Continuous optical monitoring of cerebral hemodynamics during head-of-bed manipulation in brain-injured adults

Meeri N. Kim; Brian L. Edlow; Turgut Durduran; Suzanne Frangos; Rickson C. Mesquita; Joshua M. Levine; Joel H. Greenberg; Arjun G. Yodh; John A. Detre

doi:10.1007/s12028-013-9849-7

Continuous optical monitoring of cerebral hemodynamics during head-of-bed manipulation in brain-injured adults

Meeri N. Kim^*, Brian L. Edlow, Turgut Durduran, Suzanne Frangos, Rickson C. Mesquita, Joshua M. Levine, Joel H. Greenberg, Arjun G. Yodh, John A. Detre

^*Corresponding author for this work

Computer Science

Research output: Contribution to journal › Article › peer-review

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Abstract

Introduction: Head-of-bed manipulation is commonly performed in the neurocritical care unit to optimize cerebral blood flow (CBF), but its effects on CBF are rarely measured. This pilot study employs a novel, non-invasive instrument combining two techniques, diffuse correlation spectroscopy (DCS) for measurement of CBF and near-infrared spectroscopy (NIRS) for measurement of cerebral oxy- and deoxy-hemoglobin concentrations, to monitor patients during head-of-bed lowering. Methods: Ten brain-injured patients and ten control subjects were monitored continuously with DCS and NIRS while the head-of-bed was positioned first at 30° and then at 0°. Relative CBF (rCBF) and concurrent changes in oxy- (ΔHbO₂), deoxy- (ΔHb), and total-hemoglobin concentrations (ΔTHC) from left/right frontal cortices were monitored for 5 min at each position. Patient and control response differences were assessed. Results: rCBF, ΔHbO₂, and ΔTHC responses to head lowering differed significantly between brain-injured patients and healthy controls (P < 0.02). For patients, rCBF changes were heterogeneous, with no net change observed in the group average (0.3 ± 28.2 %, P = 0.938). rCBF increased in controls (18.6 ± 9.4 %, P < 0.001). ΔHbO₂, ΔHb, and ΔTHC increased with head lowering in both groups, but to a larger degree in brain-injured patients. rCBF correlated moderately with changes in cerebral perfusion pressure (R = 0.40, P < 0.001), but not intracranial pressure. Conclusion: DCS/NIRS detected differences in CBF and oxygenation responses of brain-injured patients versus controls during head-of-bed manipulation. This pilot study supports the feasibility of continuous bedside measurement of cerebrovascular hemodynamics with DCS/NIRS and provides the rationale for further investigation in larger cohorts.

Original language	English
Pages (from-to)	443-453
Number of pages	11
Journal	Neurocritical Care
Volume	20
Issue number	3
DOIs	https://doi.org/10.1007/s12028-013-9849-7
Publication status	Published - Jun 2014

Bibliographical note

Funding Information:
Disclosure/Disclaimer Sources of Support (if applicable): Name(s) of Grantor(s), Grant or contract numbers, name of author who received the funding, and specific material support given: National Institute of Heath: NS-054575 (JAD), NS-060653 (AGY), NS-045839 (JAD), HL077699 (AGY), RR-02305 (AGY, JAD), R25-NS065743 (BLE). TD gratefully acknowledged partial support by Fundacio Cellex Barcelona, Marie Curie IRG (FP7, RPTAMON), Institute de Salud Carlos III (DOMMON, FIS), Ministerio de Ciencia e Innovación (MICINN), Ministerio de Economía y Comepetitividad, Institució CERCA (DOCNEURO, PROVAT-002-11), Generalitat de Catalunya, European Regional Development Fund (FEDER/ERDF) and LASERLAB (FP7) and Photonics4Life (FP7) consortia. University of Pennsylvania Research Foundation (JHG). Financial Disclosure AGY, JAD, JHG, TD are co-inventors on patents related to the optical technology. However, they do not receive any income or royalties from those patents.

Keywords

Cerebral blood flow
Cerebral hemodynamics
Diffuse correlation spectroscopy
Diffuse optical spectroscopy
Head-of-bed
Near-infrared spectroscopy
Neurocritical care

ASJC Scopus subject areas

Clinical Neurology
Critical Care and Intensive Care Medicine

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10.1007/s12028-013-9849-7

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@article{2cc5e9c102094abd818b3cb0b7b119cc,

title = "Continuous optical monitoring of cerebral hemodynamics during head-of-bed manipulation in brain-injured adults",

abstract = "Introduction: Head-of-bed manipulation is commonly performed in the neurocritical care unit to optimize cerebral blood flow (CBF), but its effects on CBF are rarely measured. This pilot study employs a novel, non-invasive instrument combining two techniques, diffuse correlation spectroscopy (DCS) for measurement of CBF and near-infrared spectroscopy (NIRS) for measurement of cerebral oxy- and deoxy-hemoglobin concentrations, to monitor patients during head-of-bed lowering. Methods: Ten brain-injured patients and ten control subjects were monitored continuously with DCS and NIRS while the head-of-bed was positioned first at 30° and then at 0°. Relative CBF (rCBF) and concurrent changes in oxy- (ΔHbO2), deoxy- (ΔHb), and total-hemoglobin concentrations (ΔTHC) from left/right frontal cortices were monitored for 5 min at each position. Patient and control response differences were assessed. Results: rCBF, ΔHbO2, and ΔTHC responses to head lowering differed significantly between brain-injured patients and healthy controls (P < 0.02). For patients, rCBF changes were heterogeneous, with no net change observed in the group average (0.3 ± 28.2 %, P = 0.938). rCBF increased in controls (18.6 ± 9.4 %, P < 0.001). ΔHbO2, ΔHb, and ΔTHC increased with head lowering in both groups, but to a larger degree in brain-injured patients. rCBF correlated moderately with changes in cerebral perfusion pressure (R = 0.40, P < 0.001), but not intracranial pressure. Conclusion: DCS/NIRS detected differences in CBF and oxygenation responses of brain-injured patients versus controls during head-of-bed manipulation. This pilot study supports the feasibility of continuous bedside measurement of cerebrovascular hemodynamics with DCS/NIRS and provides the rationale for further investigation in larger cohorts.",

keywords = "Cerebral blood flow, Cerebral hemodynamics, Diffuse correlation spectroscopy, Diffuse optical spectroscopy, Head-of-bed, Near-infrared spectroscopy, Neurocritical care",

author = "Kim, {Meeri N.} and Edlow, {Brian L.} and Turgut Durduran and Suzanne Frangos and Mesquita, {Rickson C.} and Levine, {Joshua M.} and Greenberg, {Joel H.} and Yodh, {Arjun G.} and Detre, {John A.}",

note = "Funding Information: Disclosure/Disclaimer Sources of Support (if applicable): Name(s) of Grantor(s), Grant or contract numbers, name of author who received the funding, and specific material support given: National Institute of Heath: NS-054575 (JAD), NS-060653 (AGY), NS-045839 (JAD), HL077699 (AGY), RR-02305 (AGY, JAD), R25-NS065743 (BLE). TD gratefully acknowledged partial support by Fundacio Cellex Barcelona, Marie Curie IRG (FP7, RPTAMON), Institute de Salud Carlos III (DOMMON, FIS), Ministerio de Ciencia e Innovaci{\'o}n (MICINN), Ministerio de Econom{\'i}a y Comepetitividad, Instituci{\'o} CERCA (DOCNEURO, PROVAT-002-11), Generalitat de Catalunya, European Regional Development Fund (FEDER/ERDF) and LASERLAB (FP7) and Photonics4Life (FP7) consortia. University of Pennsylvania Research Foundation (JHG). Financial Disclosure AGY, JAD, JHG, TD are co-inventors on patents related to the optical technology. However, they do not receive any income or royalties from those patents.",

year = "2014",

month = jun,

doi = "10.1007/s12028-013-9849-7",

language = "English",

volume = "20",

pages = "443--453",

journal = "Neurocritical Care",

issn = "1541-6933",

publisher = "Humana Press",

number = "3",

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TY - JOUR

T1 - Continuous optical monitoring of cerebral hemodynamics during head-of-bed manipulation in brain-injured adults

AU - Kim, Meeri N.

AU - Edlow, Brian L.

AU - Durduran, Turgut

AU - Frangos, Suzanne

AU - Mesquita, Rickson C.

AU - Levine, Joshua M.

AU - Greenberg, Joel H.

AU - Yodh, Arjun G.

AU - Detre, John A.

N1 - Funding Information: Disclosure/Disclaimer Sources of Support (if applicable): Name(s) of Grantor(s), Grant or contract numbers, name of author who received the funding, and specific material support given: National Institute of Heath: NS-054575 (JAD), NS-060653 (AGY), NS-045839 (JAD), HL077699 (AGY), RR-02305 (AGY, JAD), R25-NS065743 (BLE). TD gratefully acknowledged partial support by Fundacio Cellex Barcelona, Marie Curie IRG (FP7, RPTAMON), Institute de Salud Carlos III (DOMMON, FIS), Ministerio de Ciencia e Innovación (MICINN), Ministerio de Economía y Comepetitividad, Institució CERCA (DOCNEURO, PROVAT-002-11), Generalitat de Catalunya, European Regional Development Fund (FEDER/ERDF) and LASERLAB (FP7) and Photonics4Life (FP7) consortia. University of Pennsylvania Research Foundation (JHG). Financial Disclosure AGY, JAD, JHG, TD are co-inventors on patents related to the optical technology. However, they do not receive any income or royalties from those patents.

PY - 2014/6

Y1 - 2014/6

N2 - Introduction: Head-of-bed manipulation is commonly performed in the neurocritical care unit to optimize cerebral blood flow (CBF), but its effects on CBF are rarely measured. This pilot study employs a novel, non-invasive instrument combining two techniques, diffuse correlation spectroscopy (DCS) for measurement of CBF and near-infrared spectroscopy (NIRS) for measurement of cerebral oxy- and deoxy-hemoglobin concentrations, to monitor patients during head-of-bed lowering. Methods: Ten brain-injured patients and ten control subjects were monitored continuously with DCS and NIRS while the head-of-bed was positioned first at 30° and then at 0°. Relative CBF (rCBF) and concurrent changes in oxy- (ΔHbO2), deoxy- (ΔHb), and total-hemoglobin concentrations (ΔTHC) from left/right frontal cortices were monitored for 5 min at each position. Patient and control response differences were assessed. Results: rCBF, ΔHbO2, and ΔTHC responses to head lowering differed significantly between brain-injured patients and healthy controls (P < 0.02). For patients, rCBF changes were heterogeneous, with no net change observed in the group average (0.3 ± 28.2 %, P = 0.938). rCBF increased in controls (18.6 ± 9.4 %, P < 0.001). ΔHbO2, ΔHb, and ΔTHC increased with head lowering in both groups, but to a larger degree in brain-injured patients. rCBF correlated moderately with changes in cerebral perfusion pressure (R = 0.40, P < 0.001), but not intracranial pressure. Conclusion: DCS/NIRS detected differences in CBF and oxygenation responses of brain-injured patients versus controls during head-of-bed manipulation. This pilot study supports the feasibility of continuous bedside measurement of cerebrovascular hemodynamics with DCS/NIRS and provides the rationale for further investigation in larger cohorts.

AB - Introduction: Head-of-bed manipulation is commonly performed in the neurocritical care unit to optimize cerebral blood flow (CBF), but its effects on CBF are rarely measured. This pilot study employs a novel, non-invasive instrument combining two techniques, diffuse correlation spectroscopy (DCS) for measurement of CBF and near-infrared spectroscopy (NIRS) for measurement of cerebral oxy- and deoxy-hemoglobin concentrations, to monitor patients during head-of-bed lowering. Methods: Ten brain-injured patients and ten control subjects were monitored continuously with DCS and NIRS while the head-of-bed was positioned first at 30° and then at 0°. Relative CBF (rCBF) and concurrent changes in oxy- (ΔHbO2), deoxy- (ΔHb), and total-hemoglobin concentrations (ΔTHC) from left/right frontal cortices were monitored for 5 min at each position. Patient and control response differences were assessed. Results: rCBF, ΔHbO2, and ΔTHC responses to head lowering differed significantly between brain-injured patients and healthy controls (P < 0.02). For patients, rCBF changes were heterogeneous, with no net change observed in the group average (0.3 ± 28.2 %, P = 0.938). rCBF increased in controls (18.6 ± 9.4 %, P < 0.001). ΔHbO2, ΔHb, and ΔTHC increased with head lowering in both groups, but to a larger degree in brain-injured patients. rCBF correlated moderately with changes in cerebral perfusion pressure (R = 0.40, P < 0.001), but not intracranial pressure. Conclusion: DCS/NIRS detected differences in CBF and oxygenation responses of brain-injured patients versus controls during head-of-bed manipulation. This pilot study supports the feasibility of continuous bedside measurement of cerebrovascular hemodynamics with DCS/NIRS and provides the rationale for further investigation in larger cohorts.

KW - Cerebral blood flow

KW - Cerebral hemodynamics

KW - Diffuse correlation spectroscopy

KW - Diffuse optical spectroscopy

KW - Head-of-bed

KW - Near-infrared spectroscopy

KW - Neurocritical care

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DO - 10.1007/s12028-013-9849-7

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AN - SCOPUS:84902330355

SN - 1541-6933

VL - 20

SP - 443

EP - 453

JO - Neurocritical Care

JF - Neurocritical Care

IS - 3

ER -

Continuous optical monitoring of cerebral hemodynamics during head-of-bed manipulation in brain-injured adults

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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