Wir möchten allen Kolleginnen und Kollegen in der Neugeborenen-Intensivstation für ihre Arbeit zu würdigen.

dieses Protokoll wurde genehmigt durch das institutionelle Review Board von Renji Krankenhaus, Shanghai Jiaotong University School of Medicine.
 1. Vorbereitung des Patienten Hinweis: ICP Sensor sitzt der Patient durch einen chirurgischen Eingriff ( Abbildung 1). Der Sensor sitzt in den Epiduralraum, Subduralraum, Parenchym oder Ventrikelsystem.
<ol><li>Verbinden die ICP-Überwachung-Maschine mit dem Patientenmonitor über eine spezifische Kommunikationskabel.</li>
	<li>Stellen Sie die Referenz des Patienten &#39; s Bett zu überwachen, so dass die Daten aus dem Patientenmonitor im Einklang mit dem ICP Überwachung Maschine.</li>
	<li>Eine arteriellen Linie Platzierung auf Patienten durchführen &#39; s links oder rechts radialis 20.</li>
	<li>Verbinden die arterielle Linie mit der Barorezeptor.</li>
	<li>Verbinden die Druckaufnehmer mit Patienten &#39; s Patientenmonitor über ein Kommunikationskabel.</li>
	<li>Null dem Patientenmonitor so einstellen, dass der gemessene Blutdruck deckt sich mit dem tatsächlichen Wert.</li>
</ol> 2. Aufnahme von physiologischen Parametern <ol><li>verbinden den Patienten &#39; s Patientenmonitor mit den Daten sammeln und Speichern von Gerät über ein Netzwerkkabel.</li>
	<li>Drücken Sie die Power-Taste schalten Sie die Datenerfassung Gerät.</li>
	<li>Warten Sie einige Sekunden, bis die Multimodalität monitoring-Software automatisch ausgeführt wird.</li>
	<li>Geben Sie die Informationen des Patienten, einschließlich Name, ID, Diagnose und erste Glasgow Coma Scale (GCS).</li>
	<li>Klicken Sie auf die &#34; speichern und starten Sie die Überwachung &#34; Taste, um Daten sammeln und Speichern von.</li>
	<li>Klicken Sie auf den &#34; schalten Sie &#34; Taste auf dem Bildschirm am Ende der Datenerfassung ( Abbildung 2).</li>
	<li>Geben Sie die endgültige GCS.</li>
</ol> 3. Parameter-Analyse <ol><li>Dump der gespeicherten Daten zu einer U-Scheibe durch universellen seriellen Bus (USB)-Schnittstellen auf dem Host.</li>
	<li>Geben Sie einen Benutzernamen und Passwort zum Einloggen auf dem Analysis-Server.</li>
	<li>Klicken Sie auf die &#34; neuen Datensatz erstellen &#34; und wählen Sie die Datendatei in der U-Scheibe zu lade.</li>
	<li>Für rund 10 bis 20 Minuten warten, bevor die Daten (abhängig von der Datengröße) analysiert werden.</li>
	<li>Klicken Sie auf das &#34; Detail &#34; Taste jedes Datensatzes, das Ergebnis zu sehen.</li>
	<li>Klicken Sie auf das &#34; Diagramm anzeigen &#34;, das letzte Diagramm zu sehen.</li>
	<li>Ziehen Sie die Zeitleiste um weitere Details anzuzeigen.</li>
	<li>Klicken Sie auf die &#34; Scattergramm &#34; Taste, um die Verteilung der Parameter sehen.</li>
</ol>

<ol>
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W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complexity+of+intracranial+pressure+correlates+with+outcome+after+traumatic+brain+injury.">Complexity of intracranial pressure correlates with outcome after traumatic brain injury.</a> Brain. 135 (8), 2399-2408 (2012).</li><li>Nucci, C. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intracranial+pressure+wave+morphological+classification:+automated+analysis+and+clinical+validation.">Intracranial pressure wave morphological classification: automated analysis and clinical validation.</a> Acta Neurochir (Wien). 158 (3), 581-588 (2016).</li><li>Eide, P. K., Sorteberg, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Association+among+intracranial+compliance,+intracranial+pulse+pressure+amplitude+and+intracranial+pressure+in+patients+with+intracranial+bleeds.">Association among intracranial compliance, intracranial pulse pressure amplitude and intracranial pressure in patients with intracranial bleeds.</a> Neurol Res. 29 (8), 798-802 (2007).</li><li>Czosnyka, M., Czosnyka, Z. H., Whitfield, P. C., Donovan, T., Pickard, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Age+dependence+of+cerebrospinal+pressure-volume+compensation+in+patients+with+hydrocephalus.">Age dependence of cerebrospinal pressure-volume compensation in patients with hydrocephalus.</a> J Neurosurg. 94 (3), 482-486 (2001).</li><li>Howells, T., Lewen, A., Skold, M. K., Ronne-Engstrom, E., Enblad, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+evaluation+of+three+measures+of+intracranial+compliance+in+traumatic+brain+injury+patients.">An evaluation of three measures of intracranial compliance in traumatic brain injury patients.</a> Intensive Care Med. 38 (6), 1061-1068 (2012).</li><li>Schuhmann, M. U., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Value+of+overnight+monitoring+of+intracranial+pressure+in+hydrocephalic+children.">Value of overnight monitoring of intracranial pressure in hydrocephalic children.</a> Pediatr Neurosurg. 44 (4), 269-279 (2008).</li><li>Czosnyka, M., Pickard, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Monitoring+and+interpretation+of+intracranial+pressure.">Monitoring and interpretation of intracranial pressure.</a> J Neurol Neurosurg Psychiatry. 75 (6), 813-821 (2004).</li><li>Sorrentino, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Critical+thresholds+for+cerebrovascular+reactivity+after+traumatic+brain+injury.">Critical thresholds for cerebrovascular reactivity after traumatic brain injury.</a> Neurocrit Care. 16 (2), 258-266 (2012).</li><li>Carrera, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=What+shapes+pulse+amplitude+of+intracranial+pressure.">What shapes pulse amplitude of intracranial pressure.</a> J Neurotrauma. 27 (2), 317-324 (2010).</li><li>Eide, P. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pressure-derived+versus+pressure+wave+amplitude-derived+indices+of+cerebrovascular+pressure+reactivity+in+relation+to+early+clinical+state+and+12-month+outcome+following+aneurysmal+subarachnoid+hemorrhage.">Pressure-derived versus pressure wave amplitude-derived indices of cerebrovascular pressure reactivity in relation to early clinical state and 12-month outcome following aneurysmal subarachnoid hemorrhage.</a> J Neurosurg. 116 (5), 961-971 (2012).</li><li>Lazaridis, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient-specific+thresholds+of+intracranial+pressure+in+severe+traumatic+brain+injury.">Patient-specific thresholds of intracranial pressure in severe traumatic brain injury.</a> J Neurosurg. 120 (4), 893-900 (2014).</li><li>Czosnyka, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Monitoring+and+interpretation+of+intracranial+pressure+after+head+injury.">Monitoring and interpretation of intracranial pressure after head injury.</a> Acta Neurochir Suppl. 96, 114-118 (2006).</li><li>Steiner, L. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Continuous+monitoring+of+cerebrovascular+pressure+reactivity+allows+determination+of+optimal+cerebral+perfusion+pressure+in+patients+with+traumatic+brain+injury.">Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury.</a> Crit Care Med. 30 (4), 733-738 (2002).</li><li>Tegtmeyer, K., Brady, G., Lai, S., Hodo, R., Braner, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Videos+in+Clinical+Medicine.+Placement+of+an+arterial+line.">Videos in Clinical Medicine. Placement of an arterial line.</a> N Engl J Med. 354 (15), 13 (2006).</li><li>Chesnut, R. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+trial+of+intracranial-pressure+monitoring+in+traumatic+brain+injury.">A trial of intracranial-pressure monitoring in traumatic brain injury.</a> N Engl J Med. 367 (26), 2471-2481 (2012).</li></ol>

Keine finanzieller Unterstützung erhielt.

Das Ziel dieses Artikels ist, die neue Multimodalität Überwachung einzuführen und Analyse System für neurochirurgische kritischen Patienten, die verwendet werden können, um physiologische Parameter überwachen, analysieren die aktuellen klinischen Status und hoffentlich die Prognose vorhersagen der neurochirurgischen kritische Patienten. Heute liegt der Schwerpunkt der ICP Überwachung vor allem auf die mittlere ICP Wert und ignorieren andere Parameter, die Gefahr von Ungenauigkeiten oder Verzögerung4,5,21tragen können. Auf der anderen Seite der ICP Parameter abgeleitet, wie z. B. ICP Wellenform, AMP, RAP, PRx und IAAC gemeldet werden, haben großen Bedeutung in der Vorhersage Prognose und leiten entsprechende Behandlung5,16,17, 18,19. All diese Parameter erfordern jedoch Multimodalität Überwachung und große Datenerfassung und -Analyse, die viel Zeit und Mühe in Anspruch nehmen kann. Außerdem gibt es einige spezielle Geräte, die derzeit für Ärzte in ihrer täglichen klinischen Arbeit geeignet sind.
Um dieses Problem zu lösen, haben wir vor kurzem eine Multimodalität monitoring-System entwickelt. Es verwendet eine automatische Datenerfassung und Speicherung Gerät kontinuierlich Patienten physiologische Informationen vor dem Senden der Daten an den Online-Server zur Analyse der Arbeit auf die Bedeutung dieser ICP erwerben Parameter abgeleitet. Wie bereits erwähnt ist, hat die Multimodalität monitoring-System die folgenden Vorteile. Erstens kann es in Echtzeit Daten mit einer hohen Frequenz sammeln. Die Häufigkeit der Datensammlung kann bis zu 120 Hz. Zweitens erreichen, es kann mehrere Parameter, d. h., ICP Wellenform, PRx, RAP und IAAC. Alle von ihnen sind in der Analyse der aktuellen klinischen Status und in der Vorhersage der Prognose von entscheidender Bedeutung. Darüber hinaus kann es langfristig kontinuierliche Überwachung erreichen. Es können alle Details während der gesamten Behandlung der Patienten aufnehmen. Nicht zuletzt ist es tragbar und leicht zu erlernen. Kliniker können problemlos Daten mit einer bestimmten Analysis-Server hochladen, die Berechnung und graphische Konstruktion automatisch durchführen wird. Es gibt nur zwei wichtige Schritte im Protokoll. Eine ist die Platzierung der ICP-Sensor. Die andere ist die arterielle Linie Platzierung und arterielle Blutdruckmessung. Einmal richtig angeschlossen und betrieben werden, kann die Multimodalität monitoring-System Daten erheben und speichern in Echtzeit vor Analyse und grafische Darstellung sie automatisch, die für Ärzte geeignet ist.
Allerdings hat es auch einige Einschränkungen. Dieses System nur umfasst ICP und invasive Blutdruckmessung und andere Parameter wie EKG, EEG oder TCD fehlt. Eine weitere Einschränkung ist, dass die automatische Analysemodus nicht reichlich vorhanden ist, und kann nur bestimmte Berechnungen und graphischen Konstruktionen.
Wir haben wurde dieses System kontinuierlich ändern und haben feste mehrere Probleme, die während der Langzeitgebrauch auftraten. Wir sind zuversichtlich, dass alle Beschränkungen in Zukunft behoben werden werden und es wird mehr anwendbar sein.
Wir hoffen, dass die Multimodalität monitoring-System als eine wesentliche Maßnahme zur physiologischen Parameter, um den aktuellen klinischen Status zu analysieren und die Prognose der neurochirurgischen kritischen Patienten in Zukunft vorherzusagen überwachen akzeptiert werden.

ICP Überwachung ist verbreitet, intrakranielle Status in der Neurochirurgie, vor allem im neurochirurgischen kritischen Patienten1,2,3zu bewerten. Neben der Mittelwert der ICP ICP abgeleitet Parameter wie ICP Wellenform, AMP, RAP, PRx, IAAC und So weiter, können dem Stand Intrazerebrale Zirkulation, Liquor kompensatorische Reserve entsprechen und Compliance4,5, des Gehirns 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13. sie können Anzeichen für bevorstehende neurologische Verschlechterung und sogar Ergebnisse von Patienten14,15,16,17,18sein. Sie können auch als Richtschnur der richtige Behandlung19verwendet werden. Jedoch konzentrieren die meisten von den Ärzten nur auf den Mittelwert der ICP unter Missachtung dieser Parameter. Dies ist zum Teil, weil es gibt nur wenige spezifische Geräte, die für Ärzte in ihrer täglichen klinischen Arbeit geeignet sind.
Um diese Nachteile zu beheben, haben wir vor kurzem eine Multimodalität monitoring-System entwickelt. Wir verwenden eine automatische Datenerfassung und Speicherung von Gerät, um Patientenrechte physiologische Daten wie Blutdruck, ICP und Sauerstoffsättigung kontinuierlich zu erwerben, und diese physiologische Parameter zu analysieren, um den aktuellen klinischen Status zu offenbaren und Ich hoffe, die Prognose der neurochirurgischen kritische Patienten Vorhersagen. Diese Multimodalität monitoring-System hat mehrere Vorteile: (1) Es kann Echtzeit-Datensammlung bei hoher Frequenz, (2) Es kann mehrere Parameter, d. h., ICP Wellenform, PRx, RAP und IAAC, (3) es zu erreichen kann, lange Begriff kontinuierliche Überwachung, aufzeichnen und (4) Es ist portabel und einfach zu erlernen.
Das Ziel dieses Artikels ist daher zeigen eine detaillierte Methode, wie die Multimodalität monitoring-System zu verwenden, um verschiedene physiologische Parameter bei neurochirurgischen kritische Patienten aufnehmen.

<table><tbody><tr><td>Bedside monitor</td><td>Philips</td><td>IntelliVue MP40 M8003A</td><td>With interfacing module</td></tr><tr><td>ICP monitoring machine</td><td>&amp;nbsp;Johnson &amp;amp; Johnson or Sophysa</td><td></td><td></td></tr><tr><td>Arterial cannula</td><td>BD</td><td>REF682245</td><td></td></tr><tr><td>Pressure transducer</td><td>Haisheng Medical</td><td>DBPT-0103</td><td></td></tr><tr><td>Data collection device</td><td>Shanghai Haoju</td><td>Neumatic</td><td></td></tr><tr><td>Computer</td><td></td><td></td><td>Requires Windows operating system</td></tr></tbody></table>

a detailed protocol for physiological parameters acquisition and analysis in neurosurgical critical patients

Drucküberwachung von intrakraniellen (ICP) ist jetzt bei neurochirurgischen kritische Patienten verbreitet. Neben der mittlere Wert der ICP ICP abgeleitet Parameter wie z. B. ICP Wellenform, Amplitude des Impulses (AMP), die Korrelation der Amplitude der ICP und ICP bedeuten (RAP), Reaktivität Index (PRx), ICP und arteriellen Blutdruck (ABP) Welle Amplitude Korrelation (IAAC) Druck, und so aktiviert ist, können intrakranielle Status zu reflektieren, vorherzusagen Prognose und dient auch als Richtschnur der richtigen Behandlung. Jedoch konzentrieren die meisten von den Ärzten nur auf den Mittelwert der ICP unter Missachtung dieser Parameter aufgrund der Einschränkungen der aktuellen Geräte. Vor kurzem haben wir eine Multimodalität monitoring-System um diese Nachteile zu beheben. Dieses tragbare, benutzerfreundliche System verwendet eine Daten sammeln und Speichern von Gerät kontinuierlich Patienten physiologische Parameter zuerst erwerben, d. h., ABP, ICP und Sauerstoffsättigung, und dann analysieren diese physiologischen Parameter. Wir hoffen, dass die Multimodalität monitoring-System als eine wichtige Maßnahme zur Überwachung der physiologischen Parameter, um den aktuellen klinischen Status zu analysieren und die Prognose der neurochirurgischen kritische Patienten vorherzusagen akzeptiert werden.

Diese neue Multimodalität monitoring-System wurde auf 22 neurochirurgischen kritische Patienten (15 Männer) angewendet. 12 von ihnen (54.55 %) litt von Schädel-Hirn-Trauma (SHT), 9 (40,91 %) hatte intrakraniellen Blutungen und 1 (4,55 %) hatte schweren Hirninfarkt. Die gesamte Überwachungszeit ist mehr als 1.900 h (ca. 88 h pro Patient). Nach einer erfolgreichen Operation, die wir kontinuierlich überwacht und analysiert ihre ICP, BP, CPP, PRx, RAP und IAAC. Abbildung 3 zeigt repräsentative Daten von dieser monitoring-System. Wir passen die Zeitleiste um weitere Detailinformationen zu (Abbildung 4) sehen. Außerdem sind wir in der Lage, analysieren Sie die Beziehung zwischen zwei Parameter, die in Abbildung 5gezeigt.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/56388/56388fig1.jpg"> 
Abbildung 1 : ICP Sensor Platzierung. Der Patient unterzieht sich eine Operation für ICP Sensor Platzierung vor der Überwachung. Der Sensor kann in den Epiduralraum, Subduralraum, Parenchym oder Ventrikelsystem platziert werden. Diese Abbildung zeigt ventrikuläre Punktion und Sensor-Platzierung. Der ICP-Sensor befindet sich an der Spitze des Katheters. <a href="//ecsource-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/56388/56388fig1large.jpg" target="_blank">Bitte klicken Sie hier für eine größere Version dieser Figur.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/56388/56388fig2.jpg"> 
Abbildung 2 : Bildschirm des Überwachungssystems. Im obere linken Bereich zeigt aktuelle ICP-Wellenform und Blutdruck. Untere linke Bereich zeigt aktuelle RAP, PRx IAAC, CPP und AMP. Rechte Teil des Bildschirms zeigt die Geschichte. Unten sind einige der Funktionstasten wie Ausgang, Screenshot und Hinzufügen von Markern. <a href="//ecsource-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/56388/56388fig2large.jpg" target="_blank">Bitte klicken Sie hier für eine größere Version dieser Figur.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/56388/56388fig3.jpg"> 
Abbildung 3 : Repräsentative Daten eines Patienten Hirnblutung. Die Parameter wie ICP, BP, CPP, PRx, RAP und IAAC erfasst und dargestellt. Die x-Achse ist der Zeitplan und die Y-Achsen sind separate Parameter. <a href="//ecsource-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/56388/56388fig3large.jpg" target="_blank">Bitte klicken Sie hier für eine größere Version dieser Figur.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/56388/56388fig4.jpg"> 
Abbildung 4 : Detaillierte Informationen von repräsentativen Daten. Wenn wir die Zeitachse anpassen, können wir mehr Details sehen. Die x-Achse ist der Zeitplan und die Y-Achsen sind separate Parameter. <a href="//ecsource-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/56388/56388fig4large.jpg" target="_blank">Bitte klicken Sie hier für eine größere Version dieser Figur.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/56388/56388fig5.jpg"> 
Abbildung 5 : Beziehung zwischen ICP und PRx. Wir können ändern Sie die Parameter auf das X und Y Achse zur Analyse der Beziehung zwischen zwei Parameter. In dieser Abbildung die x-Achse ist die ICP und die y-Achse ist die PRx. Jeder rote Punkt steht für eine Echtzeit-Aufnahme. Wir können sehen, dass bei diesem Patienten seine PRx eine Variation von -0.7 bis 1 hat und die niedrigsten PRx erreicht ist, wenn seine ICP 10 MmHg ist. <a href="//ecsource-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/56388/56388fig5large.jpg" style="font-size: 14px;" target="_blank">Bitte klicken Sie hier für eine größere Version dieser Figur.</a>

Watch this Scientific Journal Video about A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients at JoVE.com

A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

Vor kurzem haben wir einen tragbaren Multimodalität monitoring-System für die Überwachung der verschiedenen physiologischen Parametern bei neurochirurgischen kritische Patienten entwickelt. Ausführliche Protokolle zur Verwendung dieser Multimodalität Überwachungssystem werden hier vorgestellt.

Ein detailliertes Protokoll für physiologische Parameter Erfassung und Analyse bei neurochirurgischen kritische Patienten

Intracranial pressure (ICP) monitoring is now widely used in neurosurgical critical patients. Besides mean ICP value, the ICP derived parameters such as ...

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Nanyang Technological University

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6.9K Aufrufe.  Shanghai Jiaotong University School of Medicine. Vor kurzem haben wir einen tragbaren Multimodalität monitoring-System für die Überwachung der verschiedenen physiologischen Parametern bei neurochirurgischen kritische Patienten entwickelt. Ausführliche Protokolle zur Verwendung dieser Multimodalität Überwachungssystem werden hier vorgestellt.

Serie: A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through implanted electrodes. Deep brain stimulation was first implemented as a therapeutic modality by Benabid et al. in the late 1980s, when he used this technique to stimulate the ventral intermediate nucleus of the thalamus for the treatment of tremor 1. Currently, the procedure is used to treat patients who fail to respond adequately to medical management for diseases such as Parkinson's, dystonia, and essential tremor. The efficacy of this procedure for the treatment of Parkinson's disease has been demonstrated in well-powered, randomized controlled trials 2. Presently, the U.S. Food and Drug Administration has approved DBS as a treatment for patients with medically refractory essential tremor, Parkinson's disease, and dystonia. Additionally, DBS is currently being evaluated for the treatment of other psychiatric and neurological disorders, such as obsessive compulsive disorder, major depressive disorder, and epilepsy. 
DBS has not only been shown to help people by improving their quality of life, it also provides researchers with the unique opportunity to study and understand the human brain. Microelectrode recordings are routinely performed during DBS surgery in order to enhance the precision of anatomical targeting. Firing patterns of individual neurons can therefore be recorded while the subject performs a behavioral task. Early studies using these data focused on descriptive aspects, including firing and burst rates, and frequency modulation 3. More recent studies have focused on cognitive aspects of behavior in relation to neuronal activity 4,5. This article will provide a description of the intra-operative methods used to perform behavioral tasks and record neuronal data with awake patients during DBS cases. Our exposition of the process of acquiring electrophysiological data will illuminate the current scope and limitations of intra-operative human experiments.

Deep brain stimulation surgery offers a unique opportunity to examine information encoding in the awake human brain. This article will describe intra-operative methods used to perform cognitive and behavioral tasks while simultaneously acquiring physiological data such as EMG, single-unit neuronal activity and/or local field potentials.

Intra-Operative Behavioral Aufgaben in Awake Humans Undergoing Deep Brain Stimulation Chirurgie

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through ...

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Medizin

Performing Behavioral Tasks in Subjects with Intracranial Electrodes

Patients having stereo-electroencephalography (SEEG) electrode, subdural grid or depth electrode implants have a multitude of electrodes implanted in different areas of their brain for the localization of their seizure focus and eloquent areas. After implantation, the patient must remain in the hospital until the pathological area of brain is found and possibly resected. During this time, these patients offer a unique opportunity to the research community because any number of behavioral paradigms can be performed to uncover the neural correlates that guide behavior. Here we present a method for recording brain activity from intracranial implants as subjects perform a behavioral task designed to assess decision-making and reward encoding. All electrophysiological data from the intracranial electrodes are recorded during the behavioral task, allowing for the examination of the many brain areas involved in a single function at time scales relevant to behavior. Moreover, and unlike animal studies, human patients can learn a wide variety of behavioral tasks quickly, allowing for the ability to perform more than one task in the same subject or for performing controls. Despite the many advantages of this technique for understanding human brain function, there are also methodological limitations that we discuss, including environmental factors, analgesic effects, time constraints and recordings from diseased tissue. This method may be easily implemented by any institution that performs intracranial assessments; providing the opportunity to directly examine human brain function during behavior.

Patients implanted with intracranial electrodes provide a unique opportunity to record neurological data from multiple areas of the brain while the patient performs behavioral tasks. Here, we present a method of recording from implanted patients that can be reproducible at other institutions with access to this patient population.

Darstellende Behavioral Aufgaben bei Patienten mit Hirnelektroden

Patients having stereo-electroencephalography (SEEG) electrode, subdural grid or depth electrode implants have a multitude of electrodes implanted in ...

Verhalten

Combined Invasive Subcortical and Non-invasive Surface Neurophysiological Recordings for the Assessment of Cognitive and Emotional Functions in Humans

In spite of the success in applying non-invasive electroencephalography (EEG), magneto-encephalography (MEG) and functional magnetic resonance imaging (fMRI) for extracting crucial information about the mechanism of the human brain, such methods remain insufficient to provide information about physiological processes reflecting cognitive and emotional functions at the subcortical level. In this respect, modern invasive clinical approaches in humans, such as deep brain stimulation (DBS), offer a tremendous possibility to record subcortical brain activity, namely local field potentials (LFPs) representing coherent activity of neural assemblies from localized basal ganglia or thalamic regions. Notwithstanding the fact that invasive approaches in humans are applied only after medical indication and thus recorded data correspond to altered brain circuits, valuable insight can be gained regarding the presence of intact brain functions in relation to brain oscillatory activity and the pathophysiology of disorders in response to experimental cognitive paradigms. In this direction, a growing number of DBS studies in patients with Parkinson&#39;s disease (PD) target not only motor functions but also higher level processes such as emotions, decision-making, attention, memory and sensory perception. Recent clinical trials also emphasize the role of DBS as an alternative treatment in neuropsychiatric disorders ranging from obsessive compulsive disorder (OCD) to chronic disorders of consciousness (DOC). Consequently, we focus on the use of combined invasive (LFP) and non-invasive (EEG) human brain recordings in assessing the role of cortical-subcortical structures in cognitive and emotional processing trough experimental paradigms (e.g. speech stimuli with emotional connotation or paradigms of cognitive control such as the Flanker task), for patients undergoing DBS treatment.

The present protocol aims at assessing cognitive-emotional functions in the basal ganglia by simultaneous neurophysiological recording of local field potentials and non-invasive brain cortical activity (EEG). The procedure is exemplified by the use of paradigms involving speech stimuli with emotional connotation or the Flanker task involving cognitive control.

Kombinierte Invasive Subcortical und Nicht-invasive Oberflächenneurophysiologische Aufnahmen zur Beurteilung von kognitiven und emotionalen Funktionen beim Menschen

In spite of the success in applying non-invasive electroencephalography (EEG), magneto-encephalography (MEG) and functional magnetic resonance imaging ...

Simultaneous Recordings of Cortical Local Field Potentials, Electrocardiogram, Electromyogram, and Breathing Rhythm from a Freely Moving Rat

Monitoring the physiological dynamics of the brain and peripheral tissues is necessary for addressing a number of questions about how the brain controls body functions and internal organ rhythms when animals are exposed to emotional challenges and changes in their living environments. In general experiments, signals from different organs, such as the brain and the heart, are recorded by independent recording systems that require multiple recording devices and different procedures for processing the data files. This study describes a new method that can simultaneously monitor electrical biosignals, including tens of local field potentials in multiple brain regions, electrocardiograms that represent the cardiac rhythm, electromyograms that represent awake/sleep-related muscle contraction, and breathing signals, in a freely moving rat. The recording configuration of this method is based on a conventional micro-drive array for cortical local field potential recordings in which tens of electrodes are accommodated, and the signals obtained from these electrodes are integrated into a single electrical board mounted on the animal's head. Here, this recording system was improved so that signals from the peripheral organs are also transferred to an electrical interface board. In a single surgery, electrodes are first separately implanted into the appropriate body parts and the target brain areas. The open ends of all of these electrodes are then soldered to individual channels of the electrical board above the animal's head so that all of the signals can be integrated into the single electrical board. Connecting this board to a recording device allows for the collection of all of the signals into a single device, which reduces experimental costs and simplifies data processing, because all data can be handled in the same data file. This technique will aid the understanding of the neurophysiological correlates of the associations between central and peripheral organs.

This study introduces a method for the simultaneous recording of local field potentials in the brain, electrocardiograms, electromyograms, and breathing signals of a freely moving rat. This technique, which reduces experimental costs and simplifies data analysis, will contribute to the understanding of the interactions between the brain and peripheral organs.

Gleichzeitige Aufnahmen der kortikalen lokales Feld Potentiale, Elektrokardiogramm, Elektromyogramm und Atemrhythmus aus einem frei beweglichen Ratte

Monitoring the physiological dynamics of the brain and peripheral tissues is necessary for addressing a number of questions about how the brain controls ...

Neurowissenschaften

A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury

Intracranial pressure (ICP) monitoring is a cornerstone of the intensive care management of patients with severe acute brain injuries, including traumatic brain injury. While elevations in ICP are common, data regarding the measurement and treatment of these ICP elevations are conflicting. There is increasing recognition that changes in the balance between supply and demand of brain tissue are critically important and therefore the measurement of multiple modalities is required. Approaches are not standard, and therefore this article provides a description of a bedside, single burr hole approach to multimodality monitoring that allows the passage of probes designed to measure not only ICP but brain tissue oxygen, blood flow, and intracranial electroencephalography. Patient selection criteria, operative procedures, and practical considerations for securing probes during critical care are described. This method is readily performed, safe, secure, and flexible for the adoption of a variety of multimodality monitoring approaches aimed at detecting or preventing secondary brain injuries.

A method of recording multimodality monitoring signals in patients with severe brain injuries using a bedside, single burr hole technique is described.

Ein Nachttisch, einzelne Burr Loch Ansatz zur Multimodalität Überwachung in schwere Hirnschädigung

Intracranial pressure (ICP) monitoring is a cornerstone of the intensive care management of patients with severe acute brain injuries, including traumatic ...

Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs

Hemorrhagic shock ranks among the main reasons for severe injury-related death. The loss of circulatory volume and oxygen carriers can lead to an insufficient oxygen supply and irreversible organ failure. The brain exerts only limited compensation capacities and is particularly at high risk of severe hypoxic damage.This article demonstrates the reproducible induction of life-threatening hemorrhagic shock in a porcine model by means of calculated blood withdrawal. We titrate shock induction guided by near-infrared spectroscopy&#160;and extended hemodynamic monitoring to display systemic circulatory failure, as well as cerebral microcirculatory oxygen depletion. In comparison to similar models that primarily focus on predefined removal volumes for shock induction, this approach highlights a titration by means of the resulting failure of macro- and microcirculation.

Hemorrhagic shock is a severe complication in seriously injured patients, which leads to life-threatening oxygen undersupply. We present a standardized method to induce hemorrhagic shock via blood withdrawal in pigs that is guided by hemodynamics and microcirculatory cerebral oxygenation.

Standardisierte hämorrhagische Schockinduktion geführt durch Zerebrale Oximetrie und erweiterte hämodynamische Überwachung bei Schweinen

Hemorrhagic shock ranks among the main reasons for severe injury-related death. The loss of circulatory volume and oxygen carriers can lead to an ...

Reliable Acquisition of Electroencephalography Data during Simultaneous Electroencephalography and Functional MRI

Simultaneous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI), EEG-fMRI, combines the complementary properties of scalp EEG (good temporal resolution) and fMRI (good spatial resolution) to measure neuronal activity during an electrographic event, through hemodynamic responses known as blood-oxygen-level-dependent (BOLD) changes. It is a non-invasive research tool that is utilized in neuroscience research and is highly beneficial to the clinical community, especially for the management of neurological diseases, provided that proper equipment and protocols are administered during data acquisition. Although recording EEG-fMRI is apparently straightforward, the correct preparation, especially in placing and securing the electrodes, is not only important for safety but is also critical in ensuring the reliability and analyzability of the EEG data obtained. This is also the most experience-demanding part of the preparation. To address these issues, a straightforward protocol that ensures data quality was developed. This article provides a step-by-step guide for acquiring reliable EEG data during EEG-fMRI using this protocol that utilizes readily available medical products. The presented protocol can be adapted to different applications of EEG-fMRI in research and clinical settings, and may be beneficial to both inexperienced and expert operators.

This article provides a straightforward protocol for acquiring good quality electroencephalography (EEG) data during simultaneous EEG and functional magnetic resonance imaging by utilizing readily available medical products.

Zuverlässige Erfassung von Elektroenzephalographiedaten während der simultanen Elektroenzephalographie und funktionellen MRT

Simultaneous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI), EEG-fMRI, combines the complementary properties of scalp EEG ...

How to Administer Near-Infrared Spectroscopy in Critically ill Neonates, Infants, and Children

Near infrared spectroscopy (NIRS) calculates regional tissue oxygenation (rSO2) using the different absorption spectra of oxygenated and deoxygenated hemoglobin molecules. A probe placed on the skin emits light that is absorbed, scattered, and reflected by the underlying tissue. Detectors in the probe sense the amount of reflected light: this reflects the organ-specific ratio of oxygen supply and consumption - independent of pulsatile flow. Modern devices enable the simultaneous monitoring at different body sites. A rise or dip in the rSO2 curve visualizes changes in oxygen supply or demand before vital signs indicate them. The evolution of rSO2 values in relation to the starting point is more important for interpretation than are absolute values.
A routine clinical application of NIRS is the surveillance of somatic and cerebral oxygenation during and after cardiac surgery. It is also administered in preterm infants at risk for necrotizing enterocolitis, newborns with hypoxic ischemic encephalopathy and a potential risk of impaired tissue oxygenation. In the future, NIRS could be increasingly used in multimodal neuromonitoring, or applied to monitor patients with other conditions (e.g., after resuscitation or traumatic brain injury).

This protocol is designed to assist clinicians to measure regional tissue oxygenation at different body sites in infants and children. It can be used in situations where tissue oxygenation is potentially compromised, particularly during cardiopulmonary bypass, when using non-pulsatile cardiac-assist devices, and in critically ill neonates, infants and children.

Wie man Nahinfrarot-Spektroskopie bei kritisch kranken Neugeborenen, Säuglingen und Kindern verabreicht

Near infrared spectroscopy (NIRS) calculates regional tissue oxygenation (rSO2) using the different absorption spectra of oxygenated and deoxygenated ...

Real-Time Monitoring of Neurocritical Patients with Diffuse Optical Spectroscopies

Neurophysiological monitoring is an important goal in the treatment of neurocritical patients, as it may prevent secondary damage and directly impact morbidity and mortality rates. However, there is currently a lack of suitable non-invasive, real-time technologies for continuous monitoring of cerebral physiology at the bedside. Diffuse optical techniques have been proposed as a potential tool for bedside measurements of cerebral blood flow and cerebral oxygenation in case of neurocritical patients. Diffuse optical spectroscopies have been previously explored to monitor patients in several clinical scenarios ranging from neonatal monitoring to cerebrovascular interventions in adults. However, the feasibility of the technique to aid clinicians by providing real-time information at the bedside remains largely unaddressed. Here, we report the translation of a diffuse optical system for continuous real-time monitoring of cerebral blood flow, cerebral oxygenation, and cerebral oxygen metabolism during intensive care. The real-time feature of the instrument could enable treatment strategies based on patient-specific cerebral physiology rather than relying on surrogate metrics, such as arterial blood pressure. By providing real-time information on the cerebral circulation at different time scales with relatively cheap and portable instrumentation, this approach may be especially useful in low-budget hospitals, in remote areas and for&#160;monitoring in open fields (e.g., defense and sports).

Presented here is a protocol for non-invasively monitoring cerebral hemodynamics of neurocritical patients in real-time and at the bedside using diffuse optics. Specifically, the proposed protocol uses a hybrid diffuse optical systems to detect and display real-time information on cerebral oxygenation, cerebral blood flow and cerebral metabolism.

Echtzeit-Monitoring neurokritischer Patienten mit diffuser optischer Spektroskopie

Neurophysiological monitoring is an important goal in the treatment of neurocritical patients, as it may prevent secondary damage and directly impact ...

Intra-Abdominal Pressure Measurements in Neurocritical Patients

Intra-abdominal pressure (IAP) is increasingly being recognized as an indispensable and significant physiological parameter in intensive care units (ICU). IAP has been measured in a variety of ways with the development of many techniques in recent years. The level of intra-abdominal pressure under normal conditions is generally equal to or less than 12 mmHg. Accordingly, abdominal hypertension (IAH) is defined as two consecutive IAP measurements higher than 12 mmHg within 4-6 h. When IAH deteriorates further with IAP higher than 20 mmHg along with organ dysfunction and/or failure, this clinical manifestation can be diagnosed as abdominal compartment syndrome (ACS). IAH and ACS are associated with gastrointestinal ischemia, acute renal failure, and lung injury, leading to severe morbidity and mortality. Elevated IAP and IAH may affect the cerebral venous return and outflow of the cerebrospinal fluid by increasing the intrathoracic pressure (ITP), ultimately leading to increased intracranial pressure (ICP). Therefore, it is essential to monitor IAP in critically ill patients. The reproducibility and accuracy of intra-bladder pressure (IBP) measurements in previous studies need to be further improved, although the indirect measurement of IAP is now a widely used technique. To address these limitations, we recently used a set of IAP monitoring systems with advantages of convenience, continuous monitoring, digital visualization, and long-term IAP recording and data storage in critically ill patients. This IAP monitoring system can detect intra-abdominal hypertension and potentially analyze clinical status in real time. The recorded IAP data and other physiological indicators, such as intracranial pressure, can be further used for correlation analysis to guide treatment and predict a patient&#39;s possible prognosis.

<meta charset="utf8"></head><body>Intraabdominale Druckmessungen bei neurokritischen Patienten

This protocol details the use of a set of intra-abdominal pressure monitoring systems with advantages of convenience, continuous monitoring, digital visualization, and long-term IAP recording and data storage in neurocritical patients to detect intra-abdominal hypertension, which is used for correlation analysis to guide treatment and predict prognoses.

Intraabdominale Druckmessungen bei neurokritischen Patienten

Intra-abdominal pressure (IAP) is increasingly being recognized as an indispensable and significant physiological parameter in intensive care units (ICU). ...