A novel multimodal computational system using near-infrared spectroscopy to monitor cerebral oxygenation during assisted ventilation in CDH patients

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• 作者：Stephanie M. Cruz^a ; Adesola C. Akinkuotu^a ; Craig G. Rusin^b ; Darrell L. Cass^a ; ^c ; Timothy C. Lee^a ; Stephen E. Welty^d ; Oluyinka O. Olutoye^a ; ^c ; ^{oolutoye@bcm.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：CDH ; Near infrared spectroscopy ; Cerebral oxygenation
• 刊名：Journal of Pediatric Surgery
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：51
• 期：1
• 页码：38-43
• 全文大小：654 K

文摘

The aim of this study was to create a computational simulator to serve as an early alert system for cerebral hypoxemia prior to the onset of clinical symptoms.

c_2">Methods

Neonates with congenital diaphragmatic hernia (Jan 2010–Dec 2014) were recruited to collect continuous measurements of cerebral tissue oxygen saturation (cStO₂) using a near-infrared spectroscopy (NIRS) device (FORE-SIGHT®, CASMED). Clinicians were blinded to NIRS data and treated infants based on pre-established clinical protocols. Charts were reviewed retrospectively to identify clinical events of hypoxemia (spontaneous, sustained decrease in preductal SpO₂ < 85% leading to ventilator changes). We developed a computational algorithm that determined baseline values, variability and event data for each patient.

c_3">Results

Twenty-three of 36 patients enrolled met data criteria. The algorithm anticipated an event at least 15 minutes prior to the event in 77% of cases, with an average pre-event detection of 47 minutes (range 16–122 minutes). Post-event StO₂ (SpO₂ < 85%) was determined to be 63.7% ± 11.7. In this computational model, the sensitivity to distinguish low states of cerebral perfusion was 94% with a specificity of 96%.

c_4">Conclusion

We have developed a computational algorithm with an early warning system that has the potential of being translated into a real-time clinical interface that may improve management of neonates.