Validation of NIRS CBF with XeCTCBF

描述（由申请人提供）：目前“最先进的技术”造成了一种完全令人不安的情况：一名危重病人入院时没有梗死脑组织，但在经过一段时间极其紧张和昂贵的重症监护后，出院时却带着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改进床边rCBF监测技术的发展来预防院内脑组织死亡的发展，这将使实施个体化治疗成为可能，以防止此类不良后果及其伴随的长期残疾。早期的研究表明，涉及漫射相关光谱（DCS）连续CBF测量的近红外光谱（NIRS）技术有望发展成为有价值的床边CBF监测仪。我们的具体目的是验证神经icu患者蛛网膜下腔出血（SAH）的假设：1。DCS rCBF的变化准确反映了XeCTCBF的急性变化。在血压操作前后同时测定XeCTCBF和DCS，然后分析两项指标的分数变化的相关程度。2. DCS rCBF准确地反映了血管痉挛引起的XeCTCBF的变化。连续DCS将连续地与XeCTCBF进行比较，然后分析两种测量的分数变化的相关程度。稳定的氙计算机断层扫描rCBF （XeCTCBF）将提供整个大脑的详细和定量的CBF图。金本位制。在6条主要的大脑动脉分布上测定DCS CBF。通过相关方法比较匹配区域XeCTCBF和DCS CBF的分数变化，并使用Bland-Altman分析来检验XeCTCBF和DCS之间的一致性。如果DCS CBF技术有效，将可能最终成为临床医生预防缺血性卒中、脑出血、硬脑膜下出血、蛛网膜下腔出血和创伤性脑损伤患者新脑组织死亡的重要工具。这些疾病构成了美国致残的主要原因。

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..