TY - JOUR
T1 - Non-invasive optical neuromonitoring of the temperature-dependence of cerebral oxygen metabolism during deep hypothermic cardiopulmonary bypass in neonatal swine
AU - Ko, Tiffany S.
AU - Mavroudis, Constantine D.
AU - Baker, Wesley B.
AU - Morano, Vincent C.
AU - Mensah-Brown, Kobina
AU - Boorady, Timothy W.
AU - Schmidt, Alexander L.
AU - Lynch, Jennifer M.
AU - Busch, David R.
AU - Gentile, Javier
AU - Bratinov, George
AU - Lin, Yuxi
AU - Jeong, Sejin
AU - Melchior, Richard W.
AU - Rosenthal, Tami M.
AU - Shade, Brandon C.
AU - Schiavo, Kellie L.
AU - Xiao, Rui
AU - Gaynor, J. William
AU - Yodh, Arjun G.
AU - Kilbaugh, Todd J.
AU - Licht, Daniel J.
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported by the National Institute of Health through grant numbers R01-NS072338, R01-NS60653, P41-EB015893, F31-HD085731, and the June and Steve Wolfson Family Foundation.
Publisher Copyright:
© The Author(s) 2018.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Management of deep hypothermic (DH) cardiopulmonary bypass (CPB), a critical neuroprotective strategy, currently relies on non-invasive temperature to guide cerebral metabolic suppression during complex cardiac surgery in neonates. Considerable inter-subject variability in temperature response and residual metabolism may contribute to the persisting risk for postoperative neurological injury. To characterize and mitigate this variability, we assess the sufficiency of conventional nasopharyngeal temperature (NPT) guidance, and in the process, validate combined non-invasive frequency-domain diffuse optical spectroscopy (FD-DOS) and diffuse correlation spectroscopy (DCS) for direct measurement of cerebral metabolic rate of oxygen (CMRO2). During CPB, n = 8 neonatal swine underwent cooling from normothermia to 18℃, sustained DH perfusion for 40 min, and then rewarming to simulate cardiac surgery. Continuous non-invasive and invasive measurements of intracranial temperature (ICT) and CMRO2 were acquired. Significant hysteresis (p < 0.001) between cooling and rewarming periods in the NPT versus ICT and NPT versus CMRO2 relationships were found. Resolution of this hysteresis in the ICT versus CMRO2 relationship identified a crucial insufficiency of conventional NPT guidance. Non-invasive CMRO2 temperature coefficients with respect to NPT (Q10 = 2.0) and ICT (Q10 = 2.5) are consistent with previous reports and provide further validation of FD-DOS/DCS CMRO2 monitoring during DH CPB to optimize management.
AB - Management of deep hypothermic (DH) cardiopulmonary bypass (CPB), a critical neuroprotective strategy, currently relies on non-invasive temperature to guide cerebral metabolic suppression during complex cardiac surgery in neonates. Considerable inter-subject variability in temperature response and residual metabolism may contribute to the persisting risk for postoperative neurological injury. To characterize and mitigate this variability, we assess the sufficiency of conventional nasopharyngeal temperature (NPT) guidance, and in the process, validate combined non-invasive frequency-domain diffuse optical spectroscopy (FD-DOS) and diffuse correlation spectroscopy (DCS) for direct measurement of cerebral metabolic rate of oxygen (CMRO2). During CPB, n = 8 neonatal swine underwent cooling from normothermia to 18℃, sustained DH perfusion for 40 min, and then rewarming to simulate cardiac surgery. Continuous non-invasive and invasive measurements of intracranial temperature (ICT) and CMRO2 were acquired. Significant hysteresis (p < 0.001) between cooling and rewarming periods in the NPT versus ICT and NPT versus CMRO2 relationships were found. Resolution of this hysteresis in the ICT versus CMRO2 relationship identified a crucial insufficiency of conventional NPT guidance. Non-invasive CMRO2 temperature coefficients with respect to NPT (Q10 = 2.0) and ICT (Q10 = 2.5) are consistent with previous reports and provide further validation of FD-DOS/DCS CMRO2 monitoring during DH CPB to optimize management.
KW - Cerebral oxygen metabolism
KW - cardiopulmonary bypass
KW - deep hypothermia
KW - diffuse correlation spectroscopy
KW - diffuse optical spectroscopy
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U2 - 10.1177/0271678X18809828
DO - 10.1177/0271678X18809828
M3 - Article
C2 - 30375917
AN - SCOPUS:85060522167
SN - 0271-678X
VL - 40
SP - 187
EP - 203
JO - Journal of Cerebral Blood Flow and Metabolism
JF - Journal of Cerebral Blood Flow and Metabolism
IS - 1
ER -