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

基本信息

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
项目类别：
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

项目摘要

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.

项目摘要尽管持续改善，但涉及心肺旁路（CPB）的主要血管和心脏手术仍会导致在高神经损伤的情况下。 CPB期间的病理生理变化会导致药代动力学改变使麻醉的治疗复杂化，并显着改变主要器官血流。麻醉和镇痛代理针对中枢神经系统，并结合潜在的大脑自身调节，可能导致将氧气递送到大脑不足。而患者的全身血液动力学和呼吸道监测长期以来使用了很长时间，没有评估大脑健康的接受标准。许多基于大脑氧仪，基于在连续波浪上，市场上存在近红外光谱测量。但是，尽管研究表明一些手术过程中脑血红蛋白氧饱和度（SO2）的效用与神经系统相关缺陷，它们尚未被用作临床标准。这主要是因为它们基于廉价技术以及需要许多假设的方法，使其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的解释是模棱两可的，因为反映了多个系统性和脑生理参数和临床状况的综合影响，包括脑血流，氧气消耗，血细胞比容和温度。在此应用程序中，我们建议开发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的多个方面的反馈。利用我们小组的丰富经验仪器开发，我们将结合频域近红外光谱以及弥漫性相关性具有固有或超声辅助估算的组织层厚度的光谱测量值为了获得灌注的定量测量，血红蛋白氧合和脑充氧代谢创新的蒙特卡洛基本运输建模算法。我们将确定我们的准确性和精度使用组织现实的幻象和微型猪动物模型进行测量。接下来，我们将执行验证在监测大脑的同时，在常氧，高氧和高碳酸状态下，健康人类受试者的测量使用MRI方法的灌注和区域静脉氧合。最后，我们将在在心肺旁路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是神经损伤的预测，新的缺血性病变的发展扩散加权MRI和延长的住院住院，优于当前的脑氧仪。我们将证明使用我们的设备在手术室中监测大脑健康的可行性，收集的数据将作为基础为了进一步的假设产生并计划随访，有针对性的临床研究。我们希望在非侵入性神经监测工具的最新艺术，并启用一种新的个性化护理，可以导致在心肺旁路下由手术程序导致的负面结果减少。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（1）

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

Comparing the performance potential of speckle contrast optical spectroscopy and diffuse correlation spectroscopy for cerebral blood flow monitoring using Monte Carlo simulations in realistic head geometries.

DOI：
10.1117/1.nph.11.1.015004
发表时间：
2024-01
期刊：
Neurophotonics
影响因子：
5.3
作者：
通讯作者：

Diffuse correlation spectroscopy: current status and future outlook.

DOI：
10.1117/1.nph.10.1.013509
发表时间：
2023-01
期刊：
Neurophotonics
影响因子：
5.3
作者：
通讯作者：

Functional Time Domain Diffuse Correlation Spectroscopy.

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.