Validation of NIRS CBF with XeCTCBF

使用 XeCTCBF 验证 NIRS CBF

• 批准号: 8036098
• 负责人: W ANDREW KOFKE
• 金额: $ 23.52万
• 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 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8036098
• 关键词: Acute; Agreement; 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”已经产生了完全令人不安的情况，其中危重病人被送入医院，没有梗塞的脑组织，然而，经过一段时间的极度紧张和昂贵的危重护理后，出院时又有新的医院获得的死亡脑组织。我们的长期目标和总体目标是通过开发改进的床旁rCBF监测技术来防止院内脑组织死亡的发展，该技术将能够实施个性化治疗以防止此类不良结果及其伴随的长期残疾。早期的研究表明，近红外光谱（NIRS）技术，涉及扩散相关光谱（DCS）连续CBF测量有希望发展成为有价值的床边CBF监测。我们的具体目标是在NeuroICU蛛网膜下腔出血（SAH）患者中验证以下假设：1。DCS rCBF的变化准确反映了XeCTCBF a的急性变化。将在血压操作前后同时测定XeCTCBF和DCS，然后分析两项测量的分数变化的相关程度。2. DCS rCBF准确地反映了血管痉挛诱导的XeCTCBF a变化。连续DCS将连续和连续地与XeCTCBF进行比较，然后分析两种测量中分数变化的相关程度。稳定氙计算机断层扫描rCBF（XeCTCBF）将提供整个大脑的详细和定量CBF图。黄金标准。DCS CBF将在六个主要脑动脉分布上确定。将通过相关性方法比较匹配区域XeCTCBF和DCS CBF的分数变化，Bland-Altman分析也将用于检验XeCTCBF和DCS之间的一致性。 DCS CBF技术，如果有效的话，将可能最终成为临床医生的一个重要工具，用于预防因缺血性卒中、脑内出血、硬膜下出血、蛛网膜下腔出血和创伤性脑损伤而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。 公共卫生相关性：神经系统危重患者的治疗因无法在床边简单、重复和无创地测定局部脑血流量（rCBF）而受阻。拟议的研究将在健康志愿者中验证弥散相关光谱脑血流方法，该方法可为危重患者提供连续床旁rCBF监测的能力。这项技术，如果有效的话，最终将有助于防止新的神经死亡的缺血性中风，脑内出血，蛛网膜下腔出血，创伤性脑损伤患者入院，使个性化滴定ICU治疗的重要神经生理参数。这些疾病构成了美国残疾的主要原因。