scholarly journals NIRS Measurement of Peripheral Fractional Oxygen Extraction (FOE) after Cardiopulmonary Bypass

2002 ◽  
Vol 16 (3-4) ◽  
pp. 191-197 ◽  
Author(s):  
Charles William Yoxall ◽  
Kusum Menon ◽  
Andrew John Macnab ◽  
Roy Everett Gagnon ◽  
Jacques Gerard LeBlanc
Keyword(s):  
Cardiopulmonary Bypass ◽  
Near Infrared ◽  
Tissue Perfusion ◽  
Venous Occlusion ◽  
Repeated Measurements ◽  
Oxygen Extraction ◽  
Critically Ill Children ◽  
Large Teaching Hospital ◽  
Pulmonary Artery Catheters ◽  
Oxyhaemoglobin Saturation

Objectives:To compare peripheral fractional oxygen extraction (FOE), as measured by near infrared spectroscopy (NIRS), with conventional indicators of tissue perfusion in haemodynamically stable and unstable children after cardiopulmonary bypass.Design:Observational study.Setting:Paediatric Intensive Care Unit of a large teaching hospital.Patients:17 children immediately after cardiopulmonary bypass. Male : female = 9 : 8, median age 7 months (range, newborn to 16 years).Methods:On admission, children were classified as “stable” or “unstable” based on the haemodynamic support they needed. Peripheral venous oxyhaemoglobin saturation (SvO2) was measured non-invasively using NIRS with venous occlusion. FOE was calculated from SvO2and arterial saturation measured by pulse oximetry. Repeated measurements of peripheral SvO2were made for up to 8 hours. In 5 children who had pulmonary artery catheters, simultaneous mixed SvO2measurements were recorded.Results:Median FOE was 7.9% higher in the unstable group than in the stable group (p= 0.013). Peripheral SvO2and mixed SvO2were correlated (R2= 0.65,p< 0.0001).Conclusions:Peripheral FOE is higher in unstable children. Changes in peripheral SvO2are related to changes in mixed SvO2. These measurements may provide useful information about haemodynamic status in critically ill children. Further evaluation of the technique is warranted.

scholarly journals Somatic and cerebral near infrared spectroscopy for the monitoring of perfusion during neonatal cardiopulmonary bypass

2019 ◽  
Vol 29 (6) ◽  
pp. 955-959 ◽  
Author(s):  
Mirela Bojan ◽  
Enrico Bonaveglio ◽  
Andrea Dolcino ◽  
Cristian Mirabile
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mixed Model ◽  
Near Infrared ◽  
Early Stage ◽  
Lactate Concentration ◽  
Repeated Measurements ◽  
Time Interval ◽  
Low Cardiac Output ◽  
Output State ◽  
Independent Association

Abstract OBJECTIVES The somatic-cerebral regional oxygen saturation (rSO2) gradient has the potential to reveal a low cardiac output state at an early stage, when systemic vascular resistance increases in order to maintain cerebral perfusion, and results in a drop in somatic rSO2. We hypothesized that during neonatal cardiopulmonary bypass (CPB), the somatic-cerebral rSO2 gradient can also signal poor perfusion, as assessed by an increase in lactate concentration. METHODS In a retrospective review of neonatal bypass records, we investigated the association between the somatic-cerebral rSO2 gradient and serial lactate measurements. The somatic-cerebral rSO2 gradient, i.e. the area between the somatic and cerebral rSO2, was calculated for each CPB time interval between 2 lactate measurements, using the trapezoidal method. The association between the somatic-cerebral rSO2 gradient and lactate variation was explored using a mixed model for repeated measurements adjusted for the CPB temperature across intervals. RESULTS A total of 94 CPB intervals were analysed in 24 neonates, median age 6 days, median weight 3.1 kg. The median lactate variation per interval was +0.2 mmol l−1 (range −1.5 to +2.7), the median somatic-cerebral gradient was 0 (range −1229% min to +2049% min) and the median CPB temperature was 29.5°C (IQR 28.1–33.4). There was an independent association between the lactate increase and the somatic-cerebral rSO2 gradient (regression coefficient = −0.0006 ± 0.0002, P = 0.009). CONCLUSIONS A decrease in the somatic-cerebral rSO2 gradient was associated with an increase in lactate concentration, suggesting that the somatic-cerebral rSO2 gradient is a useful monitoring tool for the adequacy of perfusion during neonatal CPB.

Noninvasive, near infrared spectroscopic-measured muscle pH and Po2 indicate tissue perfusion for cardiac surgical patients undergoing cardiopulmonary bypass*

2003 ◽  
Vol 31 (9) ◽  
pp. 2324-2331 ◽  
Author(s):  
Babs R. Soller ◽  
Patrick O. Idwasi ◽  
Jorge Balaguer ◽  
Steven Levin ◽  
Sinan A. Simsir ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Near Infrared ◽  
Tissue Perfusion ◽  
Surgical Patients ◽  
Muscle Ph ◽  
Infrared Spectroscopic

Regional muscle tissue saturation is an indicator of global inadequate circulation during cardiopulmonary bypass: a randomized porcine study using muscle, intestinal and brain tissue metabolomics

Perfusion ◽  
2016 ◽  
Vol 32 (3) ◽  
pp. 192-199 ◽  
Author(s):  
Sisse Anette Thomassen ◽  
Benedict Kjærgaard ◽  
Preben Sørensen ◽  
Jan Jesper Andreasen ◽  
Anders Larsson ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Bypass ◽  
Brain Tissue ◽  
Muscle Tissue ◽  
Near Infrared ◽  
Tissue Perfusion ◽  
Systemic Circulation ◽  
Group I ◽  
Group Ii ◽  
Oxygen Monitoring

Background: Muscle tissue saturation (StO2) measured with near-infrared spectroscopy has generally been considered a measurement of the tissue microcirculatory condition. However, we hypothesized that StO2 could be more regarded as a fast and reliable measure of global than of regional circulatory adequacy and tested this with muscle, intestinal and brain metabolomics at normal and two levels of low cardiopulmonary bypass blood flow rates in a porcine model. Methods: Twelve 80 kg pigs were connected to normothermic cardiopulmonary bypass with a blood flow of 60 mL/kg/min for one hour, reduced randomly to 47.5 mL/kg/min (Group I) or 35 mL/kg/min (Group II) for one hour followed by one hour of 60 mL/kg/min in both groups. Regional StO2 was measured continuously above the musculus gracilis (non-cannulated leg). Metabolomics were obtained by brain tissue oxygen monitoring system (Licox) measurements of the brain and microdialysis perfusate from the muscle, intestinal mucosa and brain. A non-parametric statistical method was used. Results: The systemic parameters showed profound systemic ischaemia during low CPB blood flow. StO2 did not change markedly in Group I, but in Group II, StO2 decreased immediately when blood flow was reduced and, furthermore, was not restored despite blood flow being normalized. Changes in the metabolomics from the muscle, colon and brain followed the changes in StO2. Conclusion: We found, in this experimental cardiopulmonary bypass model, that StO2 reacted rapidly when the systemic circulation became inadequate and, furthermore, reliably indicate insufficient global tissue perfusion even when the systemic circulation was restored after a period of systemic hypoperfusion.

scholarly journals Detecting Microsurgical Complications with ViOptix Tissue Oximetry in a Pediatric Myocutaneous Free Flap: Case Presentation and Literature Review

2018 ◽  
Vol 03 (01) ◽  
pp. e8-e12
Author(s):  
Steven Kozusko ◽  
Uzoma Gbulie
Keyword(s):  
Real Time ◽  
Free Flap ◽  
Near Infrared ◽  
Clinical Symptoms ◽  
Tissue Perfusion ◽  
Venous Occlusion ◽  
Tissue Oxygen Saturation ◽  
Real Time Monitoring ◽  
Flap Monitoring ◽  
Tissue Oximetry

Background Microvascular compromise from arterial or venous occlusion is a common cause of free flap failure. The salvage rate following a microvascular compromise is dependent on detecting the problem early and intervening quickly. Methods The ViOptix tissue oximeter measures tissue oxygen saturation using the near-infrared spectroscopy technology. The ViOptix device has an alarm capability to warn of potential compromise to tissue perfusion. The tissue oximetry readings are visible on the bedside monitor and are relayed to a webpage link, which is accessible on a personal computer or mobile device, allowing real-time monitoring. This article presents a case where real-time monitoring allowed almost immediate detection of inadvertent pedicle compromise allowing flap salvage by repositioning without surgical intervention. Results In the case presented, the patient's nurse inadvertently positioned a pillow under the location of the vascular pedicle likely causing microvascular compression. The ViOptix reading dropped and for this reason the nurse contacted the Plastic Surgery team. The drop was confirmed remotely and the flap was urgently evaluated in person. Once the pillow was removed, the ViOptix readings normalized and Doppler signals strengthened in the flap. Discussion While tissue oximetry monitoring does not by itself ensure flap survival, it provides critical information than conventional flap monitoring would allow giving the microsurgeon the opportunity to make a quicker decision. ViOptix tissue oximeters are able to detect vascular compromise even before conventional clinical symptoms are present. Alas in several cases by the time clinical symptoms develop the flap may be beyond salvage.

Near-infrared fluorescence imaging with indocyanine green for quantification of changes in tissue perfusion following revascularization

Vascular ◽  
2021 ◽  
pp. 170853812110328
Author(s):  
Pim Van den Hoven ◽  
Floris S Weller ◽  
Merel Van De Bent ◽  
Lauren N Goncalves ◽  
Melissa Ruig ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Fluorescence Intensity ◽  
Near Infrared ◽  
Tissue Perfusion ◽  
Control Group ◽  
Maximum Slope ◽  
Nir Fluorescence ◽  
Significant Difference ◽  
Revascularization Procedures

Objectives Current diagnostic modalities for patients with peripheral artery disease (PAD) mainly focus on the macrovascular level. For assessment of tissue perfusion, near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) seems promising. In this prospective cohort study, ICG NIR fluorescence imaging was performed pre- and post-revascularization to assess changes in foot perfusion. Methods ICG NIR fluorescence imaging was performed in 36 patients with PAD pre- and post-intervention. After intravenous bolus injection of 0.1 mg/kg ICG, the camera registered the NIR fluorescence intensity over time on the dorsum of the feet for 15 min using the Quest Spectrum Platform®. Time-intensity curves were plotted for three regions of interest (ROI): (1) the dorsum of the foot, (2) the forefoot, and (3) the hallux. Time-intensity curves were normalized for maximum fluorescence intensity. Extracted parameters were the maximum slope, area under the curve (AUC) for the ingress, and the AUC for the egress. The non-treated contralateral leg was used as a control group. Results Successful revascularization was performed in 32 patients. There was a significant increase for the maximum slope and AUC egress in all three ROIs. The most significant difference was seen for the maximum slope in ROI 3 (3.7%/s to 6.6%/s, p < 0.001). In the control group, no significant differences were seen for the maximum slope and AUC egress in all ROIs. Conclusions This study shows the potential of ICG NIR fluorescence imaging in assessing the effect of revascularization procedures on foot perfusion. Future studies should focus on the use of this technique in predicting favorable outcome of revascularization procedures.

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