A5030167258- Traumatic Brain Injury and Neurovascular Disturbances
- Optical Imaging and Spectroscopy Techniques
- Neonatal and fetal brain pathology
- Congenital Heart Disease Studies
- Hemodynamic Monitoring and Therapy
- Cardiac Arrest and Resuscitation
- Cardiac, Anesthesia and Surgical Outcomes
- Anesthesia and Neurotoxicity Research
- Cerebrospinal fluid and hydrocephalus
- Non-Invasive Vital Sign Monitoring
- Neonatal Respiratory Health Research
- Aortic Disease and Treatment Approaches
- Cardiovascular Health and Disease Prevention
- Mechanical Circulatory Support Devices
- Cardiovascular Issues in Pregnancy
- Intensive Care Unit Cognitive Disorders
- Neurosurgical Procedures and Complications
- Traumatic Brain Injury Research
- Cardiovascular Function and Risk Factors
- Intracranial Aneurysms: Treatment and Complications
- S100 Proteins and Annexins
- Acute Ischemic Stroke Management
- Anesthesia and Sedative Agents
- Spinal Fractures and Fixation Techniques
- Estrogen and related hormone effects
Northwestern University
2019-2025
Lurie Children's Hospital
2019-2025
Baylor College of Medicine
2011-2023
Beltsville Agricultural Research Center
2023
Agricultural Research Service
2023
Texas Children's Hospital
2011-2021
Committee on Publication Ethics
2019
Penn State Milton S. Hershey Medical Center
2018
Transport Research Laboratory (United Kingdom)
2017
Barro Colorado Island
2015
Objectives: We have sought to develop an automated methodology for the continuous updating of optimal cerebral perfusion pressure (CPPopt) patients after severe traumatic head injury, using monitoring cerebrovascular reactivity. then validated CPPopt algorithm by determining association between outcome and deviation actual CPP from CPPopt. Design: Retrospective analysis prospectively collected data. Setting: Neurosciences critical care unit a university hospital. Patients: A total 327...
Background and Purpose— Assessment of autoregulation in the time domain is a promising monitoring method for actively optimizating cerebral perfusion pressure (CPP) critically ill patients. The ability to detect loss autoregulatory vasoreactivity spontaneous fluctuations CPP was tested with new time-domain that used near-infrared spectroscopic measurements tissue oxyhemoglobin saturation an infant animal model. Methods— Piglets were made progressively hypotensive over 4 5 hours by inflation...
Background and Purpose— Individualizing mean arterial blood pressure targets to a patient’s cerebral flow autoregulatory range might prevent brain ischemia for patients undergoing cardiopulmonary bypass (CPB). This study compares the accuracy of real-time autoregulation monitoring using near-infrared spectroscopy with that transcranial Doppler. Methods— Sixty adult CPB had Doppler middle artery velocity monitoring. The index (Mx) was calculated as moving, linear correlation coefficient...
Mean arterial blood pressure (MAP) targets are empirically chosen during cardiopulmonary bypass (CPB). We have previously shown that near-infrared spectroscopy (NIRS) can be used clinically for monitoring cerebral flow autoregulation. The hypothesis of this study was real-time autoregulation using NIRS-based methods is more accurate delineating the MAP at lower limit (LLA) CPB than empiric determinations based on age, preoperative history, and pressure.Two hundred thirty-two patients...
To determine whether mean arterial blood pressure excursions below the lower limit of cerebral flow autoregulation during cardiopulmonary bypass are associated with acute kidney injury after surgery.Tertiary care medical center.Four hundred ten patients undergoing cardiac surgery bypass.Prospective observational study.None.Autoregulation was monitored by calculating a continuous, moving Pearson's correlation coefficient between and processed near-infrared spectroscopy signals to generate...
Clinical application of continuous autoregulation monitoring would benefit from a comparison curves generated by online with standard in animal models. We characterized the accuracy 3 monitors piglet model hypotension.Piglets 5 to10 days old intracranial pressure (ICP) at naïve or elevated (20 mm Hg) levels had gradual arterial hypotension induced balloon catheter inferior vena cava. Elevated ICP was maintained infusion artificial cerebrospinal fluid. Three indices were simultaneously and...
Background and Purpose— The pressure reactivity index (PRx) describes cerebral vessel by correlation of slow waves intracranial (ICP) arterial blood pressure. In theory, changes in the relative total hemoglobin (rTHb) measured near-infrared spectroscopy are caused same volume that cause ICP. Our objective was to develop a new vascular reactivity, (HVx), which is low-frequency rTHb with spectroscopy. Methods— Gradual hypotension induced piglets while cortical laser-Doppler flux monitored. ICP...
Background and Purpose— The limits of cerebral blood flow-pressure autoregulation have not been adequately defined for pediatric patients. Mean arterial pressure below these might contribute to brain injury during cardiac surgery. purpose this pilot study was assess a novel method determining the lower in patients supported with cardiopulmonary bypass. Methods— A prospective, observational conducted children (n=54) undergoing surgery bypass correction congenital heart defects. Cerebral...
Patient rewarming after hypothermic cardiopulmonary bypass (CPB) has been linked to brain injury cardiac surgery. In this study, we evaluated whether cooling and then of body temperature during CPB in adult patients is associated with alterations cerebral blood flow (CBF)-blood pressure autoregulation.One hundred twenty-seven undergoing surgery had transcranial Doppler monitoring the right left middle artery velocity. Eleven who arterial inflow maintained at >35 degrees C served as controls....
Summary Background Adverse neurodevelopmental outcomes are observed in up to 50% of infants after complex cardiac surgery. We sought determine the association perioperative anesthetic exposure with at age 12 months neonates undergoing surgery and effect brain injury determined by magnetic resonance imaging ( MRI ). Methods Retrospective cohort study who had preoperative 7‐day postoperative 12‐month testing Bayley Scales Infant Toddler Development, Third Edition (Bayley‐ III Doses volatile...
Background and Purpose— In patients with subarachnoid hemorrhage, the assessment of cerebral autoregulation aids in prognosis as well detection vasospasm. Mx is a validated index based on measures perfusion pressure mean flow velocity transcranial Doppler but impractical for longer-term monitoring. Near-infrared spectroscopy noninvasive suitable continuous monitoring tissue oxygenation using Tissue Oxygenation Index. this study, we compared near-infrared spectroscopy-based indices (TOx)...
Monitoring of cerebrovascular pressure reactivity (PRx) has diagnostic and prognostic value in head-injured patients, but requires invasive monitoring intracranial (ICP). Near infrared spectroscopy (NIRS) is a noninvasive method that suitable for continuous detection cerebral blood volume changes. We compared NIRS-based index reactivity, called total hemoglobin (THx), against standard measurements PRx prospective observational study. Forty patients with closed-head injury were monitored...
<h3>Importance</h3> Delirium occurs in up to 52% of patients after cardiac surgery and may result from changes cerebral perfusion. Using intraoperative autoregulation monitoring individualize optimize perfusion be a useful strategy reduce the incidence delirium surgery. <h3>Objective</h3> To determine whether targeting mean arterial pressure during cardiopulmonary bypass (CPB) using reduces compared with usual care. <h3>Design, Setting, Participants</h3> This randomized clinical trial nested...
We hypothesized that pressure reactivity index (PRx) values indicating preserved cerebrovascular autoregulation would be associated with survival in children traumatic brain injury (TBI). This hypothesis was tested a prospective, blinded, observational, pilot study.Twenty-one admitted between May 2006 and September 2008 severe TBI necessitating invasive intracranial monitoring were enrolled this study. The PRx continuously monitored as moving, linear correlation coefficient low-frequency...
No specific regimen has been universally accepted as ideal for sedation during cardiac catheterization in infants and children. We evaluated a combination of ketamine dexmedetomidine children with congenital heart disease. The study design included retrospective analysis data sheets hospital records. protocol was standardized collected prospectively an ongoing quality assurance project. Heart rate, blood pressure, oxygen saturation were recorded every 1 minute the first 5 minutes then at...
Objective: Knowledge remains limited regarding cerebral blood flow autoregulation after cardiac arrest and during postresuscitation hypothermia. We determined the relationship of to perfusion pressure in a swine model pediatric hypoxic-asphyxic normothermia hypothermia tested novel measures derived from near-infrared spectroscopy. Design: Prospective, balanced animal study. Setting: Basic physiology laboratory at an academic institution. Subjects: Eighty-four neonatal swine. Interventions:...
The frequency-response of pressure autoregulation is not well delineated; therefore, the optimal frequency arterial blood (ABP) modulation for measuring unknown. We hypothesized that cerebrovascular band-limited and delineated by a cutoff which ABP variations induce reactivity. Neonatal swine (n = 8) were anesthetized using constant minute ventilation while positive end-expiratory (PEEP) was modulated between 6 0.75 cycles/min (min(-1)). animals hemorrhaged until below lower limit (LLA),...
In patients after subarachnoid hemorrhage (SAH) failure of cerebral autoregulation is associated with delayed ischemia (DCI). Various methods assessing are available, but their predictive values remain unknown. We characterize the relationship between different indices autoregulation. Patients SAH within 5 days were included in a prospective study. The three was analyzed: two calculated using spontaneous blood pressure fluctuations, Sxa (based on transcranial Doppler) and TOxa near-infrared...
Although controversial, failing to consider the gravitational effects of head elevation on cerebral perfusion is speculated increase susceptibility rare, but devastating, neurologic complications after shoulder surgery in beach chair position (BCP). We hypothesized that patients BCP have diminished blood flow autoregulation than those who undergo lateral decubitus (LDP). A secondary aim was examine whether there a relationship between patient positioning during and postoperative cognition or...