over the course of the trial (p = 0.01, ES = 4.59). Δ[HHb] increased during each running bout until the end of the Fatigue Training Test (p < 0.001; ES = 6.0). TOI decreased significantly from the beginning of the test (p = 0.013, ES = 1.83), whereas nTHI remained stable (ES = 0.08). The Cox decline in the Fatigue Training Test was negatively correlated with the speed at which the test was completed (p = 0.017; r = -0.61), suggesting that the best performers were able to defend their Cox better than those of lower running ability. In conclusion, this study suggests that elite Kenyan runners cannot defend cerebral oxygenation when forced to exercise to their physiological limits. This emphasises the critical importance of pacing in their racing success.

Examiner's finger-mounted near-infrared spectroscopy is feasible to analyze cerebral and skeletal muscle oxygenation in conscious Chihuahuas.

To measure regional saturation of oxygen ( rSO 2 ) of hemoglobin and total hemoglobin index (HbI) in the brain (through the molera of the head) and skeletal muscle (musculus gracilis) of conscious Chihuahua dogs using an examiner’s finger-mounted near-infrared spectroscopy (NIRS) device, Toccare, we investigated brain and skeletal muscle NIRS in 48 Chihuahuas without severe disease. To measure rSO 2 and total HbI, a Toccare probe was placed on the molera of the head and musculus gracilis of each dog for real-time recording. Stable NIRS values were obtained within 10 s. We also examined the effect of anesthesia on rSO 2 and total HbI of a Chihuahua. Cerebral rSO 2 values ( 59 % ± 7 % ) were significantly lower than those obtained at femoral regions ( 67 % ± 6 % ), whereas total HbI values in the brain ( 0.38 ± 0.09 ) were significantly higher than those of the musculus gracilis ( 0.20 ± 0.05 ). Sedation with a combination of medetomidine and ketamine decreased cerebral rSO 2 along with a corresponding reduction in heart rate. Sevoflurane anesthesia with 100% O 2 maintained rSO 2 in the brain with a

Complexity of brain signals is associated with outcome in preterm infants

A characteristic feature of complex healthy biological systems is the ability to react and adapt to minute changes in the environment. This ‘complexity’ manifests itself in highly irregular patterns of various physiological measurements. Here, we apply Multiscale Entropy (MSE) analysis to assess the complexity of systemic and cerebral near-infrared spectroscopy (NIRS) signals in a cohort of 61 critically ill preterm infants born at median (range) gestational age of 26 (23–31) weeks, before 24 h of life. We further correlate the complexity of these parameters with brain injury and mortality. Lower complexity index (CoI) of oxygenated haemoglobin (HbO2), deoxygenated haemoglobin (Hb) and tissue oxygenation index (TOI) were observed in those infants who developed intraventricular haemorrhage (IVH) compared to those who did not (P = 0.002, P = 0.010 and P = 0.038, respectively). Mean CoI of HbO2, Hb and total haemoglobin index (THI) were lower in those infants who died compared to those who survived (P = 0.012, P = 0.004 and P = 0.003, respectively). CoI-HbO2 was an independent predictor of IVH (P = 0.010). Decreased complexity of brain signals was associated with mortality and brain injury. Measurement of brain signal complexity in preterm infants is feasible and could represent a significant advance in the brain-oriented care.

Craniofacial tissue oxygen saturation is associated with blood pH using an examiner's finger-mounted tissue oximetry in mice.

Although fetal scalp blood sampling is an examination to assess fetal acidosis during the intrapartum period, it has not been widely used by obstetricians because of its invasiveness. We have developed a small, portable oximetry with a sensor attached to the examiner's finger. Our previous report using this oximetry concluded that fetal head tissue oxygen saturation (StO 2 StO2 ) correlated with umbilical cord artery blood pH. We investigated whether the association between StO 2 StO2 and blood pH in mice could be validated using this oximetry. Eleven the Institute for Cancer Research (ICR) mice were measured using a near-infrared spectroscopy probe at the craniofacial site in a closed polyethylene bag while changing the oxygen concentration. A total of nine blood samples were collected and analyzed for pH. The StO 2 StO2 and tissue blood pH showed a strong positive correlation (r=0.90 r=0.90 and P=0.0009 P=0.0009 ). The StO 2 StO2 and total hemoglobin index also showed a positive correlation (r=0.84 r=0.84 and P=0.0049 P=0.0049 ). Thus, the results of the present study support those of our previous report on clinical cases and allow examiners to easily check the status of fetal acidosis. Fetal management using this oximetry might gain popularity with obstetricians in the near future.

Maintained cerebral oxygenation during maximal self-paced exercise in elite Kenyan runners.

The purpose of this study was to analyze the cerebral oxygenation response to maximal self-paced and incremental exercise in elite Kenyan runners from the Kalenjin tribe. On two separate occasions, 15 elite Kenyan distance runners completed a 5-km time trial (TT) and a peak treadmill speed test (PTS). Changes in cerebral oxygenation were monitored via near-infrared spectroscopy through concentration changes in oxy- and deoxyhemoglobin (Δ[O2Hb] and Δ[HHb]), tissue oxygenation index (TOI), and total hemoglobin index (nTHI). During the 5-km TT (15.2 ± 0.2 min), cerebral oxygenation increased over the first half (increased Δ[O2Hb] and Δ[HHb]) and, thereafter, Δ[O2Hb] remained constant (effect size, ES = 0.33, small effect), whereas Δ[HHb] increased until the end of the trial (P < 0.05, ES = 3.13, large effect). In contrast, during the PTS, from the speed corresponding to the second ventilatory threshold, Δ[O2Hb] decreased (P < 0.05, ES = 1.51, large effect), whereas Δ[HHb] continued to increase progressively until exhaustion (P < 0.05, ES = 1.22, large effect). Last, the TOI was higher during the PTS than during the 5-km TT (P < 0.001, ES = 3.08; very large effect), whereas nTHI values were lower (P < 0.001, ES = 2.36, large effect). This study shows that Kenyan runners from the Kalenjin tribe are able to maintain their cerebral oxygenation within a stable range during a self-paced maximal 5-km time trial, but not during an incremental maximal test. This may contribute to their long-distance running success.

Influence of cutaneous and muscular circulation on spatially resolved versus standard Beer-Lambert near-infrared spectroscopy.

The potential interference of cutaneous circulation on muscle blood volume and oxygenation monitoring by near‐infrared spectroscopy (NIRS) remains an important limitation of this technique. Spatially resolved spectroscopy (SRS) was reported to minimize the contribution of superficial tissue layers in cerebral monitoring but this characteristic has never been documented in muscle tissue monitoring. This study aims to compare SRS with the standard Beer–Lambert (BL) technique in detecting blood volume changes selectively induced in muscle and skin. In 16 healthy subjects, the biceps brachii was investigated during isometric elbow flexion at 70% of the maximum voluntary contractions lasting 10 sec, performed before and after exposure of the upper arm to warm air flow. From probes applied over the muscle belly the following variables were recorded: total hemoglobin index (THI, SRS‐based), total hemoglobin concentration (tHb, BL‐based), tissue oxygenation index (TOI, SRS‐based), and skin blood flow (SBF), using laser Doppler flowmetry. Blood volume indices exhibited similar changes during muscle contraction but only tHb significantly increased during warming (+5.2 ± 0.7 μmol/L·cm, an effect comparable to the increase occurring in postcontraction hyperemia), accompanying a 10‐fold increase in SBF. Contraction‐induced changes in tHb and THI were not substantially affected by warming, although the tHb tracing was shifted upward by (5.2 ± 3.5 μmol/L·cm, P < 0.01). TOI was not affected by cutaneous warming. In conclusion, SRS appears to effectively reject interference by SBF in both muscle blood volume and oxygenation monitoring. Instead, BL‐based parameters should be interpreted with caution, whenever changes in cutaneous perfusion cannot be excluded.

Effects of load magnitude on muscular activity and tissue oxygenation during repeated elbow flexions until failure

This study investigated the changes in muscular activity and tissue oxygenation while lifting and lowering a load of 20, 40, 60 or 80 % of one repetition maximum (1RM) with elbow flexor muscles until failure. The surface electromyogram (EMG) was recorded in biceps brachii (BB), brachioradialis (BRD) and triceps brachii (TB). For BB, a tissue oxygenation index (TOI) and a normalized total hemoglobin index (nTHI) were recorded by near-infrared spectroscopy. The number of repetitions decreased with the increase in load (P < 0.001), and the four loading conditions induced a decrease in MVC force immediately after failure (P < 0.001). The average of rectified EMG amplitude (aEMG) of elbow flexors increased for all loads during muscle shortening (SHO) and lengthening (LEN) phases of the movement (P < 0.05), except for the 80 % load during LEN phase. At failure, the aEMG was greater during the SHO than the LEN phase (P < 0.05), except for the 20 % load. TOI decreased for all loads and phases (P < 0.05) but less (P < 0.01) for the 20 % than 60 and 80 % loads (P < 0.01), and for LEN compared with SHO phase. At failure, TOI was negatively associated with aEMG during the SHO (r(2) = 0.99) and LEN (r(2) = 0.82) phases, while TOI and aEMG were positively associated with load magnitude (r(2) > 0.90) in both movement phases. This study emphasizes the influence of load magnitude and movement phase (SHO and LEN) on neuromuscular and oxydative adjustments during movements that involve lifting and lowering a load until failure.

What comes first? The dynamics of cerebral oxygenation and blood flow in response to changes in arterial pressure and intracranial pressure after head injury

Brain tissue partial oxygen pressure (Pbt(O(2))) and near-infrared spectroscopy (NIRS) are novel methods to evaluate cerebral oxygenation. We studied the response patterns of Pbt(O(2)), NIRS, and cerebral blood flow velocity (CBFV) to changes in arterial pressure (AP) and intracranial pressure (ICP). Digital recordings of multimodal brain monitoring from 42 head-injured patients were retrospectively analysed. Response latencies and patterns of Pbt(O(2)), NIRS-derived parameters [tissue oxygenation index (TOI) and total haemoglobin index (THI)], and CBFV reactions to fluctuations of AP and ICP were studied. One hundred and twenty-one events were identified. In reaction to alterations of AP, ICP reacted first [4.3 s; inter-quartile range (IQR) -4.9 to 22.0 s, followed by NIRS-derived parameters and CBFV (10.9 s; IQR: -5.9 to 39.6 s, 12.1 s; IQR: -3.0 to 49.1 s, 14.7 s; IQR: -8.8 to 52.3 s for THI, CBFV, and TOI, respectively), with Pbt(O(2)) reacting last (39.6 s; IQR: 16.4 to 66.0 s). The differences in reaction time between NIRS parameters and Pbt(O(2)) were significant (P<0.001). Similarly when reactions to ICP changes were analysed, NIRS parameters preceded Pbt(O(2)) (7.1 s; IQR: -8.8 to 195.0 s, 18.1 s; IQR: -20.6 to 80.7 s, 22.9 s; IQR: 11.0 to 53.0 s for THI, TOI, and Pbt(O(2)), respectively). Two main patterns of responses to AP changes were identified. With preserved cerebrovascular reactivity, TOI and Pbt(O(2)) followed the direction of AP. With impaired cerebrovascular reactivity, TOI and Pbt(O(2)) decreased while AP and ICP increased. In 77% of events, the direction of TOI changes was concordant with Pbt(O(2)). NIRS and transcranial Doppler signals reacted first to AP and ICP changes. The reaction of Pbt(O(2)) is delayed. The results imply that the analysed modalities monitor different stages of cerebral oxygenation.

Cerebrovascular Reactivity in Preterm Infants Measured by Near-Infrared Spectroscopy and Transcranial Cerebral Doppler - a Pilot Study

Background: The characteristics of cerebral autoregulation and the ideal range of systemic blood pressure in preterm infants remain unclear. Transcranial Ccerebral Doppler (TCD)1 and near infra-red spectroscopy (NIRS)2 are established techniques for the assessment of cerebral blood flow velocity (Fv) and cerebral oxygenation respectively. Aim: To study the correlation between a dynamic index of cerebral autoregulation, assessed using TCD, with indices obtained using NIRS in preterm infants and using these parameters, study the feasibility of determining the optimal MABP in individual infants. Methods: Twelve preterm infants (mean gestation 26.5 weeks) were studied over eighteen episodes (2 hours each) within median 3days(range 1-9 days)of life. ICM+ software4 was used to collect and analyse data from NIRO 200NX and DWL Doppler system as well as the physiological variables from the intensive care monitors. Using this data, mean flow index (Mx)2, total haemoglobin reactivity (THx)3 and tissue oxygenation index of dynamic autoregulation (TOx)2 were calculated as autoregulation indices. Results: Coherence analysis of tissue oxygenation index (TOI), total haemoglobin index (THI)and Fv was above 0.6 in ultralow frequency. TOx and THx correlated with Mx [(R=0.47, p=0.057) and (R=0.59, p=0.011) respectively] across individual recordings. ‘Optimal MABP’ was demonstrated in some individual recordings using Mxopt3 and TOxopt3. Conclusion: This is the first study assessing the indices of dynamic monitoring of cerebral autoregulation in preterm infants. Initial results suggest that NIRS derived cerebrovascular reactivity indices (THx, TOx) correlate well with Doppler derived index (Mx), and a non-invasive assessment of ‘optimal MABP’ is feasible in this population group.

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

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.

Noninvasive Monitoring of Cerebrovascular Reactivity with Near Infrared Spectroscopy in Head-Injured Patients

Monitoring of cerebrovascular pressure reactivity (PRx) has diagnostic and prognostic value in head-injured patients, but requires invasive monitoring of intracranial pressure (ICP). Near infrared spectroscopy (NIRS) is a noninvasive method that is suitable for continuous detection of cerebral blood volume changes. We compared a NIRS-based index of cerebrovascular reactivity, called total hemoglobin reactivity (THx), against standard measurements of PRx in a prospective observational study. Forty patients with closed-head injury were monitored daily with arterial blood pressure (ABP), ICP, and a NIRS-based total hemoglobin index. PRx and THx were calculated as the moving correlation coefficients using 5-min time windows between 10-sec averaged values of ICP and ABP, and total hemoglobin index and ABP, respectively. A total of 120 recordings were performed between the median first (IQR 0.75-2) and fourth (IQR 2-6) day after head injury, giving a total duration of 1760 hours. PRx and THx demonstrated a significant association across averaged individual recordings (r = 0.49, p < 0.0001), and across patients (r = 0.56, p = 0.0002). Assessment of optimal cerebral perfusion pressure (CPP) and ABP using THx was possible in about 50% of recordings, and showed a significant agreement with the optimal CPP and ABP assessed with PRx. THx may be of diagnostic value to optimize therapy oriented toward restoration and continuity of cerebrovascular reactivity, especially in patients for whom direct ICP monitoring is not feasible.