ESPRIT Evoked Potential Monitoring of Acute Intracranial Mass Lesions

描述（由申请人提供）： 继发于出血或水肿的急性颅内肿块病变可导致严重的脑损伤或死亡。在重症监护环境中对这些患者的评估通常通过临床检查、定期成像以及在某些情况下通过颅内压（ICP）监测来完成。然而，ICP监测是侵入性的，并且在持续继发性神经元损伤的患者中并不总是升高。也许最重要的是，它没有提供对大脑状态的直接功能评估。 我们建议通过开发技术来满足这一需求，在床边使用体感诱发电位（SEP）进行实时客观的脑功能评估。我们应用了传统的振幅和潜伏期分析以及频域测量，ESPRIT，并证明了与脑灌注压（来自ICP）在大鼠急性肿块病变模型的强相关性。 我们现在提出了一个第二阶段的努力，其中包括1）ESPRIT集成到一个实时的临床监测平台; 2）应用噪声免疫，自适应策略来解释SEP信号的趋势;和3）在神经重症监护病房的试点研究中的技术评估。 我们的长期目标是开发一种有用的工具来帮助神经重症监护医师评估急性颅内肿块患者。

DESCRIPTION (provided by applicant): An acute intracranial mass lesion secondary to hemorrhage or edema can lead to profound brain damage or death. Assessment of these patients in the critical care setting is typically done by clinical exam, periodic imaging, and in some cases by intracranial pressure (ICP) monitoring. However, ICP monitoring is invasive and it is not always elevated in patients with ongoing secondary neuronal injury. Perhaps most importantly, it does not provide for direct functional assessment of the brain's status. We propose to fulfill this need by developing technology for real-time objective assessment of brain function at the bedside, using somatosensory evoked potentials (SEP). We have applied traditional amplitude and latency analysis as well as a frequency domain measure, ESPRIT, and demonstrated strong correlation with cerebral perfusion pressure (derived from ICP) in a rat model of acute mass lesions. We now propose a Phase II effort which includes 1) integration of ESPRIT into a real-time clinical monitoring platform; 2) application of a noise-immune, adaptive strategy to interpret trends in the SEP signal; and 3) evaluation of the technology in a pilot study in the neurocritical care unit. It is our long-term goal to develop a useful tool to assist the neurointensivist in evaluating patients who present with an acute intracranial mass.