自治医科大学埼玉医療センターの透析スタッフと腎臓内科の方々に感謝します。英語の編集をしてくださったエディテージ(www.editage.com)に感謝します。

すべての参加者は書面によるインフォームドコンセントを提供しました。この研究は、自治医科大学埼玉医療センターの治験審査委員会(RIN 15–104)によって承認されました。
1. rSO2の監視装置
<ol><li>組織の酸素化を測定するためのNIRS装置を準備します。このデバイスには4つのチャンネルがあり、最大4つの臓器で同時に測定を実行できます。</li>
	<li>NIRSモニタリング用の測定センサーを用意し、2波長の付着で近赤外光を透過させることで各臓器のrSO2値を評価した。</li>
</ol>2. 測定センサーの取り付け
<ol><li>HDの前に、各患者を仰臥位で少なくとも5分間休ませます。</li>
	<li>測定センサーを額、右心気症、下肢に取り付けて、脳、肝臓、下腿の筋肉のrSO2 をそれぞれ評価します。</li>
	<li>脳酸素化のモニタリング<ol><li>測定センサーを支配的な半球の額に取り付けます。</li>
	</ol></li>
	<li>肝酸素化のモニタリング<ol><li>体表から患者の肝臓までの深さを測定するためのエコー検査を準備します。この測定値が体表から20〜30 mm以内にあることを確認してください。次に、測定センサーを右心気症に取り付けます。 注:この装置では、rSO2 値は体表から20〜30 mmの深部組織で取得する必要があります。場合によっては、肝臓は、厚い皮下脂肪の存在のために体表面から30mm以上に位置することがある。</li>
	</ol></li>
	<li>筋肉の酸素化のモニタリング<ol><li>測定センサーを右腿または両側の下肢に取り付けます。</li>
	</ol></li>
	<li>センサー接続とデバイスへの電力供給<ol><li>各センサーをデバイスからのリード線に接続します。次に、デバイスの電源を入れ、酸素化の測定を開始します。</li>
	</ol></li>
</ol>3.透析シャントの穿刺とモニタリングの開始
<ol><li>透析シャントの穿刺<ol><li>患者の透析シャントに穴を開けて、HD療法を開始します。このとき、透析装置に備え付けたデジタル血圧計を用いて血圧を測定し、注射器を用いて血液サンプルを採取する。</li>
	</ol></li>
	<li>監視を開始する<ol><li>HD療法を開始した後、脳、肝臓、下肢の筋肉の3つの臓器の組織酸素化のモニタリングを開始します。</li>
	</ol></li>
	<li>HD中のrSO2 のモニタリング<ol><li>各臓器のrSO2 値の変化を観察し、心拍数、静脈圧、血液量などのHD療法中に行われる通常のモニタリングに加えて、定期的に血圧を測定します。センサーとリード間の取り付け領域と接続を確認してください。</li>
	</ol></li>
</ol>

<ol>
	<li>Nishiyama, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regional+cerebral+oxygen+saturation+monitoring+for+predicting+interventional+outcomes+in+patients+following+out-of-hospital+cardiac+arrest+of+presumed+cardiac+cause:+A+prospective,+observational,+multicentre+study.">Regional cerebral oxygen saturation monitoring for predicting interventional outcomes in patients following out-of-hospital cardiac arrest of presumed cardiac cause: A prospective, observational, multicentre study.</a> Resuscitation. 96, 135-141 (2015).</li><li>Kobayashi, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Factors+associated+with+a+low+initial+cerebral+oxygen+saturation+value+in+patients+undergoing+cardiac+surgery.">Factors associated with a low initial cerebral oxygen saturation value in patients undergoing cardiac surgery.</a> Journal of Artificial Organs. 20 (2), 110-116 (2017).</li><li>Cruz, S. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel+multimodal+computational+system+using+near-infrared+spectroscopy+predicts+the+need+for+ECMO+initiation+in+neonates+with+congenital+diaphragmatic+hernia.">A novel multimodal computational system using near-infrared spectroscopy predicts the need for ECMO initiation in neonates with congenital diaphragmatic hernia.</a> Journal of Pediatric Surgery. 53 (1), 152-158 (2018).</li><li>MacEwen, C., Sutherland, S., Daly, J., Pugh, C., Tarassenko, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relationship+between+Hypotension+and+Cerebral+Ischemia+during+Hemodialysis.">Relationship between Hypotension and Cerebral Ischemia during Hemodialysis.</a> Journal of the American Socociety of Nephrology. 28 (8), 2511-2520 (2017).</li><li>Polinder-Bos, H. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Changes+in+cerebral+oxygenation+and+cerebral+blood+flow+during+hemodialysis+-+A+simultaneous+near-infrared+spectroscopy+and+positron+emission+tomography+study.">Changes in cerebral oxygenation and cerebral blood flow during hemodialysis - A simultaneous near-infrared spectroscopy and positron emission tomography study.</a> Journal of Cerebral Blood Flow &amp; Metablism. 40 (2), 328-340 (2020).</li><li>Ookawara, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Differences+in+tissue+oxygenation+and+changes+in+total+hemoglobin+signal+strength+in+the+brain,+liver,+and+lower-limb+muscle+during+hemodialysis.">Differences in tissue oxygenation and changes in total hemoglobin signal strength in the brain, liver, and lower-limb muscle during hemodialysis.</a> Journal of Artificial Organs. 21 (1), 86-93 (2018).</li><li>Malik, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tissue+ischemia+worsens+during+hemodialysis+in+end-stage+renal+disease+patients.">Tissue ischemia worsens during hemodialysis in end-stage renal disease patients.</a> The Journal of Vascular Access. 18 (1), 47-51 (2017).</li><li>Ito, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cerebral+oxygenation+improvement+is+associated+with+hemoglobin+increase+after+hemodialysis+initiation.">Cerebral oxygenation improvement is associated with hemoglobin increase after hemodialysis initiation.</a> TheInternational Journal of Artificial Organs. , (2020).</li><li>Valerianova, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Factors+responsible+for+cerebral+hypoxia+in+hemodialysis+population.">Factors responsible for cerebral hypoxia in hemodialysis population.</a> Physiological Research. 68 (4), 651-658 (2019).</li><li>Ookawara, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Associations+of+cerebral+oxygenation+with+hemoglobin+levels+evaluated+by+near-infrared+spectroscopy+in+hemodialysis+patients.">Associations of cerebral oxygenation with hemoglobin levels evaluated by near-infrared spectroscopy in hemodialysis patients.</a> PLoS One. 15 (8), 0236720 (2020).</li><li>Kovarova, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Low+Cerebral+Oxygenation+Is+Associated+with+Cognitive+Impairment+in+Chronic+Hemodialysis+Patients.">Low Cerebral Oxygenation Is Associated with Cognitive Impairment in Chronic Hemodialysis Patients.</a> Nephron. 139 (2), 113-119 (2018).</li><li>Miyazawa, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Association+of+cerebral+oxygenation+with+estimated+glomerular+filtration+rate+and+cognitive+function+in+chronic+kidney+disease+patients+without+dialysis+therapy.">Association of cerebral oxygenation with estimated glomerular filtration rate and cognitive function in chronic kidney disease patients without dialysis therapy.</a> PLoS One. 13 (6), 0199366 (2018).</li><li>Locatelli, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Haemodialysis+with+on-line+monitoring+equipment:+tools+or+toys.">Haemodialysis with on-line monitoring equipment: tools or toys.</a> Nephrology Dialysis Transplantation. 20 (1), 22-33 (2005).</li><li>Cordtz, J., Olde, B., Solem, K., Ladefoged, S. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Central+venous+oxygen+saturation+and+thoracic+admittance+during+dialysis:+new+approaches+to+hemodynamic+monitoring.">Central venous oxygen saturation and thoracic admittance during dialysis: new approaches to hemodynamic monitoring.</a> Hemodialysis International. 12 (3), 369-377 (2008).</li><li>Kamijo, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Continuous+monitoring+of+blood+pressure+by+analyzing+the+blood+flow+sound+of+arteriovenous+fistula+in+hemodialysis+patients.">Continuous monitoring of blood pressure by analyzing the blood flow sound of arteriovenous fistula in hemodialysis patients.</a> Clinical and Experimental Nephrology. 22 (3), 677-683 (2018).</li><li>Ito, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Factors+affecting+cerebral+oxygenation+in+hemodialysis+patients:+cerebral+oxygenation+associates+with+pH,+hemodialysis+duration,+serum+albumin+concentration,+and+diabetes+mellitus.">Factors affecting cerebral oxygenation in hemodialysis patients: cerebral oxygenation associates with pH, hemodialysis duration, serum albumin concentration, and diabetes mellitus.</a> PLoS One. 10 (2), 0117474 (2015).</li><li>Imai, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deterioration+of+Hepatic+Oxygenation+Precedes+an+Onset+of+Intradialytic+Hypotension+with+Little+Change+in+Blood+Volume+during+Hemodialysis.">Deterioration of Hepatic Oxygenation Precedes an Onset of Intradialytic Hypotension with Little Change in Blood Volume during Hemodialysis.</a> Blood Purification. 45 (4), 345-346 (2018).</li><li>Cho, A. R., Kwon, J. Y., Kim, C., Hong, J. M., Kang, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+sensor+location+on+regional+cerebral+oxygen+saturation+measured+by+INVOS+5100+in+on-pump+cardiac+surgery.">Effect of sensor location on regional cerebral oxygen saturation measured by INVOS 5100 in on-pump cardiac surgery.</a> Journal of Anesthesia. 31 (2), 178-184 (2017).</li><li>Ito, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deterioration+of+cerebral+oxygenation+by+aortic+arch+calcification+progression+in+patients+undergoing+hemodialysis:+A+cross-sectional+study.">Deterioration of cerebral oxygenation by aortic arch calcification progression in patients undergoing hemodialysis: A cross-sectional study.</a> BioMed Research International. , 2852514 (2017).</li><li>Ito, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Blood+transfusion+during+haemodialysis+improves+systemic+tissue+oxygenation:+A+case+report.">Blood transfusion during haemodialysis improves systemic tissue oxygenation: A case report.</a> Nefrologia. 37 (4), 435-437 (2017).</li><li>Ito, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improvement+of+bilateral+lower-limb+muscle+oxygenation+by+low-density+lipoprotein+apheresis+in+a+patient+with+peripheral+artery+disease+undergoing+hemodialysis.">Improvement of bilateral lower-limb muscle oxygenation by low-density lipoprotein apheresis in a patient with peripheral artery disease undergoing hemodialysis.</a> Nefrologia. 39 (1), 90-92 (2019).</li><li>Kitano, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Changes+in+tissue+oxygenation+in+response+to+sudden+intradialytic+hypotension.">Changes in tissue oxygenation in response to sudden intradialytic hypotension.</a> Journal of Artificial Organs. 23 (2), 187-190 (2020).</li><li>Lemmers, P. M. A., Toet, M. C., van Bel, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+patent+ductus+arteriosus+and+subsequent+therapy+with+indomethacin+on+cerebral+oxygenation+in+preterm+infants.">Impact of patent ductus arteriosus and subsequent therapy with indomethacin on cerebral oxygenation in preterm infants.</a> Pediatrics. 121, 142-147 (2008).</li><li>Ito, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sleep+apnea+syndrome+caused+lowering+of+cerebral+oxygenation+in+a+hemodialysis+patient:+a+case+report+and+literature+review.">Sleep apnea syndrome caused lowering of cerebral oxygenation in a hemodialysis patient: a case report and literature review.</a> Renal Replacement Therapy. 4, 54 (2018).</li><li>Minato, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Continuous+monitoring+of+changes+in+cerebral+oxygenation+during+hemodialysis+in+a+patient+with+acute+congestive+heart+failure.">Continuous monitoring of changes in cerebral oxygenation during hemodialysis in a patient with acute congestive heart failure.</a> Journal of Artificial Organs. , (2019).</li></ol>

利益相反はありません。

NIRSモニタリングは、特に体外循環を必要とする心血管または脳血管手術において、主に脳rSO2を評価するために使用されてきました。HD療法を含む体外循環中に、一部の臓器は相対虚血を示す可能性があります7,17,18;しかし、組織の酸素化が低くなるかどうかは不明である。HD中の筋肉のけいれんまたは腹痛は、臓?...

近赤外分光法(NIRS)は、組織の酸素化、特にさまざまな臨床現場での脳酸素化のマーカーである局所酸素飽和度(rSO2)を評価するために使用されており1,2,3、最近、血液透析(HD)を受けている患者に適用されています4,5,6,7,8,9,10、11.脳rSO2は、HDまたは透析されていない慢性腎臓病(CKD)の患者の認知機能に関連していると報告されています11,12。しかし、これまでのところ、CKD患者におけるNIRSモニタリングの使用は限られている。
NIRSモニタリングはリアルタイムかつ非侵襲的であるため、HDを受けている患者のモニタリングデバイスとしての有用性を評価しました。NIRSは主に脳のrSO2の測定に用いられますが、HD中の他の臓器のrSO2値も調査しました。 具体的には、rSO2測定センサーを額、右心気症、下肢に取り付けて、それぞれ脳、肝臓、下肢のrSO2を評価しました。その結果、NIRSモニタリングは、HD時の臓器酸素化の変化やCKD患者の組織酸素化に影響を与える要因を明らかにするための新しいアプローチである可能性があることが示されました。
現在までに、臨床現場でのHD、血液量モニタリング、中心静脈酸素飽和度、胸部アドミタンス、および電子聴診器ガイド推定血圧(BP)中に継続的なモニタリングが実施されました13,14,15;ただし、低血圧の予測やデバイスの幅広い使用には制限があります。対照的に、ここでの新しい非侵襲的アプローチは、個々の臓器における透析内酸素動態に関するリアルタイムの情報を提供する可能性があります。したがって、このモニタリング方法は、透析内低血圧の初期段階における一過性臓器虚血の検出を可能にし、HDの安全な性能も可能にし得る。この記事では、HDを受けている患者に適用される、rSO2で表される組織酸素化を測定するためのプロトコルについて説明します。

<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

近赤外分光法(NIRS)は、心臓血管外科や脳外科、新生児モニタリング、病院前医療などの臨床現場で、組織の酸素化のマーカーである局所酸素飽和度(rSO2)を測定するためのツールとして最近適用されています。NIRSモニタリングデバイスはリアルタイムで非侵襲的であり、主に手術中または集中治療中の重症患者の脳酸素化を評価するために使用されてきました。これまでのところ、血液透析(HD)を含む慢性腎臓病(CKD)患者におけるNIRSモニタリングの使用は制限されています。そこで、HD中の一部の臓器におけるrSO2値を調べた。近赤外光を2波長の付着で透過するNIRS装置を用いてrSO2値をモニターした。HD患者は仰臥位に置かれ、rSO 2測定センサーを額、右心気症、下肢に取り付けて、それぞれ脳、肝臓、下腿の筋肉のrSO2を評価しました。NIRSモニタリングは、HD中の臓器酸素化の変化やCKD患者の組織酸素化に影響を与える要因を明らかにするための新しいアプローチになる可能性があります。この記事では、HD患者に適用されるrSO2で表される組織酸素化を測定するためのプロトコルについて説明します。

HD前の脳rSO2値は健常者よりも低く、糖尿病(DM)のHD患者の脳rSO2はDMのないHD患者の値よりも低かった(図1)16。さらに、HD期間中はBPの低下なしに組織の酸素化が継続しますが、透析内低血圧による脳および肝臓のrSO2の変化が偶発的に観察されました(図2)。継続的なモニタリングにより、組織の酸素化の変化は?...

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

近赤外分光モニターを用いて血液透析(HD)患者の局所酸素飽和度(rSO2)を測定するためのプロトコルを提示する。rSO2値は、組織の酸素化の指標である。この非侵襲的でリアルタイムのモニタリングは、HD中の臓器酸素化の変化を確認するのに役立つ可能性があります。

血液透析患者における近赤外分光法を用いた組織酸素化の測定

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 de Cartagena UDEC

Research

JoVE Journal

Medicine

2.1K ビュー.  Jichi Medical University. 近赤外分光モニターを用いて血液透析(HD)患者の局所酸素飽和度(rSO2)を測定するためのプロトコルを提示する。rSO2値は、組織の酸素化の指標である。この非侵襲的でリアルタイムのモニタリングは、HD中の臓器酸素化の変化を確認するのに役立つ可能性があります。

ビデオ: 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.

皮膚組織の酸素化と血管機能のデュアルモードイメージング

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

医学

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.

乳幼児の脳代謝と血行動態の非侵襲的光計測

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).

モデルは、ヒトにおける臨床的に関連する低酸素症をシミュレートします

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.

骨格筋血管カップリング、酸化容量、および 'ワンストップ ショップ「近赤外分光法を用いた微小血管機能

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 ...

神経科学

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.

心不全患者における心肺運動検査における脳組織飽和モニタリングの統合

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.

重症新生児、乳児、小児における近赤外分光の管理方法

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.

救命救急のためのハイブリッド近赤外拡散光学分光法を用いた微小血管酸素化および反応性充血の非侵襲的モニタリング

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.

近赤外分光ウェアラブルデバイスを使用して、運動中の中心と末梢の制限を特定する

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

下肢血管機能の評価のためのNIRSの最適化

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.

著者スポットライト:新しい介入とNIRS技術による心血管疾患における血管機能と身体能力の強化

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.

下肢血管機能評価のための反応性充血中の近赤外分光法 

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

血液透析患者における近赤外分光法を用いた組織酸素化の測定

要約

さらに動画を探す

この動画の章

皮膚組織の酸素化と血管機能のデュアルモードイメージング

乳幼児の脳代謝と血行動態の非侵襲的光計測

モデルは、ヒトにおける臨床的に関連する低酸素症をシミュレートします

骨格筋血管カップリング、酸化容量、および 'ワンストップショップ「近赤外分光法を用いた微小血管機能

Cerebrovascular Reactivity Measurement with Functional Near Infrared Spectroscopy

心不全患者における心肺運動検査における脳組織飽和モニタリングの統合

重症新生児、乳児、小児における近赤外分光の管理方法

救命救急のためのハイブリッド近赤外拡散光学分光法を用いた微小血管酸素化および反応性充血の非侵襲的モニタリング

近赤外分光ウェアラブルデバイスを使用して、運動中の中心と末梢の制限を特定する

下肢血管機能評価のための反応性充血中の近赤外分光法

血液透析患者における近赤外分光法を用いた組織酸素化の測定

要約

さらに動画を探す

この動画の章

皮膚組織の酸素化と血管機能のデュアルモードイメージング

乳幼児の脳代謝と血行動態の非侵襲的光計測

モデルは、ヒトにおける臨床的に関連する低酸素症をシミュレートします

骨格筋血管カップリング、酸化容量、および 'ワンストップ ショップ「近赤外分光法を用いた微小血管機能

Cerebrovascular Reactivity Measurement with Functional Near Infrared Spectroscopy

心不全患者における心肺運動検査における脳組織飽和モニタリングの統合

重症新生児、乳児、小児における近赤外分光の管理方法

救命救急のためのハイブリッド近赤外拡散光学分光法を用いた微小血管酸素化および反応性充血の非侵襲的モニタリング

近赤外分光ウェアラブルデバイスを使用して、運動中の中心と末梢の制限を特定する

下肢血管機能評価のための反応性充血中の近赤外分光法

骨格筋血管カップリング、酸化容量、および 'ワンストップショップ「近赤外分光法を用いた微小血管機能