Name: measurement of tissue oxygenation using near-infrared spectroscopy in patients undergoing hemodialysis
Uploaded: 2020-10-02T13:00:00.000+00:00
Duration: 4 min 36 s
Description: Watch this Scientific Journal Video about Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis at JoVE.com

투석 직원과 지치 의과 대학 사이타마 의료 센터의 신장학과 구성원에게 감사드립니다. 영어 편집을 해주신 Editage (www.editage.com)님께 감사드립니다.

모든 참가자는 서면 동의서를 제공했습니다. 이 연구는 일본 지치 의과 대학 사이타마 의료 센터의 기관 검토위원회 (RIN 15-104)의 승인을 받았습니다.
1.rSO2의 모니터링 장치
<ol><li>조직 산소화 측정을 위한 NIRS 장치를 준비합니다. 이 장치에는 4개의 채널이 있으며 동시에 최대 4개의 기관에서 측정을 수행할 수 있습니다.</li>
	<li>NIRS 모니터링을 위한 측정 센서를 준비하여 두 개의 부착 파장에서 근적외선을 전송하여 각 기관의 rSO2 값을 평가합니다.</li>
</ol>2. 측정 센서 부착
<ol><li>HD 전에 각 환자가 최소 5분 동안 앙와위 자세로 쉬도록 합니다.</li>
	<li>측정 센서를 이마, 오른쪽 hypochondrium 및 다리 아래쪽에 부착하여 각각 뇌, 간 및 다리 근육에서 rSO2 를 평가합니다.</li>
	<li>뇌 산소 공급 모니터링<ol><li>측정 센서를 지배적 인 반구의 이마에 부착하십시오.</li>
	</ol></li>
	<li>간 산소 공급 모니터링<ol><li>신체 표면에서 환자의 간까지의 깊이를 측정하기 위해 초음파 검사를 준비하십시오. 이 측정값이 신체 표면에서 20-30mm 이내에 있는지 확인합니다. 다음으로, 측정 센서를 오른쪽 hypochondrium에 부착하십시오. 알림: 이 장치에서 rSO2 값은 신체 표면에서 20-30mm 떨어진 깊은 조직에서 얻어야 합니다. 일부 예에서, 간은 두꺼운 피하 지방의 존재로 인해 신체 표면으로부터 30 mm 이상 위치할 수 있다.</li>
	</ol></li>
	<li>근육 산소 공급 모니터링<ol><li>측정 센서를 오른쪽 또는 양측 아래쪽 다리에 부착합니다.</li>
	</ol></li>
	<li>센서 연결 및 장치 전원 공급<ol><li>각 센서를 장치의 리드에 연결합니다. 그런 다음 장치를 켜고 산소 측정을 시작하십시오.</li>
	</ol></li>
</ol>3. 투석 션트 천공 및 모니터링 시작
<ol><li>투석 션트 천공<ol><li>환자의 투석 션트에 구멍을 뚫어 HD 치료를 시작합니다. 이때 투석기가 장착된 디지털 혈압계를 이용하여 혈압을 측정하고 주사기를 이용하여 혈액 샘플을 수집한다.</li>
	</ol></li>
	<li>모니터링 시작<ol><li>HD 치료를 시작한 후 뇌, 간 및 다리 근육의 세 기관의 조직 산소 공급 모니터링을 시작하십시오.</li>
	</ol></li>
	<li>HD 중 rSO2 모니터링<ol><li>각 장기의 rSO2 값의 변화를 관찰하고 심박수, 정맥압 및 혈액량을 포함하여 HD 치료 중에 수행되는 일반적인 모니터링 외에도 정기적으로 BP를 측정합니다. 부착 영역과 센서와 리드 사이의 연결을 확인하십시오.</li>
	</ol></li>
</ol>

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이해 상충이 없습니다.

NIRS 모니터링은 주로 대뇌 rSO2를 평가하기 위해, 특히 체외 순환을 필요로 하는 심혈관 또는 뇌혈관 수술에서 사용되었다. HD 치료를 포함한 체외 순환 동안 일부 장기는 상대 허혈 7,17,18을 나타낼 수 있습니다. 그러나 조직 산소화가 낮아지는지 여부는 불분명합니다. HD 중 근육 경련이나 복통은 장기 저관류를 통한 투석 중 저혈압의 전구 증상 중 하나일 수 있습니다. 그러나 HD 치료에서 현재 조직 산소화를 실시간으로 평가하는 방법은 없습니다. 따라서 우리는 위에서 설명한 프로토콜을 사용하여 장기 산소 공급을 평가하기 위해이 모니터링 장치를 사용하는 데 중점을 두었습니다. 이 프로토콜은 HD 환자에게 비침습적이며 조직 산소화의 변화를 실시간으로 확인하는 데 유용합니다.
도 1에 나타낸 바와 같이, DM이 있는 HD 환자에서의 대뇌rSO2는 DM이 없는 환자에서의 것보다 낮았다. 또한, 더 높은 혈관 석회화는 더 낮은 뇌 산소화와 관련이 있었다19. 따라서, 미세 및 거대 혈관 장애는 뇌 산소 공급의 손상과 관련 될 수있다. 더욱이, 대뇌rSO2는HD 환자4에서 60-150 mmHg 내에서 비교적 일정하게 유지되었다. 그러나 투석 중 저혈압에서 혈압의 급격한 감소는 장기 산소 공급의 변화로 이어질 수 있습니다(그림 2). 이 프로토콜에 의한rSO2 값의 변화를 관찰하기 전에, 우리는 HD 동안 조직 산소화의 영향을 확인할 수 없었다. 지속적인 동맥압 모니터링 외에도 BP는 일반적으로 간헐적으로 평가됩니다. 대조적으로, NIRS에 의한 지속적인 모니터링은 HD 동안 혈압의 변화에 의해 감지되기 전에 장기 산소 공급의 변화를 감지할 수 있습니다. 따라서 우리는 BP의 저하를 확인하기 전에 저산소증 상태를 관찰 할 수있었습니다. 혈압의 변화 이외에, 수혈, 저밀도 지단백질 성분채집 및 한외여과는 하부 다리20,21,22의 rSO2와 같은 기관 산소화의 변화를 야기할 수 있다. 따라서 우리는 HD 동안 장기 산소 공급의 급격한 변화에 주의를 기울여야 합니다.
이 프로토콜에는 몇 가지 제한 사항이 있습니다. 첫째, 대뇌 rSO2는 이마에서만 측정할 수 있었다; 그러나 후방 뇌 순환에서이 평가를 수행하는 것은 어렵습니다. 측정 센서는 씰 유형이므로 센서를 머리카락에 고정할 수 있습니다. 다음으로, 간rSO2의 측정은 피하 지방 두께의 확인을 필요로 한다. 비만 환자에서, 측정된rSO2는 근적외선이 표적 기관에 도달할 수 없기 때문에 정확하지 않을 수 있다. 셋째,rSO2 값은 신체 움직임 또는 위치(즉, 앙와위 및 앉은 자세)에 의해 영향을 받을 수 있다. 따라서 HD 동안 환자는 가능한 한 침대에서 같은 위치에 있는 동안 측정해야 합니다.
더욱이, 이 프로토콜에서 측정된rSO2 값은 혼합 정맥 포화도를 나타내며, 이는 정맥(70-80%), 모세관(5%), 및 동맥(20-25%) 혈액에서 조직 산소화를 반영한다(23). 따라서,rSO2 값의 변화가 경피적 산소 포화도24,25에서의 변화를 반드시 평행하게 하는 것은 아니다. 따라서, 측정된rSO2 값은 신중하게 해석되어야 한다. 또한 이 프로토콜은 NIRS 모니터링 장치를 사용할 수 있는 경우 환자에게 수행하기 쉽고 비침습적입니다. 따라서 이 방법은 널리 일반적인 다양성을 제공합니다. 우리는 이 NIRS 모니터링이 미래에 투석 모니터로 투석 기계가 장착되기를 바랍니다.
결론적으로, 우리는 HD를 받는 환자에서 NIRS에 의한 조직 산소화 측정을 위한 프로토콜을 설명했습니다. HD 중 이러한 모니터링은 HD 요법의 영향을 받는 조직 산소화의 변화에 대한 새로운 발견을 제공할 수 있습니다.

근적외선 분광법 (NIRS)은 조직 산소화, 특히 다양한 임상 환경에서 뇌 산소화의 마커 인 국소 산소 포화도 (rSO 2)를 평가하는 데 사용되었습니다 1,2,3 최근에는 혈액 투석 (HD)4,5,6,7,8,9,10, 11. 대뇌 rSO2는 HD 환자 또는 투석되지 않은 만성 신장 질환(CKD) 환자의 인지 기능과 관련이 있는 것으로 보고되었습니다11,12. 그러나 지금까지 만성콩팥병 환자에서 NIRS 모니터링의 사용은 제한적이었습니다.
NIRS 모니터링은 실시간 및 비침습적이기 때문에 HD를 받는 환자에서 모니터링 장치로서의 유용성을 평가했습니다. NIRS는 주로 대뇌 rSO2를 측정하는 데 사용되지만, HD 동안 다른 장기의 rSO2 값도 조사했습니다. 구체적으로,rSO2 측정 센서를 이마, 오른쪽 hypochondrium 및 다리 아래쪽에 부착하여 각각 뇌, 간 및 하부 근육에서 rSO2를 평가하였다. 결과는 NIRS 모니터링이 헌팅턴병 중 장기 산소화 변화 또는 CKD 환자의 조직 산소화 영향을 미치는 요인을 명확히 하는 새로운 접근 방식이 될 수 있음을 보여주었습니다.
현재까지 임상 환경13,14,15에서 HD, 혈액량 모니터링, 중심 정맥 산소 포화도, 흉부 입원 및 전자 청진기 유도 예상 혈압(BP) 동안 지속적인 모니터링이 수행되었습니다. 그러나 저혈압의 예측이나 장치의 광범위한 사용에는 한계가 있습니다. 대조적으로, 여기서 새로운 비침습적 접근 방식은 개별 장기의 투석 내 산소 역학에 대한 실시간 정보를 제공할 수 있습니다. 따라서 이 모니터링 방법은 투석 중 저혈압의 초기 단계에서 일과성 장기 허혈을 감지할 수 있고 HD의 안전한 수행을 허용할 수도 있습니다. 이 기사는 HD를 받는 환자에게 적용되는 rSO2로 대표되는 조직 산소화를 측정하는 프로토콜을 설명합니다.

<table><tbody><tr><td>DBB-100NX</td><td>Nikkiso</td><td>DBB-100NX</td><td>Dialysis machine</td></tr><tr><td>INVOS 5100c</td><td>Covidien Japan</td><td>INVOSTM 5100c</td><td>tissue oxygenation device</td></tr><tr><td>SOMASENSER</td><td>Covidien Japan</td><td>CV-SAFB-SM/INTL</td><td>NIRS sensor</td></tr></tbody></table>

measurement of tissue oxygenation using near-infrared spectroscopy in patients undergoing hemodialysis

근적외선 분광법(NIRS)은 최근 심혈관 및 뇌 수술, 신생아 모니터링 및 병원 전 의학을 포함한 임상 환경에서 조직 산소화 마커인 국소 산소 포화도(rSO2)를 측정하는 도구로 적용되었습니다. NIRS 모니터링 장치는 실시간 및 비침습적이며 주로 수술 또는 집중 치료 중 중환자의 뇌 산소 공급을 평가하는 데 사용되었습니다. 지금까지 혈액 투석 (HD)을 포함한 만성 신장 질환 (CKD) 환자에서 NIRS 모니터링의 사용은 제한적이었습니다. 따라서, 우리는 HD 동안 일부 장기에서rSO2 값을 조사하였다. 2개의 부착 파장에서 근적외선을 전송하는 NIRS 장치를 사용하여rSO2 값을 모니터링했습니다. HD 환자는 뇌, 간 및 다리 아래 근육에서 rSO2를 각각 평가하기 위해 이마, 오른쪽 hypochondrium 및 다리 아래쪽에 부착된 rSO2 측정 센서를 사용하여 앙와위 자세로 배치되었습니다. NIRS 모니터링은 헌팅턴병 중 장기 산소화의 변화 또는 CKD 환자의 조직 산소화에 영향을 미치는 요인을 명확히 하는 새로운 접근 방식이 될 수 있습니다. 이 기사는 HD 환자에서 적용되는rSO2로 대표되는 조직 산소화를 측정하는 프로토콜을 설명합니다.

HD 이전의 대뇌 rSO2 값은 건강한 피험자보다 낮았고 당뇨병(DM)이 있는 HD 환자의 대뇌rSO2 값은 DM이 없는 HD 환자의 값보다 낮았습니다(그림 1)16. 또한 HD 동안 BP의 감소 없이 조직 산소 공급이 계속되지만 투석 중 저혈압으로 인한 뇌 및 간 rSO2의 변화를 우연히 관찰했습니다(그림 2). 지속적인 모니터링으로 인해, 조직 산소화의 변화는 간헐적으로 모니터링된 BP에 의해서보다 더 빨리 관찰되었다. 데이터는 표준 오차± 평균으로서 표현되었다. 쌍을 이루지 않은 값에 대한 분산 분석을 사용하여 세 그룹을 비교했습니다.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/61721/61721fig01.jpg"> 그림 1: 당뇨병이 있는 HD 환자(n=27), 당뇨병이 없는 HD 환자(n=27) 및 건강한 피험자(n=28)의 HD 전 대뇌 rSO2 비교. 환자는 평균 연령이 67.7 세에서 1.2 세이고 HD 기간이 6.5 세에서 1.9 세± 38 명의 남성과 16 명의 여성± 포함되었습니다. 만성 신장 질환의 원인은 DM (27 명), 만성 사구체 신염 (14 명), 신장 경화증 (4 명), 다낭성 신장 질환 (4 명) 및 기타 (5 명)였다. 오차 막대는 표준 오차를 나타냅니다. 데이터는 이전 보고서16을 기반으로 했으며 그림은 수정되었습니다. 데시미터; 당뇨병, HD; 혈액 투석, rSO2; 국소 산소 포화도. <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/61721/61721fig01large.jpg" target="_blank">이 그림의 더 큰 버전을 보려면 여기를 클릭하십시오.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/61721/61721fig2v2.jpg"> 그림 2 : 급성 투석 내 저혈압 환자에서 뇌 및 간 rSO2 의 변화. 혈압; 혈압, HR; 시간,rSO2; 국소 산소 포화도, UFR; 한외 여과율. <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/61721/61721fig2v2large.jpg" target="_blank">이 그림의 더 큰 버전을 보려면 여기를 클릭하십시오.</a>

Watch this Scientific Journal Video about Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis at JoVE.com

Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis

우리는 근적외선 분광 모니터를 사용하여 혈액 투석 (HD) 환자의 국소 산소 포화도 (rSO2)를 측정하는 프로토콜을 제시합니다. rSO2 값은 조직 산소화의 지표이다. 이 비침습적 및 실시간 모니터링은 HD 동안 장기 산소 공급의 변화를 확인하는 데 유용할 수 있습니다.

혈액 투석을받는 환자에서 근적외선 분광법을 사용한 조직 산소화 측정

Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in ...

measurement-tissue-oxygenation-using-near-infrared-spectroscopy

Universidad San Sebastian

Research

JoVE Journal

Medicine

2.1K 조회수.  Jichi Medical University. 우리는 근적외선 분광 모니터를 사용하여 혈액 투석 (HD) 환자의 국소 산소 포화도 (rSO2)를 측정하는 프로토콜을 제시합니다. rSO2 값은 조직 산소화의 지표이다. 이 비침습적 및 실시간 모니터링은 HD 동안 장기 산소 공급의 변화를 확인하는 데 유용할 수 있습니다.

비디오: Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis

Dual-mode Imaging of Cutaneous Tissue Oxygenation and Vascular Function

Accurate assessment of cutaneous tissue oxygenation and vascular function is important for appropriate detection, staging, and treatment of many health disorders such as chronic wounds. We report the development of a dual-mode imaging system for non-invasive and non-contact imaging of cutaneous tissue oxygenation and vascular function. The imaging system integrated an infrared camera, a CCD camera, a liquid crystal tunable filter and a high intensity fiber light source. A Labview interface was programmed for equipment control, synchronization, image acquisition, processing, and visualization. Multispectral images captured by the CCD camera were used to reconstruct the tissue oxygenation map. Dynamic thermographic images captured by the infrared camera were used to reconstruct the vascular function map. Cutaneous tissue oxygenation and vascular function images were co-registered through fiduciary markers. The performance characteristics of the dual-mode image system were tested in humans.

A dual-mode imaging system was developed for non-contact assessment of cutaneous tissue oxygenation and vascular function.

피부 조직 산소와 혈관 기능의 듀얼 모드 영상

Accurate assessment of cutaneous tissue oxygenation and vascular function is important for appropriate detection, staging, and treatment of many health ...

연구

의학

Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants

Perinatal brain injury remains a significant cause of infant mortality and morbidity, but there is not yet an effective bedside tool that can accurately screen for brain injury, monitor injury evolution, or assess response to therapy. The energy used by neurons is derived largely from tissue oxidative metabolism, and neural hyperactivity and cell death are reflected by corresponding changes in cerebral oxygen metabolism (CMRO2). Thus, measures of CMRO2 are reflective of neuronal viability and provide critical diagnostic information, making CMRO2 an ideal target for bedside measurement of brain health.
Brain-imaging techniques such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT) yield measures of cerebral glucose and oxygen metabolism, but these techniques require the administration of radionucleotides, so they are used in only the most acute cases.
Continuous-wave near-infrared spectroscopy (CWNIRS) provides non-invasive and non-ionizing radiation measures of hemoglobin oxygen saturation (SO2) as a surrogate for cerebral oxygen consumption. However, SO2 is less than ideal as a surrogate for cerebral oxygen metabolism as it is influenced by both oxygen delivery and consumption. Furthermore, measurements of SO2 are not sensitive enough to detect brain injury hours after the insult 1,2, because oxygen consumption and delivery reach equilibrium after acute transients 3. We investigated the possibility of using more sophisticated NIRS optical methods to quantify cerebral oxygen metabolism at the bedside in healthy and brain-injured newborns. More specifically, we combined the frequency-domain NIRS (FDNIRS) measure of SO2 with the diffuse correlation spectroscopy (DCS) measure of blood flow index (CBFi) to yield an index of CMRO2 (CMRO2i) 4,5.
With the combined FDNIRS/DCS system we are able to quantify cerebral metabolism and hemodynamics. This represents an improvement over CWNIRS for detecting brain health, brain development, and response to therapy in neonates. Moreover, this method adheres to all neonatal intensive care unit (NICU) policies on infection control and institutional policies on laser safety. Future work will seek to integrate the two instruments to reduce acquisition time at the bedside and to implement real-time feedback on data quality to reduce the rate of data rejection.

We combined frequency-domain near-infrared spectroscopy measures of cerebral hemoglobin oxygenation with diffuse correlation spectroscopy measures of cerebral blood flow index to estimate an index of oxygen metabolism. We tested the utility of this measure as a bedside screening tool to evaluate the health and development of the newborn brain.

유아의 뇌 신진 대사와 혈류 역학의 비 침습적 광학 측정

Perinatal brain injury remains a significant cause of infant mortality  and morbidity, but there is not yet an effective bedside tool that can  accurately ...

A Model to Simulate Clinically Relevant Hypoxia in Humans

In case of apnea, arterial partial pressure of oxygen (pO2) decreases, while partial pressure of carbon dioxide (pCO2) increases. To avoid damage to hypoxia sensitive organs such as the brain, compensatory circulatory mechanisms help to maintain an adequate oxygen supply. This is mainly achieved by increased cerebral blood flow. Intermittent hypoxia is a commonly seen phenomenon in patients with obstructive sleep apnea. Acute airway obstruction can also result in hypoxia and hypercapnia. Until now, no adequate model has been established to simulate these dynamics in humans. Previous investigations focusing on human hypoxia used inhaled hypoxic gas mixtures. However, the resulting hypoxia was combined with hyperventilation and is therefore more representative of high altitude environments than of apnea. Furthermore, the transferability of previously performed animal experiments to humans is limited and the pathophysiological background of apnea induced physiological changes is poorly understood. In this study, healthy human apneic divers were utilized to mimic clinically relevant hypoxia and hypercapnia during apnea. Additionally, pulse-oximetry and Near Infrared Spectroscopy (NIRS) were used to evaluate changes in cerebral and peripheral oxygen saturation before, during, and after apnea.

Hypoxia simulation in humans has usually been performed by inhaling hypoxic gas mixtures. For this study, apneic divers were used to simulate dynamic hypoxia in humans. Additionally, physiological changes in desaturation and re-saturation kinetics were evaluated with non-invasive tools such as Near-Infrared-Spectroscopy (NIRS) and peripheral oxygenation saturation (SpO2).

A 모델은 인간의 임상 관련 저산소증을 시뮬레이션하기

In case of apnea, arterial partial pressure of oxygen (pO2) decreases, while partial pressure of carbon dioxide (pCO2) increases. To avoid damage to ...

Skeletal Muscle Neurovascular Coupling, Oxidative Capacity, and Microvascular Function with 'One Stop Shop' Near-infrared Spectroscopy

Exercise represents a major hemodynamic stress that demands a highly coordinated neurovascular response in order to match oxygen delivery to metabolic demand. Reactive hyperemia (in response to a brief period of tissue ischemia) is an independent predictor of cardiovascular events and provides important insight into vascular health and vasodilatory capacity. Skeletal muscle oxidative capacity is equally important in health and disease, as it determines the energy supply for myocellular processes. Here, we describe a simple, non-invasive approach using near-infrared spectroscopy to assess each of these major clinical endpoints (reactive hyperemia, neurovascular coupling, and muscle oxidative capacity) during a single clinic or laboratory visit. Unlike Doppler ultrasound, magnetic resonance images/spectroscopy, or invasive catheter-based flow measurements or muscle biopsies, our approach is less operator-dependent, low-cost, and completely non-invasive. Representative data from our lab taken together with summary data from previously published literature illustrate the utility of each of these end-points. Once this technique is mastered, application to clinical populations will provide important mechanistic insight into exercise intolerance and cardiovascular dysfunction.

Here, we describe a simple, non-invasive approach using near-infrared spectroscopy to assess reactive hyperemia, neurovascular coupling and skeletal muscle oxidative capacity in a single clinic or laboratory visit.

골격 근육 혈관 결합, 산화 용량 및 Microvascular 함수 '원스톱 쇼핑' 근처-적외선 분광학

Exercise represents a major hemodynamic stress that demands a highly coordinated neurovascular response in order to match oxygen delivery to metabolic ...

Cerebrovascular Reactivity Measurement with Functional Near Infrared Spectroscopy

Cerebrovascular reactivity (CVR) is the capacity of blood vessels in the brain to alter cerebral blood flow (either with dilation or constriction) in response to chemical or physical stimuli. The amount of reactivity in the cerebral microvasculature depends on the integrity of the capacitance vasculature and is the primary function of endothelial cells. CVR is, therefore, an indicator of the microvasculature&#8217;s physiology and overall health. Imaging methods that can measure CVR are available but can be costly, and require magnetic resonance imaging centers and technical expertise. In this study, we used fNIRS technology to monitor changes of oxyhemoglobin (HbO) and deoxyhemoglobin (HbR) in the cerebral microvasculature to assess the CVR of 15 healthy controls (HC) in response to a vasoactive stimulus (inhaled 5% carbon dioxide or CO2). Our results suggest that this is a promising imaging technology that offers a non-invasive, accurate, portable, and cost-effective method of mapping cortical CVR and associated microvasculature function, resulting from a traumatic brain injury or other conditions associated with cerebral microvasculopathy.

Presented here is a protocol for imaging and measurement of cerebrovascular reactivity in humans with functional Near Infrared Spectroscopy (fNIRS). fNIRS is a novel imaging modality that captures the concentration changes of hemoglobin species in the brain&#8217;s outermost cortex under specific stimuli.

Cerebrovascular reactivity (CVR) is the capacity of blood vessels in the brain to alter cerebral blood flow (either with dilation or constriction) in ...

신경과학

Integration of Brain Tissue Saturation Monitoring in Cardiopulmonary Exercise Testing in Patients with Heart Failure

Cerebral hypo-oxygenation during rest or exercise negatively impacts the exercise capacity of patients with heart failure with reduced ejection fraction (HF). However, in clinical cardiopulmonary exercise testing (CPET), cerebral hemodynamics is not assessed. NIRS is used to measure cerebral tissue oxygen saturation (SctO2) in the frontal lobe. This method is reliable and valid and has been utilized in several studies. SctO2 is lower during both rest and peak exercise in patients with HF than in healthy controls (66.3 &#177; 13.3% and 63.4 &#177; 13.8% vs. 73.1 &#177; 2.8% and 72 &#177; 3.2%). SctO2 at rest is significantly linearly correlated with peak VO2 (r = 0.602), oxygen uptake efficiency slope (r = 0.501), and brain natriuretic peptide (r = -0.492), all of which are recognized prognostic and disease severity markers, indicating its potential prognostic value. SctO2 is determined mainly by end-tidal CO2 pressure, mean arterial pressure, and hemoglobin in the HF population. This article demonstrates a protocol that integrates SctO2 using NIRS into incremental CPET on a calibrated bicycle ergometer.

This protocol integrated near-infrared spectroscopy into conventional cardiopulmonary exercise testing to identify the involvement of the cerebral hemodynamic response in exercise intolerance in patients with heart failure.

심부전 환자에서 심폐 운동 테스트에서 뇌 조직 포화 모니터링의 통합

Cerebral hypo-oxygenation during rest or exercise negatively impacts the exercise capacity of patients with heart failure with reduced ejection fraction ...

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.

중증 신생아, 유아 및 어린이의 근적외선 분광기 관리 방법

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

Non-Invasive Monitoring of Microvascular Oxygenation and Reactive Hyperemia using Hybrid, Near-Infrared Diffuse Optical Spectroscopy for Critical Care

The detection of levels of impairment in microvascular oxygen consumption and reactive hyperemia is vital in critical care. However, there are no practical means for a robust and quantitative evaluation. This paper describes a protocol to evaluate these impairments using a hybrid near-infrared diffuse optical device. The device contains modules for near-infrared time-resolved and diffuse correlation spectroscopies and pulse-oximetry. These modules allow the non-invasive, continuous, and real-time measurement of the absolute, microvascular blood/tissue oxygen saturation (StO2) and the blood flow index (BFI) along with the peripheral arterial oxygen saturation (SpO2). This device uses an integrated, computer-controlled tourniquet system to execute a standardized protocol with optical data acquisition from the brachioradialis muscle. The standardized vascular occlusion test (VOT) takes care of the variations in the occlusion duration and pressure reported in the literature, while the automation minimizes inter-operator differences. The protocol we describe focuses on a 3-min occlusion period but the details described in this paper can readily be adapted to other durations and cuff pressures, as well as other muscles. The inclusion of an extended baseline and post-occlusion recovery period measurement allows the quantification of the baseline values for all the parameters and the blood/tissue deoxygenation rate that corresponds to the metabolic rate of oxygen consumption. Once the cuff is released, we characterize the tissue reoxygenation rate, magnitude, and duration of the hyperemic response in BFI and StO2. These latter parameters correspond to the quantification of the reactive hyperemia, which provides information about the endothelial function. Furthermore, the above-mentioned measurements of the absolute concentration of oxygenated and deoxygenated hemoglobin, BFI, the derived metabolic rate of oxygen consumption, StO2, and SpO2 provide a yet-to-be-explored rich data set that can exhibit disease severity, personalized therapeutics, and management interventions.

We describe a protocol to non-invasively and continuously measure absolute microvascular blood flow index and blood oxygen saturation using a multi-modal device based on near-infrared diffuse optics. We then evaluate the metabolic rate of oxygen consumption and reactive hyperemia utilizing a vascular occlusion test.

중환자 치료를 위한 하이브리드, 근적외선 확산 광학 분광법을 사용한 미세혈관 산소화 및 반응성 충혈의 비침습적 모니터링

The detection of levels of impairment in microvascular oxygen consumption and reactive hyperemia is vital in critical care. However, there are no ...

Using Near-Infrared Spectroscopy Wearable Devices to Identify Central Versus Peripheral Limitations During Exercise

The gold standard to assess the aerobic capacity in physically active subjects and athletes is the maximal oxygen consumption test (VO2&#8211;max), which involves analysis of exhaled&#8211;gases and cardiorespiratory variables obtained via the breath-by-breath method in an ergospirometer during an incremental exercise. However, this method cannot elucidate metabolic changes at the muscular level. Near-infrared spectroscopy (NIRS) has emerged as a valuable technology to evaluate local oxygen levels (Tissular Saturation Index, TSI) by quantifying the concentrations of oxygenated (O2-Hb) and deoxygenated (H-Hb) hemoglobin in the microvasculature of tissues. NIRS applications extend to respiratory and locomotor muscles, assessing metabolic changes associated with the cost of breathing (COB) and peripheral workload, respectively. Additionally, cerebral regions, such as the prefrontal cortex, have been explored with NIRS technology to assess physiological changes related to cognitive demand associated with planning or ideation of motor tasks linked to sports performance. Thus, by analyzing exercise-induced changes (D) in O2-Hb, H-Hb, and TSI, it is possible to identify central and peripheral exercise limitations, particularly when endurance training is the main component of physical fitness (e.g., running, cycling, triathlon, etc.). Addressing these factors is paramount for coaches and exercise physiologists to optimize athletic performance, incorporating training strategies focused on the primary exercise-limiting factors. This study outlines a protocol for utilizing wearables devices equipped with NIRS technology to analyze exercise changes in TSI, O2-Hb, and H-Hb, alongside cardiorespiratory variables typically registered in athletes during VO2&#8211;max tests. This approach offers a comprehensive method for identifying the primary systems involved in stopping exercise progression and sports performance improvement.

This protocol integrates near-infrared spectroscopy (NIRS) technology to assess localized hematological and oxygenation changes at the prefrontal cortex, respiratory (m.Intercostales), and locomotor (m.Vastus Lateralis) muscles during cardiopulmonary exercise testing, enabling the identification of central and peripheral limiting factors affecting exercise performance.

Near-Infrared Spectroscopy 웨어러블 장치를 사용하여 운동 중 중추 및 주변 장치 제한 식별

The gold standard to assess the aerobic capacity in physically active subjects and athletes is the maximal oxygen consumption test (VO2&#8211;max), which ...

하지 혈관 기능 평가를 위한 NIRS 최적화

Near-Infrared Spectroscopy During Reactive Hyperemia for the Assessment of Lower Limb Vascular Function

Vascular diseases of the lower limb contribute substantially to the&#160;global burden of cardiovascular disease and comorbidities such as diabetes. Importantly, microvascular dysfunction can occur prior to, or alongside, macrovascular pathology, and both potentially contribute to patient symptoms and disease burden. Here, we describe a non-invasive approach using near-infrared spectroscopy (NIRS) during reactive hyperemia, which provides a standardized assessment of lower limb vascular (dys)function and a potential method to evaluate the efficacy of therapeutic interventions. Unlike alternative methods, such as contrast-enhanced ultrasound, this approach does not require venous access or sophisticated image analysis, and it is inexpensive and less operator-dependent. This description of the NIRS method includes representative results and standard terminology alongside the discussion of measurement considerations, limitations, and alternative methods. Future application of this work will improve standardization of vascular research design, data collection procedures, and harmonized reporting, thereby enhancing translational research outcomes in the areas of lower limb vascular (dys)function, disease, and treatment.

저자 스포트라이트: Enhancing Vascular Function and Physical Capacity in Cardiovascular Disease Through Novel Interventions and NIRS Technology (새로운 중재 및 NIRS 기술을 통한 심혈관 질환

Here, we describe a non-invasive approach using near-infrared spectroscopy to assess reactive hyperemia in the lower limb. This protocol provides a standardized assessment of vascular and microvascular responsiveness that may be used to determine the presence of vascular dysfunction as well as the efficacy of therapeutic interventions.

Near-Infrared Spectroscopy during Reactive Hyperemia for the assessment of lower limb vasscular function(하지 혈관 기능 평가를 위한 반응성 충혈 중 근적외선 분광법) 

Vascular diseases of the lower limb contribute substantially to the&#160;global burden of cardiovascular disease and comorbidities such as diabetes. ...