Detection of delayed cerebral ischemia (DCI) in subarachnoid haemorrhage applying near-infrared spectroscopy: elimination of the extracerebral signal by transcutaneous and intraparenchymatous measurements in parallel.

BACKGROUND: Detection of delayed cerebral ischemia (DCI) in high-grade subarachnoid haemorrhage (SAH) is an unsolved issue. Conventional near-infrared spectroscopy (NIRS) with optodes applied over the skin is controversial because the NIRS signal is contaminated by extracerebral tissue. The objective is to quantify and subtract the contribution from extracerebral tissue from the signal by using measurements in parallel with a NIRS brain tissue probe and conventional NIRS. METHODS: In a patient with high-grade SAH, two approaches for NIRS were applied. First, a conventional brain tissue probe for intracranial pressure (ICP) monitoring, supplied by optical fibres, was placed into the brain tissue 2 cm deep from the dura. Second, for conventional NIRS, a plaster-based patch carrying optodes (one emitter, two detectors) was attached to the skin. Central venous injections of 0.3 mg/kg body weight (bw) indocyanine green (ICG) were performed. ICG dye dilution curves obtained with the probe and patch were collected simultaneously and analysed for blood flow values. RESULTS: Twelve measurements in parallel with the probe and patch were performed. Mean cerebral blood flow (CBF) for the probe was higher (24.8 ± 9.1 ml/100 g/min) compared with the values obtained with the patch (for detector 1, extra-cerebral blood flow [ECBF] mean 5.1 ± 1.8 ml/100 g/min; p = 0.002; for detector 2, 6.6 ± 2.1 ml/100 g/min; p = 0.002). CBF values obtained with the probe correlated with blood flow values obtained with the patch (for CBF vs. ECBF detector 1, r = 0.72 [p = 0.008]; ECBF detector 2, r = 0.79 [p = 0.002]). CONCLUSIONS: Blood flow values obtained with conventional NIRS correlated significantly with absolute CBF values obtained directly within the brain tissue. Simultaneous measurements with the NeMo Probe and NeMo Patch allow quantification and subtraction of the contribution from extracerebral tissues from the signal obtained with conventional NIRS.

Circulation time measurement from sleep studies in patients with obstructive sleep apnea.

INTRODUCTION: Lung to finger circulation time (LFCT) can be estimated from polysomnography (PSG) in the presence of an apneic event by using oxygen as an indicator and a finger as the site of detection. The purpose of this study was to refine the methodology of LFCT measurement and to compare LFCT in patients with obstructive sleep apnea (OSA) with and without heart failure (HF). METHODS: In a retrospective manner, 10 LFCT measurements per patient were made from the PSG in 171 consecutive patients with a diagnosis of OSA who were divided into two groups: (a) those with a clinical history of underlying HF (N = 42) and (b) those without HF (N = 129). Mean values were compared between the two groups. We also examined associations of LFCT with various factors in each group and the combined group separately using multiple regression analysis. RESULTS: Gender and age were significantly associated with LFCT in patients with OSA alone. Use of ß-blockers was associated with LFCT in the group with OSA with HF. Among the entire cohort, HF, ß-blocker, gender, and age were found to be significantly associated with LFCT. The presence of HF was the strongest predictor of a prolonged LFCT (adjusted mean LFCT: OSA only = 18.5 [95% CI: 17.2-19.7 sec] vs. OSA with HF = 26.1 [95% CI: 24.3-28.0 sec], p < 0.0001). CONCLUSION: LFCT can be reliably measured and is prolonged in patients with OSA and underlying HF. LFCT based on PSG may be a useful marker for detection of coexisting HF in patients with OSA.

Rapid and local autoregulation of cerebrovascular blood flow: a deep-brain imaging study in the mouse.

The brain obtains energy by keeping the cerebral blood flow constant against unexpected changes in systemic blood pressure. Although this homeostatic mechanism is widely known as cerebrovascular autoregulation, it is not understood how widely and how robustly it works in the brain. Using a needle-like objective lens designed for deep-tissue imaging, we quantified the degree of autoregulation in the mouse hippocampus with single-capillary resolution. On average, hippocampal blood flow exhibited autoregulation over a comparatively broad range of arterial blood pressure and did not significantly respond to pressure changes induced by the pharmacological activation of autonomic nervous system receptors, whereas peripheral tissues showed linear blood flow changes. At the level of individual capillaries, however, about 40% of hippocampal capillaries did not undergo rapid autoregulation. This heterogeneity suggests the presence of a local baroreflex system to implement cerebral autoregulation.

Pulse transit time based on piezoelectric technique at the radial artery.

OBJECTIVES: Pulse transit time (PTT) has shown its potential in relevant cardiovascular and cardiorespiratory studies. However, the use of photoplethysmography (PPG) in PTT measurement can be limited in events of poor peripheral perfusion. Uninterrupted PTT monitoring may also not be achievable when less cooperative patients distribute the PPG probe due to its prominent light source. Hence, there is a need for an alternative method to measure PTT in such incidents. METHODS: In this study, the piezoelectric (PIEZO) technique to detect pulsations from a human wrist above the radial artery to estimate PTT is presented. 17 healthy adults (11 male; age range of 21-33 years) were recruited to compare PTT and heart rate (HR) differences between the PPG and PIEZO methods. These time-related derivations were made with respect to an electrocardiogram (ECG). RESULTS: The timing consistency of the PIEZO transducer shows significant correlations (p < 0.01) to those derived from the ECG and a pulse oximeter. Particularly, there is a high level of agreement of < 1 beat per minute (bpm) difference in HR estimates observed when compared to the two commercial devices in the respective Bland-Altman plots. Comparison of PTT obtained from the PIEZO transducer against the PPG signal shows constantly lower values due to the shorter path length it requires to propagate. A regression equation was formulated to relate the PTT values acquired from both these signals. CONCLUSIONS: Preliminary findings herein suggest that the PIEZO technique can be useful as an alternative for PTT monitoring. This shows promise to be more accommodating for less cooperative patients or those with insufficient peripheral perfusion.

Measurement of the mean transit time of cerebral circulation by external detection of an intravenously injected radioisotope.

A technique is described in which the mean circulation (transit) time of each hemisphere is determined by means of an intravenous radioisotope technique. A sharp bolus of a rapidly excreted I131 labeled compound is released from an antecubital vein. The time of entrance into the brain blood pool of the densest portion of this bolus is determined by plotting the first derivative of the amount of isotope seen in the brain by a paired external collimation-detection system. The time of exit of the densest portion of the bolus is also similarly determined. The interval between the entrance and exit represents, we believe, the mean cerebral transit time. In 15 normal males transit times were obtained between 6.5 and 10 seconds. The test is virtually painless, repeatable, and exposes the patient to minimal radiation.