Alwyn Gomez1, Josh Dian1, Logan Froese2, Frederick Adam Zeiler3,4,2,5,6. 1. Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CA. 2. Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, CA. 3. Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, GF231 Health Sciences Centre820 Sherbrook Street, Winnipeg, CA. 4. Department of Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CA. 5. Centre on Aging, University of Mantioba, Winnipeg, CA. 6. Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, GB.
Abstract
BACKGROUND: Impaired cerebrovascular reactivity after traumatic brain injury (TBI) in adults is emerging as an important prognostic factor, with strong independent association with 6-month outcomes. To date, it is unknown if impaired cerebrovascular reactivity during the acute phase is associated with ongoing impaired continuously measured cerebrovascular reactivity at in the long-term, and if such measures are associated with clinical phenotype at those points in time. OBJECTIVE: Within this manuscript we highlight a prospective pilot study that will preliminarily assess near-infrared spectroscopy (NIRS) derived continuous measures of cerebrovascular reactivity during both acute and long-term phases in adults with TBI. METHODS: Over the course of a 2 year period we will recruit up to 80 moderate/severe TBI patients admitted to the intensive care unit (ICU) with an invasive intracranial pressure (ICP) monitoring. These patients will undergo high-frequency data capture of ICP, arterial blood pressure (ABP), and NIRS for the first 5 days of care. Patients will then have 30 minutes of non-invasive NIRS and ABP monitoring in clinic at 3, 6, and 12 months post-injury. Outcomes will be assessed via Glasgow Outcome Scale and Short Form-12 questionnaires. Various relationships between NIRS and ICP derived cerebrovascular reactivity metrics, and associated outcomes, will be assessed using biomedical signal processing techniques and both multi-variate and time-series statistical methodologies. RESULTS: This study has currently started recruitment as of the end of February 2020, with data collection ongoing, having enrolled 3 patients at the time of this manuscript composition. Expected duration of data collection will be from February 2020 to January 2022, as per our local research ethics board (REB) approval (B2018:103). Support for this work has been obtained through the National Institutes of Health (NIH), though the National Institute of Neurological Disorders and Stroke (NINDS) (R03NS114335), funded in January 2020. CONCLUSIONS: Through application of NIRS technology in the monitoring of TBI patients, we expect to be able to outline core relationships between non-invasively measured aspects of cerebral physiology and both invasive measures, as well as patient outcomes. Documenting these relationships carries the potential to revolutionize the way we monitor TBI patients, moving to more non-invasive techniques. CLINICALTRIAL: Not Applicable - not a trial, as deemed by NIH protocol approval.
BACKGROUND:Impaired cerebrovascular reactivity after traumatic brain injury (TBI) in adults is emerging as an important prognostic factor, with strong independent association with 6-month outcomes. To date, it is unknown if impaired cerebrovascular reactivity during the acute phase is associated with ongoing impaired continuously measured cerebrovascular reactivity at in the long-term, and if such measures are associated with clinical phenotype at those points in time. OBJECTIVE: Within this manuscript we highlight a prospective pilot study that will preliminarily assess near-infrared spectroscopy (NIRS) derived continuous measures of cerebrovascular reactivity during both acute and long-term phases in adults with TBI. METHODS: Over the course of a 2 year period we will recruit up to 80 moderate/severe TBI patients admitted to the intensive care unit (ICU) with an invasive intracranial pressure (ICP) monitoring. These patients will undergo high-frequency data capture of ICP, arterial blood pressure (ABP), and NIRS for the first 5 days of care. Patients will then have 30 minutes of non-invasive NIRS and ABP monitoring in clinic at 3, 6, and 12 months post-injury. Outcomes will be assessed via Glasgow Outcome Scale and Short Form-12 questionnaires. Various relationships between NIRS and ICP derived cerebrovascular reactivity metrics, and associated outcomes, will be assessed using biomedical signal processing techniques and both multi-variate and time-series statistical methodologies. RESULTS: This study has currently started recruitment as of the end of February 2020, with data collection ongoing, having enrolled 3 patients at the time of this manuscript composition. Expected duration of data collection will be from February 2020 to January 2022, as per our local research ethics board (REB) approval (B2018:103). Support for this work has been obtained through the National Institutes of Health (NIH), though the National Institute of Neurological Disorders and Stroke (NINDS) (R03NS114335), funded in January 2020. CONCLUSIONS: Through application of NIRS technology in the monitoring of TBI patients, we expect to be able to outline core relationships between non-invasively measured aspects of cerebral physiology and both invasive measures, as well as patient outcomes. Documenting these relationships carries the potential to revolutionize the way we monitor TBI patients, moving to more non-invasive techniques. CLINICALTRIAL: Not Applicable - not a trial, as deemed by NIH protocol approval.
Authors: Jennifer C Laws; Lori C Jordan; Lindsay M Pagano; John C Wellons; Michael S Wolf Journal: Pediatr Neurol Date: 2022-02-02 Impact factor: 3.372
Authors: Amanjyot Singh Sainbhi; Alwyn Gomez; Logan Froese; Trevor Slack; Carleen Batson; Kevin Y Stein; Dean M Cordingley; Arsalan Alizadeh; Frederick A Zeiler Journal: Front Neurol Date: 2022-04-26 Impact factor: 4.086
Authors: Alwyn Gomez; Amanjyot Singh Sainbhi; Logan Froese; Carleen Batson; Trevor Slack; Kevin Y Stein; Dean M Cordingley; Francois Mathieu; Frederick A Zeiler Journal: Front Physiol Date: 2022-07-15 Impact factor: 4.755