Detection of Cerebral Ischemia With a Noninvasive Neurometabolic Optical Monitor

描述(由申请人提供)：重症监护医生需要床边脑血流监测仪(CBF)和脑氧代谢率(CMRO2)。危重病患者对脑缺血/缺氧耐受的时间敏感性研究 神经血管病理生理学的患者一直不能在床边轻松、反复、无创地测定CBF和CMRO2，以便于快速诊断缺血。这方面的替代品有很多。没有一个是令人满意的。其他几个 这种方法需要将患者运送到成像套件，因此不是真正的监护仪，增加了运输的风险。这导致临床医生做出针对非神经学终点的治疗决定，例如血压、二氧化碳分压等，“希望”这种干预措施将对脑血流和新陈代谢产生预期的效果。漫反射相关光谱(DCS)和漫反射光谱(DOS)是宾夕法尼亚大学正在开发的一种很有前途的光学技术，它们可以分别提供连续的定量rCBF、rCMRO2和氧提取分数(OEF)信息，新技术可以提供CBF、CMRO2和OEF的连续绝对测量。我们的长期目标是通过开发改进的床边CBF/CMR监测技术来防止住院期间脑组织死亡的发展，这将使个性化治疗得以实施，以防止此类伴随着长期残疾的不良后果。我们的具体目的是验证神经ICU患者的假设：1.光学监测皮质rCBF指示皮质下组织CBF 2.光学监测技术可以检测无氧脑血流阈值3.光学监测技术可以预测无氧脑缺血无创光学监测将通过有创微透析和PbrO2和有创热稀释CBF证实无氧状态的检测和低CBF以有创监测仪作为无氧缺血的金标准，将进行敏感性/特异性和模式分析，利用光学监测无创性检测和预测无氧缺血。这项拟议的研究将使生理学和药物治疗的程序化但个体化的目标导向滴定的概念成为可能，以防止因缺血性中风、脑出血、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.