Confirmation of brain death using optical methods based on tracking of an optical contrast agent: assessment of diagnostic feasibility.
Confirmation of brain death using optical methods based on tracking of an optical contrast agent: assessment of diagnostic feasibility.
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DOI：
10.1038/s41598-018-25351-6
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发表时间：
2018-05-09
影响因子：
4.6
通讯作者：
Liebert A
中科院分区：
文献类型：
--
作者：
Weigl W;Milej D;Gerega A;Toczyłowska B;Sawosz P;Kacprzak M;Janusek D;Wojtkiewicz S;Maniewski R;Liebert A
我们的目的是确定基于光学造影剂团注跟踪的光学方法是否有助于确认接受脑死亡评估的患者的脑循环停止。比较了三组受试者脑血流灌注障碍的不同阶段：对照组、创伤后脑水肿患者和脑死亡患者。我们使用时间分辨近红外光谱装置和吲哚青绿(ICG)作为血管内血流示踪剂。采用正交偏最小二乘判别分析(OPLS-DA)建立考虑分组分离的统计模型。37例中正确分型30例(81.1%)，其中对照组9例，占88.9%；水肿组15例，占86.7%；脑死亡组13例，占69.2%；p <； ，0.0001)。根据OPLS-DA模型中使用的变量组合，敏感性、特异性和准确性分别为66.7-92.9%、81.8-92.9%和77.3-89.3%。该方法在要求较高的重症监护病房环境中是可行的，具有良好的应用前景。然而，它的准确性没有达到确认脑死亡所需的水平。通过增加光的穿透深度，与其他评估脑血流停止的方法相比，确认其准确性，并开发脑血流灌注的绝对参数，可以提高该方法的潜在有用性。
We aimed to determine whether optical methods based on bolus tracking of an optical contrast agent are useful for the confirmation of cerebral circulation cessation in patients being evaluated for brain death. Different stages of cerebral perfusion disturbance were compared in three groups of subjects: controls, patients with posttraumatic cerebral edema, and patients with brain death. We used a time-resolved near-infrared spectroscopy setup and indocyanine green (ICG) as an intravascular flow tracer. Orthogonal partial least squares-discriminant analysis (OPLS-DA) was carried out to build statistical models allowing for group separation. Thirty of 37 subjects (81.1%) were classified correctly (8 of 9 control subjects, 88.9%; 13 of 15 patients with edema, 86.7%; and 9 of 13 patients with brain death, 69.2%; p < 0.0001). Depending on the combination of variables used in the OPLS-DA model, sensitivity, specificity, and accuracy were 66.7–92.9%, 81.8–92.9%, and 77.3–89.3%, respectively. The method was feasible and promising in the demanding intensive care unit environment. However, its accuracy did not reach the level required for brain death confirmation. The potential usefulness of the method may be improved by increasing the depth of light penetration, confirming its accuracy against other methods evaluating cerebral flow cessation, and developing absolute parameters for cerebral perfusion.
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影响因子：
5.7
作者：
Elliott, Jonathan T.;Diop, Mamadou;Lawrence, Keith St.
通讯作者：
Lawrence, Keith St.
影响因子：
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作者：
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Maniewski, Roman
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6.3
作者：
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通讯作者：
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