A whole-cortex fNIRS system to shine light on the problem of post-operative delirium

项目摘要：对于60岁的个人来说，手术的危险不止于手术。 并发症：术后妄想(POD)是一个公认的问题，报告的发病率 超过50%的某些手术，包括心脏手术。近390万老年患者面临着 仅因心脏手术造成的Pod。与POD相关的危险后遗症包括增加 围手术期发病率、住院时间延长和痴呆症风险增加， 其中成本高达1520亿美元。尽管有大量与POD有关的调查，但没有 令人满意的术中生物标志物或术前预测指标已经出现，可以预防或缩短 功能障碍，暴露了我们对这种疾病的征兆和诱因的理解上的严重差距。新的 需要评估方法来指导外科手术过程中的变化和干预 可降低POD的发生率。 在对精神错乱的研究中一个共同的缺点是缺乏认识和 对手术中神经认知变化的理解。因此，这样的研究不足以 确定哪些方面的手术会导致精神错乱，并指导外科手术程序的改变 可能会阻止它的发生。手术期间的神经监测在很大程度上仅限于不确定的脑氧仪。 和脑电(EEG)研究。脑血氧仪缺乏对整个大脑皮层的透视 外科手术--缺失可能是精神错乱生物标志物的关键标志；脑电研究存在空间低的问题 分辨率和对信号伪影的高度敏感性。此外，目前的工具体积庞大，而且不可靠 粘性附着物易受运动、活动限制、安装困难和不一致性的影响 由于围手术期工作流程中传感器位置的预期变化，数据质量有所下降。 相比之下，基于功能近红外光谱(FNIRS)的围术期整体监测 大脑皮质将提供更好的空间分辨率，更低的伪影敏感性，以及更好的大脑视图。 术前、术中、术后。我们提出了一种新的用于围手术期监测的fNIRS帽来克服 当前神经成像技术的可用性和感知限制。这顶帽子将比我们的 第一代无线fNIRS系统(鲍登)，并利用我们新型颗粒的固定功能 干扰技术(韦伯斯特)。在目标1中，我们将开发fNIRS电子学，将它们与颗粒集成在一起 干扰并进行机械和电气测试。在目标2中，我们将执行i)人体试验研究 在模拟手术室和ii)嵌套的术中飞行员中确认结果的生理有效性 研究(Shah)以确认检测与麻醉护理相关的fNIRS数据变化的可行性 唱片。如果成功，我们的新型帽子将使我们能够更全面地研究术中贡献者和 POD和其他术后认知障碍的指标。

PROJECT SUMMARY: For individuals > 60 years of age, the dangers of surgery include more than surgical complications: postoperative delirium (POD) is an established concern with reported incidence rates that exceed 50% for certain surgeries, including cardiac surgery. Nearly 3.9 million elderly patients are at risk for POD due to cardiac surgery alone. The dangerous sequelae associated with POD include increased perioperative morbidity, increased duration of hospitalization and increased risk of dementia, the additional costs of which amount to ~$152 billion. Despite the large number of investigations related to POD, no satisfactory intraoperative biomarkers or preoperative predictors have emerged that can prevent or curtail the dysfunction, exposing a critical gap in our understanding of signs and contributors to the condition. New methods of assessment are needed to guide changes and interventions in surgical procedures that can reduce the incidence of POD. A common shortcoming in research studies on delirium has been the lack of awareness and understanding of neurocognitive changes during surgery. Consequently, such studies are inadequate to identify what aspects of surgery contribute to delirium and to guide changes to surgical procedures that can possibly prevent it. Neuromonitoring during surgery has been largely limited to inconclusive cerebral oximetry and electroencephalography (EEG) studies. Cerebral oximetry lacks perspective of the whole cortex during surgery – missing potentially critical landmarks for delirium biomarkers; EEG studies suffer from low spatial resolution and high susceptibility to signal artifacts. Moreover, current tools are bulky and have unreliable adhesive attachments that imbue susceptibility to motion, mobility limitations, setup difficulty and inconsistency in data quality due to changes in sensor positioning expected during the perioperative workflow. In contrast, functional near infrared spectroscopy (fNIRS)-based perioperative monitoring of the whole cortex would offer better spatial resolution, lower susceptibility to artifacts, and a better view of the brain before, during and after surgery. We propose a novel fNIRS cap for perioperative monitoring to overcome the usability and sensing limitations of current neuroimaging technologies. This cap will improve on our first-generation wireless fNIRS system (Bowden) and leverage the immobilizing features of our novel granular jamming technology (Webster). In Aim 1 we will develop the fNIRS electronics, integrate them with granular jamming and perform mechanical and electrical testing. In Aim 2 we will perform i) a human pilot study to confirm the physiological validity of the results in a mock operating room and ii) a nested intraoperative pilot study (Shah) to confirm the feasibility to detect changes in fNIRS data correlated with the anesthesia care record. If successful, our novel cap will enable more comprehensive study of intraoperative contributors to and indicators of POD and other postoperative cognitive disorders.