Cerebral oximetry with cerebral blood volume index in detecting pediatric stroke in a pediatric ED

Pediatric Strokes are increasing with recognition and imaging delays. Limited pediatric stroke knowledge, vague signs & symptoms and no reliable stroke detection tools is the cause. Improving recognition improves outcomes. Objective: To assess utility of Left & Right Cerebral rcSO2 and cerebral blood volume index (CBVI) in Pediatric Stroke Alert and Altered Mental Status (AMS) patients. Methods: Observational study of Stroke Alert & AMS patient’s Cerebral rcSO2 and CBVI. Stroke rcSO2 and CBVI values in stroke patients were compared to controls & AMS (no cerebral pathology) patients. Results: Controls (N=133), Stroke alert (N=25) & AMS stroke (N=52)'s rcSO2, CBVI means were consistent 0-60 minutes. Lower rcSO2 with or without CBVI readings correlated with stroke (Left rcSO2, CBVI (P<0.0001), Right rcSO2 (P=0.0038), CBVI (p=0.0006)). A 19.1% rcSO2 side difference had 100% PPV for stroke. Across 0-60 minutes, rcSO2, CBVI were consistent for stroke & type (Hemorrhagic or Ischemic) (P<0.0001). Left Stroke’s rcSO2, CBVI were lower than Right Strokes (P<0.0001). Hemorrhagic ipsilateral stroke and contralateral side had lower rcSO2, CBVI (P<0.001) then Ischemic. Conclusion: The rcSO2, CBVI difference between sidess objectively and consistently detected stroke, location, and stroke types (Hemorrhagic or Ischemic). A 19.1% rcSO2 differencehad had 100% PPV for detecting strokes demonstrating cerebral oximetry’s utility. Cerebral Oximetry with CBVI has shown its’ potential as an objective screening tool for identify pediatric strokes and types. Cerebral Oximetry with CBVI has potential for expediting stroke recognition and decreasing imaging time.

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Cerebral blood volume index as a predictor of functional independence after basilar artery thrombectomy

Journal of Neuroimaging ◽

10.1111/jon.12933 ◽

2021 ◽

Author(s):

Rahul R. Karamchandani ◽

Dale Strong ◽

Jeremy B. Rhoten ◽

Tanushree Prasad ◽

Jacob Selig ◽

...

Keyword(s):

Blood Volume ◽

Basilar Artery ◽

Cerebral Blood Volume ◽

Functional Independence ◽

Volume Index

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Cerebral oximetry with blood volume index and capnography in intubated and hyperventilated patients

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2016.03.005 ◽

2016 ◽

Vol 34 (6) ◽

pp. 1102-1107 ◽

Cited By ~ 6

Author(s):

Taylor A. Bagwell ◽

Thomas J. Abramo ◽

Gregory W. Albert ◽

Jonathan W. Orsborn ◽

Elizabeth A. Storm ◽

...

Keyword(s):

Blood Volume ◽

Cerebral Oximetry ◽

Volume Index

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Intracranial pressure dynamics in patients with acute brain damage

Journal of Applied Physiology ◽

10.1152/jappl.1997.82.4.1270 ◽

1997 ◽

Vol 82 (4) ◽

pp. 1270-1282 ◽

Cited By ~ 16

Author(s):

M. Ursino ◽

C. A. Lodi ◽

S. Rossi ◽

N. Stocchetti

Keyword(s):

Intracranial Pressure ◽

Brain Damage ◽

Blood Volume ◽

Time Constant ◽

Cerebral Blood Volume ◽

Volume Index ◽

Parameter Estimates ◽

Time Pattern ◽

Pressure Dynamics ◽

Parameter Values

Ursino, M., C. A. Lodi, S. Rossi, and N. Stocchetti.Intracranial pressure dynamics in patients with acute brain damage. J. Appl. Physiol. 82(4): 1270–1282, 1997.—The time pattern of intracranial pressure (ICP) during pressure-volume index (PVI) tests was analyzed in 20 patients with severe acute brain damage by means of a simple mathematical model. In most cases, a satisfactory fitting between model response and patient data was achieved by adjusting only four parameters: the cerebrospinal fluid (CSF) outflow resistance, the intracranial elastance coefficient, and the gain and time constant of cerebral autoregulation. The correlation between the parameter estimates was also analyzed to elucidate the main mechanisms responsible for ICP changes in each patient. Starting from information on the estimated parameter values and their correlation, the patients were classified into two main classes: those with weak autoregulation (8 of 20 patients) and those with strong autoregulation (12 of 20 patients). In the first group of patients, ICP mainly reflects CSF circulation and passive cerebral blood volume changes. In the second group, ICP exhibits paradoxical responses attributable to active changes in cerebral blood volume. Moreover, in two patients of the second group, the time constant of autoregulation is significantly increased (>40 s). The correlation between the parameter estimates was significantly different in the two groups of patients, suggesting the existence of different mechanisms responsible for ICP changes. Moreover, analysis of the correlation between the parameter estimates might give information on the directions of parameter changes that have a greater impact on ICP.

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Abstract P557: Hypoperfusion Intensity Ratio and Cerebral Blood Volume Index as Predictors of Outcome for Recanalized Middle Cerebral Artery Occlusions

Stroke ◽

10.1161/str.52.suppl_1.p557 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Jonathan M Parish ◽

Dale Strong ◽

Tanushree Prasad ◽

Jeremy B Rhoten ◽

Jonathan D Clemente ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Computerized Tomography ◽

Blood Volume ◽

Cerebral Artery ◽

Intensity Ratio ◽

Cerebral Blood Volume ◽

Favorable Outcome ◽

Volume Index ◽

Collateral Flow ◽

Mca Occlusion

Introduction: Preliminary data suggest the Hypoperfusion Intensity Ratio (HIR) and the Cerebral Blood Volume Index (CBVI) derived from Computerized Tomography Perfusion (CTP) imaging predict the rate of collateral flow, speed of infarct growth, and clinical outcome. We hypothesized that functional outcomes at hospital discharge would be significantly better for middle cerebral artery (MCA) occlusion patients achieving Thrombolysis in Cerebral Infarction (TICI) 2b or greater recanalization with presenting hospital CTPs consistent with “good” (HIR <0.5 and CBVI >0.7) versus “poor” (HIR ≥0.5 and CBVI ≤0.7) indices. Methods: We conducted a retrospective cohort study. A neuroradiologist confirmed the MCA occlusion based on the initial Computerized Tomography Angiogram (CTA). All TICI scores were confirmed by neurointerventionalists blinded to patient outcomes. We defined independent outcome as mRS ≤2, and favorable outcome as an mRS ≤3. We additionally stratified patients as initially presenting to thrombectomy versus non-thrombectomy centers. Results: We identified a total of 162 patients over a 3 ½ year period with an MCA occlusion achieving TICI 2b recanalization or greater, of whom 67 had good indices and 48 had poor indices. For patients with good compared to poor indices, there was a trend for achieving independent outcome (55% vs 37%, p=0.061) that reached significance for favorable outcome (69% vs 50%, p=0.043). Limiting the analysis to only patients presenting to non-thrombectomy centers (n=67), these findings were consistent, with a trend for achieving independent outcome for good versus poor collaterals (48% vs 30% p=0.173), which was again significant for a favorable outcome (66% vs 39%, p=0.036). Across all patients, HIR <0.5 (n=86) or CBVI >0.7 (n=95) were not independently associated with independent outcomes, but for patients presenting to non-thrombectomy centers, an HIR <0.5 alone (n=51) was significantly associated with favorable outcome. Conclusion: For MCA occlusion patients achieving TICI 2b recanalization, the combination of good HIR and CBVI is significantly associated with a favorable functional outcome. For patients presenting to non-thrombectomy centers, HIR alone may be sufficient to predict favorable outcome.

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Cerebral oximetry with blood volume index in asystolic pediatric cerebrospinal fluid malfunctioning shunt patients

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2014.04.007 ◽

2014 ◽

Vol 32 (11) ◽

pp. 1439.e1-1439.e7 ◽

Cited By ~ 2

Author(s):

Thomas J. Abramo ◽

Mark Meredith ◽

Mathew Jaeger ◽

Bradford Schneider ◽

Holli Bagwell ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Blood Volume ◽

Cerebral Oximetry ◽

Volume Index

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Abstract 17967: Systemic Hypertension in Children After Superior Cavo-pulmonary Shunt is Associated With Cerebrovascular Dysautoregulation

Circulation ◽

10.1161/circ.132.suppl_3.17967 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Antonio G Cabrera ◽

Ronald B Easley ◽

Rachel Dugan ◽

Michelle Goldsworthy ◽

Katherine K Kibler ◽

...

Keyword(s):

Near Infrared ◽

Cerebral Blood Volume ◽

Venous Pressure ◽

Cerebral Oximetry ◽

Volume Index ◽

Systemic Hypertension ◽

Pulmonary Shunt ◽

Piecewise Regression ◽

Arterial Blood ◽

Cerebral Venous Pressure

Introduction: Hypertension is frequently seen after superior cavo-pulmonary shunt. It is unknown if hypertension is necessary to maintain cerebral blood flow due to increased cerebral venous pressure. We sought to determine the range of arterial blood pressures (ABP) associated with intact and impaired autoregulation after superior cavo-pulmonary shunt. Hypothesis: Hypertension (mean ABP>60 mmHg) is associated with cerebrovascular dysautoregulation after superior cavo-pulmonary shunt. Methods: All patients < 12 months undergoing superior cavo-pulmonary shunt from 10/2014 were eligible. Subjects underwent continuous 100 Hz monitoring of ABP, pulmonary arterial pressure (PAP), and near-infrared spectroscopy measurements of cerebral oximetry (rSO 2 ) and cerebral blood volume (CBV). Cerebrovascular autoregulation was measured by the hemoglobin volume index (HVx). ABP and CBV were low-pass filtered as 10 sec average values. Pearson’s correlation coefficient was performed over 300 sec windows. The associations between HVx changes relative to ABP and PAP were tested using linear regression with generalized estimation of equations. Optimal ABP and PAP defined by lowest HVx was determined using a curve-fit algorithm. The relationship between PAP and ABP was tested by piecewise regression. Results: Ten patients were enrolled. Median age and weight were 6.5 months and 6.2 kg. Optimal ABP and PAP were obtained in 7/10. HVx became impaired with increased ABP (top panel) and increased PAP (middle panel), indicating worse cerebrovascular dysautoregulation. PAP increased with increasing ABP (r = 0.55, p<0.0001) with an intercept of 72 mmHg above which ΔPAP/ΔABP doubled from 0.23 [0.22- 0.24] to 0.46 [0.43 - 0.49] (bottom panel). Elevations of ABP above optimal for HVx did not improve rSO2 (p>0.05). Conclusion: Hypertension after superior cavo-pulmonary shunt is associated with elevated PAP, no improvement in rSO 2 , and cerebrovascular dysautoregulation.

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