Augmented Physiologic Monitoring to Predict Brain Injury in Infants with CHD

描述（由申请人提供）：新型无创光学仪器，包括近红外光谱（NIRS）和漫射相关光谱（DCS），提高了我们实时测量脑血流动力学和氧合的能力。近红外光谱测量脑氧合已迅速应用于临床实践，但尚未得到严格的研究。用于测量脑血流量的DCS是光学成像领域的最新创新。DCS和NIRS的联合应用扩展了我们研究早期心脏手术后临床护理对脑血流动力学和脑代谢的影响的能力。此外，使用DCS连续评估脑血流量，我们将能够通过对平均动脉血压进行新的时间序列相关分析来评估脑自动调节。脑自动调节是一种保护机制，其宽泛的定义是在体压波动的情况下维持恒定和充足的脑血流量的能力，可能因危重疾病而功能失调。使用这些新的光学仪器，我们计划研究需要进行婴儿心脏手术的严重先天性心脏缺陷（CHD）婴儿脑室周围白质软化（PVL）形式脑损伤的时间和原因。在患有冠心病的婴儿中，手术前PVL损伤发生率为20%，手术后仅为50%以上。通过监测婴儿心脏手术后脑组织血氧、血流和代谢，我们将探讨冠心病患者发生新的或恶化的PVL损伤的脑血流动力学危险因素。更好地了解这一人群发生PVL的时间和原因将有助于医生制定治疗或预防PVL的策略。此外，从这项研究中获得的知识将有助于设计其他“高危”婴儿群体的研究，如早产儿或有出生创伤的婴儿。

DESCRIPTION (provided by applicant): Novel non-invasive optical instrumentation including near infrared spectroscopy (NIRS) and diffuse correlation spectroscopy (DCS) increase our ability to measure cerebral hemodynamics and oxygenation in real time. NIRS measurement of cerebral oxygenation has been rapidly accepted into clinical practice, but has not been rigorously studied. DCS for measuring cerebral blood flow, is a more recent innovation in optical imaging. Used in combination DCS and NIRS expand our capability to study how cerebral hemodynamics and cerebral metabolism are affected by clinical care following early heart surgery. Further, using DCS to continuously assess cerebral blood flow we will be able to assess cerebral autoregulation by performing new time-series correlation analysis with mean arterial blood pressure. Cerebral autoregulation is a protective mechanism loosely defined as the ability to maintain constant and adequate cerebral blood flow despite fluctuations in systemic blood pressures, may become dysfunctional as a consequence of critical illness. Using these new optical instruments we plan to study the timing and causes of brain injury in the form of periventricular leukomalacia (PVL) in infants with severe forms congenital heart defects (CHD) that require infant heart surgery. In infants with CHD the PVL injury occurs in 20% before surgery and just over 50% afterwards. By monitoring brain tissue blood oxygenation, flow, and metabolism after infant heart surgery, we will investigate the cerebral hemodynamic risk-factors for developing new or worsened PVL injury in CHD patients. A better understanding of the timing and causes of PVL in this population will help physicians build strategies to treat or prevent it. Furthermore, the knowledge gained from this study will help design studies for other 'at- risk' populations of infants, such as premature infants or infants who have had birth trauma.