Validation of NIRS CBF with XeCTCBF

描述(由申请人提供)：目前的“最先进技术”造成了一种完全令人不安的情况，即一名危重患者入院时没有脑梗塞组织，但在经过一段时间的极端紧张和昂贵的危重护理后，又出院时得到了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开发改进的床边rCBF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。早期研究表明，近红外光谱(NIRS)技术包括扩散相关光谱(DCS)连续脑血流测量，有望发展成为有价值的床边脑血流监测仪。我们的具体目的是验证神经ICU蛛网膜下腔出血(SAH)患者的假设：1.DCSrCBF的变化准确地反映XeCTCBF a的急性变化，在血压控制前后同时测定XeCTCBF和DCSs，并分析这两个指标的分数变化的相关程度。2.稳定氙气计算机断层扫描rCBF(XeCTCBF)能准确反映血管痉挛引起的XeCTCBF的变化。连续的DCS值将连续和连续地与XeCTCBF进行比较，然后分析两种测量的分数变化的相关程度。稳定氙气计算机断层扫描rCBF(XeCTCBF)将提供整个大脑的详细和定量的CBF图。DCSCBF将在六个主要大脑动脉分布上进行测定。匹配的区域XeCTCBF和DCSCBF的分数变化将通过相关方法进行比较，并将使用Bland-Altman分析来检验XeCTCBF和DCSF之间的一致性。如果DCSCBF技术有效，可能最终将成为临床医生努力预防缺血性中风、脑内出血、硬膜下出血、蛛网膜下腔出血和创伤性脑损伤患者新的脑组织死亡的重要工具。这些疾病构成了美国残疾的主要原因。 公共卫生相关性：神经危重病患者的叙事管理因不能在床边轻松、重复和无创地测定局部脑血流量(RCBF)而受到阻碍。这项拟议的研究将在健康志愿者中验证弥散相关光谱脑血流方法，该方法可能提供在危重患者床边进行连续rCBF监测的能力。这项技术如果有效，最终将有助于防止因缺血性中风、脑出血、蛛网膜下腔出血和创伤性脑损伤而入院的患者出现新的神经死亡，因为它能够根据重要的神经生理参数对ICU治疗进行个性化滴定。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..