Detection of Cerebral Ischemia With a Noninvasive Neurometabolic Optical Monitor

描述（由申请人提供）：重症监护医生需要一个与脑氧代谢率（CMRO 2）耦合的床旁脑血流监测仪（CBF）。 在时间敏感性脑缺血/缺氧不耐受的情况下， 患有神经血管病理生理学的患者总是由于不能容易地、重复地和非侵入性地在床边测定CBF和CMRO 2以促进缺血的快速诊断而受到阻碍。 这方面存在许多替代品。 没有一个是令人满意的。 若干附加 这些方法需要将患者运送到成像室，因此不是真正的具有额外的运送风险的监视器。这导致临床医生做出针对非神经学终点的治疗决策，例如，血压、PaCO 2等，“希望”这样的干预措施能对大脑灌注和代谢产生预期的效果。 扩散相关光谱（DCS）和扩散光学光谱（DOS）是宾夕法尼亚大学正在开发的有前途的光学技术，可以提供连续定量的rCBF，rCMRO 2和氧提取分数（OEF）信息，分别与新技术可提供连续的绝对测量CBF，CMRO 2和OEF。我们的长期目标是通过开发改进的床边CBF/CMR监测技术来防止院内脑组织死亡的发展，这些技术将能够实施个性化治疗，以防止伴随长期残疾的不良结局。我们的具体目标是在神经ICU患者中验证以下假设：1。皮质rCBF的光学监测表明皮质下组织CBF 2。光学监测技术可以检测无氧CBF阈值3。 光学监测技术可以预测无氧脑缺血无创光学监测检测无氧条件将确认有创微透析和PbrO 2和低CBF将确认有创热稀释CBF使用有创监测器作为无氧缺血的金标准，灵敏度/特异性和模式分析将进行无创检测和预测无氧缺血与光学监测。拟议的研究将使可行的概念，协议，但个性化的目标导向滴定的生理和药物治疗 预防因缺血性卒中、脑内出血、硬膜下出血、蛛网膜下腔出血和创伤性脑损伤入院的患者发生新的脑组织死亡。 这些疾病构成了美国残疾的主要原因。

DESCRIPTION (provided by applicant): Critical care physician's need a bedside cerebral blood flow monitor (CBF) coupled to cerebral metabolic rate for oxygen (CMRO2). In the context of time-sensitive intolerance of the brain to ischemia/hypoxia management of critically ill patients with neurovascular pathophysiology has always been hindered by inability to easily, repeatedly, and noninvasively, at the bedside~ determine CBF and CMRO2 to facilitate fast diagnosis of ischemia. Many surrogates for this exist. None are satisfactory. Several additional methods require transport of the patient to an imaging suite and thus are not true monitors with added risk of transport. This has resulted in clinicians making therapeutic decisions directed to non-neurologic endpoints, e.g., blood pressure, PaCO2 and so on, "hoping" that such interventions will have a desired effect on brain perfusion and metabolism. Diffuse Correlation Spectroscopy(DCS) and diffuse optical spectroscopy(DOS) are promising optical techniques under development at UPenn which can provide continuous quantitative rCBF,rCMRO2 and oxygen extraction fraction (OEF) information, respectively, with new technology available to provide for continuous absolute measures of CBF, CMRO2, and OEF. Our long range goal is to prevent the development of in-hospital brain tissue death through development of improved bedside CBF/CMR monitoring techniques that will enable implementation of individualized therapy to prevent such adverse outcomes with their attendant long term disabilities. Our specific aims are to test the hypotheses in neuroICU patients that: 1. Optical monitoring of cortical rCBF indicates subcortical tissue CBF 2. Optical monitoring techniques can detect anaerobic CBF thresholds 3. Optical monitoring techniques can predict anaerobic brain ischemia Noninvasive optical monitoring detection of anaerobic conditions will be confirmed with invasive microdialysis and PbrO2 and low CBF will be confirmed with invasive thermodilution CBF Using invasive monitors as the gold standard for anaerobic ischemia, sensitivity/specificity and pattern analyses will be performed for noninvasive detection and prediction of anaerobic ischemia with optical monitoring. The proposed research will make feasible the notion of protocolized yet individualized goal-directed titration of physiologic and pharmacologic therapy to prevent new brain tissue death in patients admitted with ischemic stroke, intracerebral hemorrhage, subdural hemorrhage, subarachnoid hemorrhage, and traumatic brain injury. These diseases constitute the leading causes of disability in the United States.