Ultrasound-tagged near-infrared spectroscopy does not disclose absent cerebral circulation in brain-dead adults

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Near-infrared spectroscopy, a non-invasive technique for monitoring cerebral oxygenation, is widely used, but its accuracy is questioned because of the possibility of extra-cranial contamination. Ultrasound-tagged near-infrared spectroscopy (UT-NIRS) has been proposed as an improvement over previous methods. We investigated UT-NIRS in healthy volunteers and in brain-dead patients.

METHODS: We studied 20 healthy volunteers and 20 brain-dead patients with two UT-NIRS devices, CerOx™ and c-FLOW™ (Ornim Medical, Kfar Saba, Israel), which measure cerebral flow index (CFI), a parameter related to changes in cerebral blood flow (CBF). Monitoring started after the patients had been declared brain dead for a median of 34 (range: 11-300) min. In 11 cases, we obtained further demonstration of absent CBF.

RESULTS: In healthy volunteers, CFI was markedly different in the two hemispheres in the same subject, with wide variability amongst subjects. In brain-dead patients (median age: 64 yr old, 45% female; 20% traumatic brain injury, 40% subarachnoid haemorrhage, and 40% intracranial haemorrhage), the median (inter-quartile range) CFI was 41 (36-47), significantly higher than in volunteers (33; 27-36).

CONCLUSIONS: In brain-dead patients, where CBF is absent, the UT-NIRS findings can indicate an apparently perfused brain. This might reflect an insufficient separation of signals from extra-cranial structures from a genuine appraisal of cerebral perfusion. For non-invasive assessment of CBF-related parameters, the near-infrared spectroscopy still needs substantial improvement.

Original languageEnglish
Pages (from-to)588-594
Number of pages7
JournalBritish Journal of Anaesthesia
Volume121
Issue number3
DOIs
Publication statusPublished - Sep 2018

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Cerebrovascular Circulation
Brain Death
Near-Infrared Spectroscopy
Healthy Volunteers
Intracranial Hemorrhages
Israel
Subarachnoid Hemorrhage
Volunteers
Perfusion
Equipment and Supplies
Brain

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Death/diagnostic imaging
  • Cerebrovascular Circulation/physiology
  • Female
  • Healthy Volunteers
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic/methods
  • Reference Values
  • Spectroscopy, Near-Infrared/methods
  • Tomography, X-Ray Computed
  • Ultrasonography/methods

Cite this

@article{895398075cf14652a05d189bb082d70b,
title = "Ultrasound-tagged near-infrared spectroscopy does not disclose absent cerebral circulation in brain-dead adults",
abstract = "BACKGROUND: Near-infrared spectroscopy, a non-invasive technique for monitoring cerebral oxygenation, is widely used, but its accuracy is questioned because of the possibility of extra-cranial contamination. Ultrasound-tagged near-infrared spectroscopy (UT-NIRS) has been proposed as an improvement over previous methods. We investigated UT-NIRS in healthy volunteers and in brain-dead patients.METHODS: We studied 20 healthy volunteers and 20 brain-dead patients with two UT-NIRS devices, CerOx™ and c-FLOW™ (Ornim Medical, Kfar Saba, Israel), which measure cerebral flow index (CFI), a parameter related to changes in cerebral blood flow (CBF). Monitoring started after the patients had been declared brain dead for a median of 34 (range: 11-300) min. In 11 cases, we obtained further demonstration of absent CBF.RESULTS: In healthy volunteers, CFI was markedly different in the two hemispheres in the same subject, with wide variability amongst subjects. In brain-dead patients (median age: 64 yr old, 45{\%} female; 20{\%} traumatic brain injury, 40{\%} subarachnoid haemorrhage, and 40{\%} intracranial haemorrhage), the median (inter-quartile range) CFI was 41 (36-47), significantly higher than in volunteers (33; 27-36).CONCLUSIONS: In brain-dead patients, where CBF is absent, the UT-NIRS findings can indicate an apparently perfused brain. This might reflect an insufficient separation of signals from extra-cranial structures from a genuine appraisal of cerebral perfusion. For non-invasive assessment of CBF-related parameters, the near-infrared spectroscopy still needs substantial improvement.",
keywords = "Adult, Aged, Aged, 80 and over, Brain Death/diagnostic imaging, Cerebrovascular Circulation/physiology, Female, Healthy Volunteers, Humans, Male, Middle Aged, Monitoring, Physiologic/methods, Reference Values, Spectroscopy, Near-Infrared/methods, Tomography, X-Ray Computed, Ultrasonography/methods",
author = "A Caccioppola and M Carbonara and M Macr{\`i} and L Longhi and S Magnoni and F Ortolano and F Triulzi and Zanier, {E R} and T Zoerle and N Stocchetti",
note = "Copyright {\circledC} 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.",
year = "2018",
month = "9",
doi = "10.1016/j.bja.2018.04.038",
language = "English",
volume = "121",
pages = "588--594",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Oxford University Press",
number = "3",

}

TY - JOUR

T1 - Ultrasound-tagged near-infrared spectroscopy does not disclose absent cerebral circulation in brain-dead adults

AU - Caccioppola, A

AU - Carbonara, M

AU - Macrì, M

AU - Longhi, L

AU - Magnoni, S

AU - Ortolano, F

AU - Triulzi, F

AU - Zanier, E R

AU - Zoerle, T

AU - Stocchetti, N

N1 - Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

PY - 2018/9

Y1 - 2018/9

N2 - BACKGROUND: Near-infrared spectroscopy, a non-invasive technique for monitoring cerebral oxygenation, is widely used, but its accuracy is questioned because of the possibility of extra-cranial contamination. Ultrasound-tagged near-infrared spectroscopy (UT-NIRS) has been proposed as an improvement over previous methods. We investigated UT-NIRS in healthy volunteers and in brain-dead patients.METHODS: We studied 20 healthy volunteers and 20 brain-dead patients with two UT-NIRS devices, CerOx™ and c-FLOW™ (Ornim Medical, Kfar Saba, Israel), which measure cerebral flow index (CFI), a parameter related to changes in cerebral blood flow (CBF). Monitoring started after the patients had been declared brain dead for a median of 34 (range: 11-300) min. In 11 cases, we obtained further demonstration of absent CBF.RESULTS: In healthy volunteers, CFI was markedly different in the two hemispheres in the same subject, with wide variability amongst subjects. In brain-dead patients (median age: 64 yr old, 45% female; 20% traumatic brain injury, 40% subarachnoid haemorrhage, and 40% intracranial haemorrhage), the median (inter-quartile range) CFI was 41 (36-47), significantly higher than in volunteers (33; 27-36).CONCLUSIONS: In brain-dead patients, where CBF is absent, the UT-NIRS findings can indicate an apparently perfused brain. This might reflect an insufficient separation of signals from extra-cranial structures from a genuine appraisal of cerebral perfusion. For non-invasive assessment of CBF-related parameters, the near-infrared spectroscopy still needs substantial improvement.

AB - BACKGROUND: Near-infrared spectroscopy, a non-invasive technique for monitoring cerebral oxygenation, is widely used, but its accuracy is questioned because of the possibility of extra-cranial contamination. Ultrasound-tagged near-infrared spectroscopy (UT-NIRS) has been proposed as an improvement over previous methods. We investigated UT-NIRS in healthy volunteers and in brain-dead patients.METHODS: We studied 20 healthy volunteers and 20 brain-dead patients with two UT-NIRS devices, CerOx™ and c-FLOW™ (Ornim Medical, Kfar Saba, Israel), which measure cerebral flow index (CFI), a parameter related to changes in cerebral blood flow (CBF). Monitoring started after the patients had been declared brain dead for a median of 34 (range: 11-300) min. In 11 cases, we obtained further demonstration of absent CBF.RESULTS: In healthy volunteers, CFI was markedly different in the two hemispheres in the same subject, with wide variability amongst subjects. In brain-dead patients (median age: 64 yr old, 45% female; 20% traumatic brain injury, 40% subarachnoid haemorrhage, and 40% intracranial haemorrhage), the median (inter-quartile range) CFI was 41 (36-47), significantly higher than in volunteers (33; 27-36).CONCLUSIONS: In brain-dead patients, where CBF is absent, the UT-NIRS findings can indicate an apparently perfused brain. This might reflect an insufficient separation of signals from extra-cranial structures from a genuine appraisal of cerebral perfusion. For non-invasive assessment of CBF-related parameters, the near-infrared spectroscopy still needs substantial improvement.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Brain Death/diagnostic imaging

KW - Cerebrovascular Circulation/physiology

KW - Female

KW - Healthy Volunteers

KW - Humans

KW - Male

KW - Middle Aged

KW - Monitoring, Physiologic/methods

KW - Reference Values

KW - Spectroscopy, Near-Infrared/methods

KW - Tomography, X-Ray Computed

KW - Ultrasonography/methods

U2 - 10.1016/j.bja.2018.04.038

DO - 10.1016/j.bja.2018.04.038

M3 - Article

VL - 121

SP - 588

EP - 594

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 3

ER -