Validation of NIRS CBF with XeCTCBF

使用 XeCTCBF 验证 NIRS CBF

• 批准号: 7893486
• 负责人: W ANDREW KOFKE
• 金额: $ 19.88万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7893486
• 关键词: Acute; Agreement; Arts; Blood Pressure; Blood flow; Brain; Brain Infarction; Caregivers; Cerebral hemisphere hemorrhage; Cerebrovascular Circulation; Cerebrum; Cessation of life; Clinical Protocols; Core-Binding Factor; Critical Care; Critical Illness; Development; Diffuse; Disease; Functional disorder; Goals; Gold; Homeostasis; Hospitals; Image; Infarction; Ischemic Stroke; Life; Maps; Measurement; Measures; Methods; Monitor; Near-Infrared Spectroscopy; Optics; Oxygen saturation measurement; Patients; Physical Examination; Physicians; Physiological; Principal Investigator; Radionuclide Imaging; Research; Spectrum Analysis; Subarachnoid Hemorrhage; Subdural Hematoma; Techniques; Technology; Testing; Titrations; Transcranial Doppler Ultrasonography; Traumatic Brain Injury; United States; Validation; Vasospasm; Xenon; adverse outcome; brain tissue; cerebral artery; design; disability; expectation; healthy volunteer; improved; prevent; programs; public health relevance; relating to nervous system; tool

DESCRIPTION (provided by applicant): Present "state of the art" has created the altogether unsettling situation wherein a critically ill patient is admitted to the hospital with no infarcted brain tissue and yet, after a period of extremely intense and expensive critical care, is discharged with new hospital-acquired dead brain tissue. Our long range goal and overall objective is to prevent the development of in- hospital brain tissue death through development of improved bedside rCBF monitoring techniques that will enable implementation of individualized therapy to prevent such adverse outcomes with their attendant long term disabilities. Early studies suggest near infrared spectroscopy (NIRS) techniques that involve diffuse correlation spectroscopic (DCS) continuous CBF measurement have promise to be developed into valuable bedside CBF monitors. Our specific aims are to test the hypotheses in NeuroICU patients with subarachnoid hemorrhage (SAH) that: 1. Changes in DCS rCBF accurately reflect acute changes in XeCTCBF a. XeCTCBF and DCS will concurrently be determined before and after blood pressure manipulation followed by analysis for degree of correlation of the fractional changes in the two measures. 2. DCS rCBF accurately reflects vasospasm-induced changes in XeCTCBF a. Continuous DCS will be employed continuously and serially compared with XeCTCBF followed by analysis for degree of correlation of the fractional changes in the two measures Stable xenon computed tomographic rCBF (XeCTCBF) will provide a detailed and quantitative CBF map throughout the brain...the Gold standard. DCS CBF will be determined over the six major cerebral artery distributions. Fractional changes in matched regional XeCTCBF's and DCS CBF will be compared through correlation methods and Bland-Altman analysis also will be used to test agreement between XeCTCBF and DCS. The DCS CBF technique, if valid, will likely eventually become an important tool for clinicians in their efforts 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 cause of disability in the United States. PUBLIC HEALTH RELEVANCE: Narrative Management of neurologically critically ill patients is hindered by inability to easily, repeatedly, and noninvasively, at the bedside, determine regional cerebral blood flow (rCBF). The proposed research will validate in healthy volunteers the Diffuse Correlation Spectroscopy Brain Blood Flow method which may provide the ability to do continuous bedside rCBF monitoring in critically ill patients. This technique, if valid, will eventually help prevent new neural death in patients admitted with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic brain injury by enabling individualized titration of ICU therapies against an important neurophysiologic parameter. These diseases constitute the leading cause of disability in the United States..

描述（由申请人提供）：目前的“现有技术”已经造成了一种完全令人不安的情况，一名重症患者入院时没有梗塞的脑组织，但经过一段时间极其紧张和昂贵的重症监护后，出院时却出现了新的医院获得性死亡脑组织。我们的长期目标和总体目标是通过开发改进的床边 rCBF 监测技术来预防院内脑组织死亡的发生，该技术将能够实施个体化治疗，以防止此类不良后果及其伴随的长期残疾。早期研究表明，涉及漫相关光谱 (DCS) 连续 CBF 测量的近红外光谱 (NIRS) 技术有望发展成为有价值的床边 CBF 监测仪。我们的具体目标是在患有蛛网膜下腔出血 (SAH) 的 NeuroICU 患者中检验以下假设： 1. DCS rCBF 的变化准确反映了 XeCTCBF a 的急性变化。 XeCTCBF 和 DCS 将在血压操作前后同时测定，然后分析这两种测量值分数变化的相关程度。 2. DCS rCBF 准确反映血管痉挛引起的 XeCTCBF 变化将连续采用连续 DCS 与 XeCTCBF 进行比较，然后分析两种测量中分数变化的相关程度。稳定的氙计算机断层扫描 rCBF (XeCTCBF) 将提供整个大脑详细且定量的 CBF 图……金标准。 DCS CBF 将根据六个主要大脑动脉分布来确定。将通过相关方法比较匹配的区域 XeCTCBF 和 DCS CBF 的分数变化，并且 Bland-Altman 分析也将用于测试 XeCTCBF 和 DCS 之间的一致性。 DCS CBF 技术如果有效，最终可能会成为临床医生预防缺血性中风、脑内出血、硬膜下出血、蛛网膜下腔出血和创伤性脑损伤患者新发脑组织死亡的重要工具。这些疾病构成了美国残疾的主要原因。 公共卫生相关性：神经危重患者的叙述管理因无法在床边轻松、重复和无创地确定局部脑血流量 (rCBF) 而受到阻碍。拟议的研究将在健康志愿者中验证扩散相关光谱脑血流方法，该方法可能提供对危重患者进行连续床边 rCBF 监测的能力。这项技术如果有效，最终将通过针对重要的神经生理参数对 ICU 治疗进行个体化调整，最终有助于预防因缺血性中风、脑出血、蛛网膜下腔出血和创伤性脑损伤入院的患者出现新的神经死亡。这些疾病构成了美国残疾的主要原因。