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      Optical Bedside Monitoring of Cerebral Blood Flow in Acute Ischemic Stroke Patients During Head-of-Bed Manipulation

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          Abstract

          A primary goal of acute ischemic stroke (AIS) management is to maximize perfusion in the affected region and surrounding ischemic penumbra. However, interventions to maximize perfusion, such as flat head-of-bed (HOB) positioning, are currently prescribed empirically. Bedside monitoring of cerebral blood flow (CBF) allows the effects of interventions such as flat HOB to be monitored and may ultimately be used to guide clinical management.

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          Measuring cerebral blood flow using magnetic resonance imaging techniques.

          Lisa Pell, F Calamante, Elizabeth Turner … (1999)
          Magnetic resonance imaging techniques measuring CBF have developed rapidly in the last decade, resulting in a wide range of available methods. The most successful approaches are based either on dynamic tracking of a bolus of a paramagnetic contrast agent (dynamic susceptibility contrast) or on arterial spin labeling. This review discusses their principles, possible pitfalls, and potential for absolute quantification and outlines clinical and neuroscientific applications.
          Article 0 comments Cited 80 times – based on 0 reviews     Review now
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            Noninvasive measurement of cerebral blood flow and blood oxygenation using near-infrared and diffuse correlation spectroscopies in critically brain-injured adults.

            Mark Moss, Judith R. L. M. Wolf, Turgut Durduran … (2010)
            This study assesses the utility of a hybrid optical instrument for noninvasive transcranial monitoring in the neurointensive care unit. The instrument is based on diffuse correlation spectroscopy (DCS) for measurement of cerebral blood flow (CBF), and near-infrared spectroscopy (NIRS) for measurement of oxy- and deoxy-hemoglobin concentration. DCS/NIRS measurements of CBF and oxygenation from frontal lobes are compared with concurrent xenon-enhanced computed tomography (XeCT) in patients during induced blood pressure changes and carbon dioxide arterial partial pressure variation. Seven neurocritical care patients were included in the study. Relative CBF measured by DCS (rCBF(DCS)), and changes in oxy-hemoglobin (DeltaHbO(2)), deoxy-hemoglobin (DeltaHb), and total hemoglobin concentration (DeltaTHC), measured by NIRS, were continuously monitored throughout XeCT during a baseline scan and a scan after intervention. CBF from XeCT regions-of-interest (ROIs) under the optical probes were used to calculate relative XeCT CBF (rCBF(XeCT)) and were then compared to rCBF(DCS). Spearman's rank coefficients were employed to test for associations between rCBF(DCS) and rCBF(XeCT), as well as between rCBF from both modalities and NIRS parameters. rCBF(DCS) and rCBF(XeCT) showed good correlation (r (s) = 0.73, P = 0.010) across the patient cohort. Moderate correlations between rCBF(DCS) and DeltaHbO(2)/DeltaTHC were also observed. Both NIRS and DCS distinguished the effects of xenon inhalation on CBF, which varied among the patients. DCS measurements of CBF and NIRS measurements of tissue blood oxygenation were successfully obtained in neurocritical care patients. The potential for DCS to provide continuous, noninvasive bedside monitoring for the purpose of CBF management and individualized care is demonstrated.
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              Direct measurement of tissue blood flow and metabolism with diffuse optics.

              G. N. Kim, Ren-Chao Zhou, Arjun G. Yodh … (2011)
              Diffuse optics has proven useful for quantitative assessment of tissue oxy- and deoxyhaemoglobin concentrations and, more recently, for measurement of microvascular blood flow. In this paper, we focus on the flow monitoring technique: diffuse correlation spectroscopy (DCS). Representative clinical and pre-clinical studies from our laboratory illustrate the potential of DCS. Validation of DCS blood flow indices in human brain and muscle is presented. Comparison of DCS with arterial spin-labelled MRI, xenon-CT and Doppler ultrasound shows good agreement (0.50
              Article 0 comments Cited 55 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: Stroke
                Abbreviated Title: Stroke
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 0039-2499
                ISSN (Electronic): 1524-4628
                Publication date Created: May 2014
                Publication date (Print): May 2014
                Volume: 45
                Issue: 5
                Pages: 1269-1274
                Affiliations
                [1 ]From the Departments of Neurology (C.G.F., M.M., X.L., S.E.K., J.H.G., J.A.D.), Physics and Astronomy (R.C.M., M.N.K., D.L.M., A.G.Y.), and Radiology (J.A.D.), University of Pennsylvania, Philadelphia, PA; Institute of Physics, University of Campinas, Campinas, Brazil (R.C.M.); and ICFO-Institut de Ciències Fotòniques, Castelldefels, Barcelona, Spain (T.D.).
                Article
                DOI: 10.1161/STROKEAHA.113.004116
                PMC ID: 4006296
                PubMed ID: 24652308
                SO-VID: d9897cc0-be6a-4056-a92b-64007e2f6fd9
                Copyright © © 2014
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