Assessment of Optimal Arterial Pressure with Near-Infrared Spectroscopy in Traumatic Brain Injury Patients.
Assessment of Optimal Arterial Pressure with Near-Infrared Spectroscopy in Traumatic Brain Injury Patients.
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DOI：
10.1007/978-3-031-14190-4_23
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发表时间：
2022
影响因子：
--
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中科院分区：
文献类型：
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在严重创伤性脑损伤（TBI）患者中，同时测量颅内压和动脉压（ICP和ABP）可监测脑灌注压（CPP）并评估脑自动调节（CA）。CPP是ICP和ABP之间的差异，是驱动氧气输送到脑组织的压力梯度。CA是脑血管系统在CPP改变的情况下维持稳定血流的能力，因此是重要的稳态机制。压力反应性指数（PRx），ICP和ABP慢波之间的移动Pearson相关性，在过去的二十年中最常被文献引用作为CA评估的工具。然而，在某些临床情况下，ICP监测可能不可用或禁忌。在这种情况下，同时平均动脉压（MAP）监测和近红外光谱（NIRS）可用于通过脑血氧指数（考克斯）进行CA评估，从而计算最佳血压（MAPOPT）。本研究的目的是比较TBI患者中基于局部氧饱和度（rSO 2）的CA（考克斯）与基于ICP/ABP的CA（PRx），并比较两种技术的MAPOPT。在床边监测三名TBI患者，使用PRx和考克斯测量CA。从TBI开始，每天监测患者长达三天。使用Pearson相关性比较平均PRx和考克斯以及基于PRx和考克斯的MAPOPT。在这些相同的CA指标之间进行偏倚分析。考克斯和PRx平均值之间的相关性为R = 0.35，p = 0.15。考克斯和PRx计算的最佳MAP之间的相关性为R = 0.49，p < 0.038。Bland-Altman分析显示，COx与PRx的中度一致性（偏倚为0.16 ± 0.23）和考克斯与PRx确定的最佳MAP的良好一致性（偏倚为0.39 ± 7.89）。NIRS法无创性测量CA（考克斯）与有创性ICP/ABP法CA（PRx）无相关性。然而，使用考克斯测定MAPOPT与从PRx得到的MAPOPT相关。获得的结果表明，考克斯不是TBI患者中PRx的可接受替代品。但在某些TBI病例中，NIRS可能有助于最佳MAP测定。
In patients with severe traumatic brain injury (TBI), simultaneous measurement of intracranial and arterial blood pressure (ICP and ABP) allows monitoring cerebral perfusion pressure (CPP) and assessing cerebral autoregulation (CA). CPP, a difference between ICP and ABP, is the pressure gradient that drives oxygen delivery to cerebral tissue. CA is the cerebral vasculature ability to maintain stable blood flow despite changes in CPP and thus is an important homeostatic mechanism. Pressure reactivity index (PRx), moving Pearson correlation between slow waves in ICP and ABP, has been most frequently cited in literature over the past two decades as a tool for CA evaluation. However, in some clinical situations, ICP monitoring may be unavailable or contraindicated. In such cases, simultaneous mean arterial pressure (MAP) monitoring and Near-Infrared Spectroscopy (NIRS) can be used for CA assessment by cerebral oximetry index (COx), allowing calculation of the optimal blood pressure (MAPOPT). The purpose of this study was to compare regional oxygen saturation (rSO2)-based CA (COx) with ICP/ABP-based CA (PRx) in TBI patients and to compare MAPOPT derived from both technologies. Three TBI patients were monitored at the bedside to measure CA using both PRx and COx. Patients were monitored daily for up to three days from TBI. Averaged PRx and COx, and PRx and COx –based MAPOPT were compared using Pearson’s correlation. Bias analysis was performed between these same CA metrics. Correlation between averaged values of COx and PRx was R = 0.35, p = 0.15. Correlation between optimal MAP calculated for COx and PRx was R = 0.49, p < 0.038. Bland–Altman analysis showed moderate agreement with a bias of 0.16 ± 0.23 for COx versus PRx and good agreement with a bias of 0,39 ± 7.89 for optimal MAP determined by COx versus PRx. Non-invasive measurement of CA by NIRS (COx) is not correlated with invasive ICP/ABP-based CA (PRx). However, the determination of MAPOPT using COx is correlated with MAPOPT derived from PRx. Obtained results demonstrate that COx is not an acceptable substitute for PRx in TBI patients. But in some TBI cases, NIRS may be useful for optimal MAP determination.
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验证近红外光谱法，以监测昏迷患者的脑自动调节。
影响因子：
3.5
作者：
Rivera-Lara L;Geocadin R;Zorrilla-Vaca A;Healy R;Radzik BR;Palmisano C;Mirski M;Ziai WC;Hogue C
通讯作者：
Hogue C
DOI：
10.1007/978-3-030-59436-7_29
发表时间：
2021-01-01
期刊：
Acta neurochirurgica. Supplement
影响因子：
--
作者：
Tas, Jeanette;Beqiri, Erta;Aries, Marcel J
通讯作者：
Aries, Marcel J
影响因子：
3.3
作者：
Brady, Ken M.;Easley, R. Blaine;Rusin, Craig G.
通讯作者：
Rusin, Craig G.
影响因子：
8.8
作者：
Sekhon, Mypinder S.;Gooderham, Peter;Griesdale, Donald E. G.
通讯作者：
Griesdale, Donald E. G.
影响因子：
2.4
作者：
Stocchetti, Nino;Picetti, Edoardo;Servadei, Franco
通讯作者：
Servadei, Franco