Real-time myoglobin saturation measurement to assess benefit of RBC transfusion

实时肌红蛋白饱和度测量以评估红细胞输血的益处

• 批准号: 8880786
• 负责人: LORILEE S. L. ARAKAKI
• 金额: $ 15万
• 依托单位: OPTICYTE, INC.
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2016-08-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8880786
• 关键词: Accident and Emergency department; Algorithms; Ambulances; Anemia; Animal Model; Biological Markers; Blood; Blood Transfusion; Blood capillaries; Caring; Cells; Chemical Industry; Clinical; Clinical Research; Color; Consumption; Critical Illness; Cytochromes; Decision Making; Devices; Dissociation; Erythrocyte Transfusion; Evaluation; Explosion; Factor Analysis; Food Industry; Goals; Government; Heart failure; Hemoglobin; Hemorrhagic Shock; Hospitals; Hypoxia; In Vitro; Intensive Care Units; Intention; Left; Light; Limb structure; Marketing; Measurement; Measures; Medical; Methods; Modeling; Monitor; Morbidity - disease rate; Muscle; Muscle Cells; Myoglobin; Near-Infrared Spectroscopy; Operating Rooms; Optics; Organ; Oryctolagus cuniculus; Outcome; Oxygen; Oxygen saturation measurement; Patient Care; Patients; Peripheral Vascular Diseases; Persons; Physiologic pulse; Pulse Oximetry; Qualifying; Research; Sepsis; Shock; Skeletal Muscle; Skin; Spectrum Analysis; Standardization; Surface; Technology; Testing; Therapeutic; Time; Tissues; Training; Universities; Venous; Washington; Weight; Work; abstracting; base; capillary; clinical care; clinical practice; experience; in vivo; innovation; medical specialties; monitoring device; mortality; novel; oxidation; patient oriented; phantom model; prevent; public health relevance; standard of care; temporal measurement

 DESCRIPTION (provided by applicant): Critically ill patients commonly arrive at an intensive care unit with anemia. While blood transfusions are the standard of care with the intention to increase or maintain oxygen delivery to tissues, questions have been raised about the benefit of blood transfusions, particularly in non-bleeding patients with moderate anemia. A noninvasive measure of intracellular PO2 is needed to evaluate the effect and efficacy of blood transfusions on tissue and organ oxygen sufficiency. Evidenced by the explosion of new pulse oximetry and near infrared spectroscopy (NIRS) devices on the market, optical spectroscopy is attractive for noninvasive tissue monitoring in many hospital settings. But we are not there yet - no existing clinical device has overcome the critical hurdle of accurately quantifying cellular biomarkers that are sensitive to oxygenation. We propose to develop a novel, noninvasive cell oximeter that will provide real-time measurement of myoglobin saturation from optical reflectance spectra. Intracellular PO2 will be calculated from myoglobin saturation using known myoglobin oxygen dissociation curves. Continuous intracellular PO2 measurement will allow unprecedented assessment of oxygen delivery and consumption. The specific aims of this proposal are to: 1) build a three-distance optical probe; 2) develop and validate measurement of myoglobin saturation in vitro; and 3) assess the benefit of RBC transfusion in an animal model. A new probe will be built to measure spectra from superficial, intermediate, and deep tissue regions from the surface of the rabbit hind limb. In Aim 2, Parallel Factor analysis (PARAFAC) models will be developed and tested with phantoms that model the rabbit hind limb. The phantoms will have known myoglobin and hemoglobin saturations and concentrations so that the accuracy of myoglobin saturation measurement can be objectively evaluated. Finally, in Aim 3, spectra will be acquired from rabbits subjected to hemorrhagic shock. These spectra will be used to calibrate in vivo PARAFAC models. The models will enable myoglobin saturation monitoring in real time from new spectra collected from rabbits with moderate anemia that will receive RBC transfusions. The study will answer two key questions: is tissue hypoxic during moderate anemia and if so, does RBC transfusion remedy the hypoxia? Intracellular PO2 monitoring with our new device will have broad implications in clinical practice and clinical research. We envision that intracellular PO2 monitoring will become a critical component in the care of patients with oxygen insufficiency, including those with sepsis, shock, and cardiac failure. Our long-term goal is to develop the cell oximeter for clinical use in ambulances, emergency departments, intensive care units, and operating rooms.

 描述（由适用提供）：病重的患者通常到达患有贫血的重症监护室。虽然输血是护理的标准，目的是增加或维持向组织的氧气递送，但已经提出了有关输血的益处的问题，尤其是在现代性贫血的非出血患者中。需要对细胞内PO2进行无创测量，以评估输血对组织和器官氧气安全的影响和有效性。市场上新的脉搏氧和近红外光谱（NIRS）设备的爆炸证明，光谱对于许多医院环境中的非侵入性组织监测都有吸引力。但是我们还没有在那里 - 没有现有的临床装置克服了准确量化细胞生物标志物的关键障碍 我们建议开发一种新型的非侵入性细胞氧合剂，该氧合将通过光反射光谱提供实时测量肌红蛋白饱和度。细胞内PO2将使用已知的肌红蛋白氧解离曲线根据肌红蛋白饱和度计算。连续的细胞内PO2测量将允许对氧递送和消耗的前所未有的评估。该提案的具体目的是：1）构建三距光学探测； 2）体外的开发和验证肌红蛋白饱和度的测量； 3）评估动物模型中RBC输血的好处。将建造一个新的探针，以测量兔后肢表面的表面，中间和深层组织区域的光谱。在AIM 2中，将使用对兔子后肢进行建模的幻象来开发和测试并行因子分析（PARAFAC）模型。幻影将知道肌红蛋白和血红蛋白饱和度和浓度，因此可以客观地评估肌红蛋白饱和度测量的准确性。最后，在AIM 3中，光谱将从兔子受到出血性休克的影响。这些光谱将用于校准体内parafac模型。这些模型将从具有中度贫血的兔子收集的新光谱中实时实时进行肌红蛋白饱和度监测，该光谱将接受RBC输血。研究将回答两个关键问题：中度贫血期间组织缺氧是否吗？如果是，RBC输血是否会补救缺氧？使用我们的新设备的细胞内PO2监测将在临床实践和临床研究中具有广泛的影响。我们设想，细胞内PO2监测将成为氧气功能不全患者的关键组成部分，包括患有败血症，休克和心脏衰竭的患者。我们的长期目标是开发氧化细胞氧化物，用于救护车，急诊部门，重症监护病房和手术室。