Non-invasive monitoring of brain health during cardio-pulmonary bypass

体外循环期间大脑健康的无创监测

• 批准号: 10319491
• 负责人: Stefan Alexandru Carp
• 金额: $ 60.3万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10319491
• 关键词: 3-Dimensional; Adopted; Algorithms; Analgesics; Anesthesia procedures; Anesthetics; Animal Model; Animals; Area; Blood Pressure; Blood Vessels; Blood flow; Brain; Brain hemorrhage; Bypass; Cardiac Surgery procedures; Cardiopulmonary Bypass; Cardiovascular Surgical Procedures; Cerebrovascular Circulation; Cerebrum; Clinical; Clinical Research; Cognitive deficits; Consumption; Data; Development; Devices; Diffuse; Diffusion Magnetic Resonance Imaging; Drops; Drug Kinetics; Electroencephalography; Failure; Family suidae; Feedback; Frequencies; General Anesthesia; Generations; Geometry; Goals; Gold; Guidelines; Head; Health; Hematocrit procedure; Hemoglobin; Homeostasis; Human; Hypercapnia; Hyperthermia; Hypotension; Hypoxia; Impairment; Incidence; Intervention; Lead; Length of Stay; Lesion; Light; Location; Magnetic Resonance Imaging; Maintenance; Measurement; Measures; Metabolic; Metabolism; Methods; Microcirculation; Modeling; Monitor; Morbidity - disease rate; Near-Infrared Spectroscopy; Nervous System Trauma; Neuraxis; Neurologic Deficit; Neurological outcome; Normal Range; Operating Rooms; Operative Surgical Procedures; Organ; Outcome; Oxygen; Oxygen Consumption; Oxygen saturation measurement; Patient Monitoring; Patient-Focused Outcomes; Patients; Perfusion; Perioperative; Physiological; Physiology; Pilot Projects; Postoperative Period; Procedures; Rewarming; Risk; Scalp structure; Seizures; Shapes; Signal Transduction; Spectrum Analysis; Techniques; Technology; Temperature; Therapeutic Embolization; Thick; Time; Tissues; Transcranial Doppler Ultrasonography; Validation; Venous; Water; base; brain health; cerebral hypoperfusion; cerebral oxygenation; cranium; data quality; experience; follow-up; functional status; health management; hemodynamics; human subject; improved; indexing; innovation; instrument; instrumentation; ischemic lesion; metabolic rate; middle cerebral artery; mortality; natural hypothermia; non-invasive monitor; novel; patient variability; personalized care; prevent; respiratory; standard measure; targeted agent; tool; ultrasound

PROJECT SUMMARY Despite continued improvements, major vascular and cardiac surgeries involving cardio-pulmonary bypass (CPB) still result in high rates of neurological injury. Pathophysiologic changes during CPB result in pharmacokinetic alterations that complicate the management of anesthesia and significantly alter major organ blood flow. Both anesthetic and analgesic agents target the central nervous system and, in conjunction with potentially impaired cerebral auto-regulation, can result in insufficient delivery of oxygen to the brain. While systemic hemodynamic and respiratory monitoring of the patients has been used for a long time, there is no accepted standard for assessing brain health. A number of cerebral oximeters, based on continuous-wave near-infrared spectroscopy measurements exist on the market. However, despite studies showing some utility in that drops in brain hemoglobin oxygen saturation (SO2) during surgery have been correlated with neurological deficits, they have not been adopted as clinical standards. This is largely because they are based on inexpensive technology and approaches that require many assumptions, making them sensitive to extracerebral contamination and unable to provide a quantitative threshold for guiding clinical interventions. Further, interpretation of SO2 alone is ambiguous, as it reflects the combined influence of multiple systemic and cerebral physiological parameters and clinical conditions, including cerebral blood flow, oxygen consumption, hematocrit, and temperature. In this application, we propose to develop a state-of-the art non-invasive brain health monitoring tool to provide real-time feedback on multiple aspects of the brain functional status. Leveraging the substantial experience of our group in instrumentation development, we will combine frequency domain near-infrared spectroscopy as well as diffuse correlation spectroscopy measurements at multiple distances with intrinsic or ultrasound assisted estimates of tissue layer thicknesses to obtain quantitative measures of perfusion, hemoglobin oxygenation and cerebral oxygen metabolism by means of innovative Monte Carlo based light transport modeling algorithms. We will determine the accuracy and precision of our measurements using both tissue-realistic phantoms and a miniature pig animal model. Next, we will perform validation measurements in healthy human subjects during normoxic, hyperoxic and hypercapnic states while monitoring brain perfusion and regional venous oxygenation using MRI methods. Finally, we will perform a pilot clinical measurements in patients undergoing cardiovascular surgery under cardio-pulmonary bypass. We hypothesize that decreases in brain oxygenation and perfusion during surgery are predictive of neurological injury, development of new ischemic lesions on diffusion weighted MRI and extended hospital stay and superior to current cerebral oximeters. We will demonstrate the feasibility of monitoring cerebral health using our device in the operating room and the collected data will serve as a basis for further hypothesis generation and to plan follow-up, targeted clinical studies. We hope to offer a significant advance in the state-of-the art of non-invasive neuromonitoring tools, and enable a new level of personalized care that can lead to a reduction in negative outcomes resulting from surgical procedures under cardio-pulmonary bypass.

项目概要 尽管不断改进，但涉及体外循环 (CPB) 的主要血管和心脏手术仍然会发生 神经损伤的发生率很高。 CPB 期间的病理生理变化导致药代动力学改变 使麻醉管理变得复杂并显着改变主要器官的血流。兼具麻醉和镇痛作用 药物以中枢神经系统为目标，与潜在的大脑自动调节功能受损相结合，可能会导致 向大脑输送氧气不足。虽然对患者进行全身血流动力学和呼吸监测 虽然已经使用了很长时间，但目前还没有评估大脑健康的公认标准。一些脑血氧计，基于 市场上存在连续波近红外光谱测量的方法。然而，尽管研究表明一些 手术期间脑血红蛋白氧饱和度 (SO2) 下降的效用与神经功能相关 缺陷，尚未被采纳为临床标准。这主要是因为它们基于廉价的技术 以及需要许多假设的方法，使它们对脑外污染敏感并且无法 为指导临床干预提供定量阈值。此外，单独对 SO2 的解释是不明确的，因为它 反映了多种全身和脑生理参数以及临床状况的综合影响，包括 脑血流量、耗氧量、血细胞比容和温度。 在此应用中，我们建议开发一种最先进的非侵入性大脑健康监测工具，以提供实时 大脑功能状态多个方面的反馈。凭借我们集团在以下方面的丰富经验 仪器开发，我们将结合频域近红外光谱以及漫相关 通过内在或超声辅助估计组织层厚度进行多距离光谱测量 通过以下方式获得灌注、血红蛋白氧合和脑氧代谢的定量测量 基于蒙特卡罗的创新光传输建模算法。我们将确定我们的准确性和精确度 使用组织逼真的模型和小型猪动物模型进行测量。接下来我们将进行验证 在监测大脑的同时，对健康受试者在正常含氧量、高含氧量和高碳酸血症状态下进行测量 使用 MRI 方法进行灌注和局部静脉氧合。最后，我们将进行试点临床测量 在体外循环下接受心血管手术的患者。我们假设大脑减少 手术期间的氧合和灌注可预测神经损伤、新缺血性病变的发生 弥散加权 MRI 和延长的住院时间并优于当前的脑血氧计。我们将展示 在手术室使用我们的设备监测脑健康的可行性，收集的数据将作为基础 用于进一步的假设生成并计划后续、有针对性的临床研究。我们希望在以下方面取得重大进展 最先进的非侵入性神经监测工具，并实现新水平的个性化护理，从而实现 减少体外循环手术造成的负面结果。

项目成果

Interferometric diffuse correlation spectroscopy improves measurements at long source-detector separation and low photon count rate.

• DOI: 10.1117/1.jbo.25.9.097004
• 发表时间: 2020-09
• 期刊: Journal of biomedical optics
• 影响因子: 3.5
• 作者: Robinson M;Boas D;Sakadžic S;Franceschini MA;Carp S
• 通讯作者: Carp S

Diffuse correlation spectroscopy measurements of blood flow using 1064 nm light.

• DOI: 10.1117/1.jbo.25.9.097003
• 发表时间: 2020-09
• 期刊: Journal of biomedical optics
• 影响因子: 3.5
• 作者: Carp S;Tamborini D;Mazumder D;Wu KC;Robinson M;Stephens K;Shatrovoy O;Lue N;Ozana N;Blackwell M;Franceschini MA
• 通讯作者: Franceschini MA

The role of diffuse correlation spectroscopy and frequency-domain near-infrared spectroscopy in monitoring cerebral hemodynamics during hypothermic circulatory arrests.

• DOI: 10.1016/j.xjtc.2021.01.023
• 发表时间: 2021-06
• 期刊: JTCVS techniques
• 影响因子: 1.6
• 作者: Zavriyev AI;Kaya K;Farzam P;Farzam PY;Sunwoo J;Jassar AS;Sundt TM;Carp SA;Franceschini MA;Qu JZ
• 通讯作者: Qu JZ

Complete head cerebral sensitivity mapping for diffuse correlation spectroscopy using subject-specific magnetic resonance imaging models.

使用特定对象的磁共振成像模型完成漫相关光谱的头部大脑敏感性图。

• DOI: 10.1364/boe.449046
• 发表时间: 2022
• 期刊: Biomedical optics express
• 影响因子: 3.4
• 作者: Wu,MelissaM;Perdue,Katherine;Chan,Suk-Tak;Stephens,KimberlyA;Deng,Bin;Franceschini,MariaAngela;Carp,StefanA
• 通讯作者: Carp,StefanA

Functional Time Domain Diffuse Correlation Spectroscopy.

功能域扩散相关光谱。

• DOI: 10.3389/fnins.2022.932119
• 发表时间: 2022
• 期刊: FRONTIERS IN NEUROSCIENCE
• 影响因子: 4.3
• 作者: Ozana, Nisan;Lue, Niyom;Renna, Marco;Robinson, Mitchell B.;Martin, Alyssa;Zavriyev, Alexander I.;Carr, Bryce;Mazumder, Dibbyan;Blackwell, Megan H.;Franceschini, Maria A.;Carp, Stefan A.
• 通讯作者: Carp, Stefan A.