Amirali Mirsajadi, Dustin Erickson, Soumya Alias, Logan Froese, Amanjyot Singh Sainbhi, Alwyn Gomez, Raju Majumdar, Isuru Herath, Maggie Wilson, Ryan Zarychanski, Frederick A Zeiler, Asher A Mendelson
{"title":"使用近红外光谱分析骨骼肌的微血管自动调节并推导重症监护病房的最佳平均动脉压:试点研究及与大脑近红外光谱仪的比较。","authors":"Amirali Mirsajadi, Dustin Erickson, Soumya Alias, Logan Froese, Amanjyot Singh Sainbhi, Alwyn Gomez, Raju Majumdar, Isuru Herath, Maggie Wilson, Ryan Zarychanski, Frederick A Zeiler, Asher A Mendelson","doi":"10.1097/CCE.0000000000001111","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>Microvascular autoregulation (MA) maintains adequate tissue perfusion over a range of arterial blood pressure (ABP) and is frequently impaired in critical illness. MA has been studied in the brain to derive personalized hemodynamic targets after brain injury. The ability to measure MA in other organs is not known, which may inform individualized management during shock.</p><p><strong>Objectives: </strong>This study determines the feasibility of measuring MA in skeletal muscle using near-infrared spectroscopy (NIRS) as a marker of tissue perfusion, the derivation of optimal mean arterial pressure (MAPopt), and comparison with indices from the brain.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>Medical and surgical ICU in a tertiary academic hospital.</p><p><strong>Participants: </strong>Adult critically ill patients requiring vasoactive support on the first day of ICU admission.</p><p><strong>Main outcomes and measures: </strong>Fifteen critically ill patients were enrolled. NIRS was applied simultaneously to skeletal muscle (brachioradialis) and brain (frontal cortex) while ABP was measured continuously via invasive catheter. MA correlation indices were calculated between ABP and NIRS from skeletal muscle total hemoglobin (MVx), muscle tissue saturation index (MOx), brain total hemoglobin (THx), and brain tissue saturation index (COx). Curve fitting algorithms derive the MAP with the lowest correlation index value, which is the MAPopt.</p><p><strong>Results: </strong>MAPopt values were successfully calculated for each correlation index for all patients and were frequently (77%) above 65 mm Hg. For all correlation indices, median time was substantially above impaired MA threshold (24.5-34.9%) and below target MAPopt (9.0-78.6%). Muscle and brain MAPopt show moderate correlation (MVx-THx r = 0.76, p < 0.001; MOx-COx r = 0.69, p = 0.005), with a median difference of -1.27 mm Hg (-9.85 to -0.18 mm Hg) and 0.05 mm Hg (-7.05 to 2.68 mm Hg).</p><p><strong>Conclusions and relevance: </strong>This study demonstrates, for the first time, the feasibility of calculating MA indices and MAPopt in skeletal muscle using NIRS. Future studies should explore the association between impaired skeletal muscle MA, ICU outcomes, and organ-specific differences in MA and MAPopt thresholds.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 7","pages":"e1111"},"PeriodicalIF":0.0000,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196085/pdf/","citationCount":"0","resultStr":"{\"title\":\"Microvascular Autoregulation in Skeletal Muscle Using Near-Infrared Spectroscopy and Derivation of Optimal Mean Arterial Pressure in the ICU: Pilot Study and Comparison With Cerebral Near-Infrared Spectroscopy.\",\"authors\":\"Amirali Mirsajadi, Dustin Erickson, Soumya Alias, Logan Froese, Amanjyot Singh Sainbhi, Alwyn Gomez, Raju Majumdar, Isuru Herath, Maggie Wilson, Ryan Zarychanski, Frederick A Zeiler, Asher A Mendelson\",\"doi\":\"10.1097/CCE.0000000000001111\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>Microvascular autoregulation (MA) maintains adequate tissue perfusion over a range of arterial blood pressure (ABP) and is frequently impaired in critical illness. MA has been studied in the brain to derive personalized hemodynamic targets after brain injury. The ability to measure MA in other organs is not known, which may inform individualized management during shock.</p><p><strong>Objectives: </strong>This study determines the feasibility of measuring MA in skeletal muscle using near-infrared spectroscopy (NIRS) as a marker of tissue perfusion, the derivation of optimal mean arterial pressure (MAPopt), and comparison with indices from the brain.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>Medical and surgical ICU in a tertiary academic hospital.</p><p><strong>Participants: </strong>Adult critically ill patients requiring vasoactive support on the first day of ICU admission.</p><p><strong>Main outcomes and measures: </strong>Fifteen critically ill patients were enrolled. NIRS was applied simultaneously to skeletal muscle (brachioradialis) and brain (frontal cortex) while ABP was measured continuously via invasive catheter. MA correlation indices were calculated between ABP and NIRS from skeletal muscle total hemoglobin (MVx), muscle tissue saturation index (MOx), brain total hemoglobin (THx), and brain tissue saturation index (COx). Curve fitting algorithms derive the MAP with the lowest correlation index value, which is the MAPopt.</p><p><strong>Results: </strong>MAPopt values were successfully calculated for each correlation index for all patients and were frequently (77%) above 65 mm Hg. For all correlation indices, median time was substantially above impaired MA threshold (24.5-34.9%) and below target MAPopt (9.0-78.6%). Muscle and brain MAPopt show moderate correlation (MVx-THx r = 0.76, p < 0.001; MOx-COx r = 0.69, p = 0.005), with a median difference of -1.27 mm Hg (-9.85 to -0.18 mm Hg) and 0.05 mm Hg (-7.05 to 2.68 mm Hg).</p><p><strong>Conclusions and relevance: </strong>This study demonstrates, for the first time, the feasibility of calculating MA indices and MAPopt in skeletal muscle using NIRS. Future studies should explore the association between impaired skeletal muscle MA, ICU outcomes, and organ-specific differences in MA and MAPopt thresholds.</p>\",\"PeriodicalId\":93957,\"journal\":{\"name\":\"Critical care explorations\",\"volume\":\"6 7\",\"pages\":\"e1111\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-06-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196085/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical care explorations\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/CCE.0000000000001111\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical care explorations","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/CCE.0000000000001111","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
重要性:微血管自动调节(MA)可在一定范围的动脉血压(ABP)内维持足够的组织灌注,在危重病人中经常会受到影响。已对脑部的 MA 进行了研究,以确定脑损伤后的个性化血液动力学目标。在其他器官测量 MA 的能力尚不清楚,这可能会为休克期间的个性化管理提供信息:本研究确定了使用近红外光谱(NIRS)测量骨骼肌 MA 作为组织灌注标志物的可行性、最佳平均动脉压(MAPopt)的推导以及与大脑指数的比较:前瞻性观察研究:地点:一家三级学术医院的内科和外科重症监护室:主要结果和测量指标:15 名重症患者入选。在通过有创导管连续测量 ABP 的同时,对骨骼肌(肱肌)和大脑(额叶皮层)同时应用近红外光谱。根据骨骼肌总血红蛋白 (MVx)、肌肉组织饱和度指数 (MOx)、大脑总血红蛋白 (THx) 和大脑组织饱和度指数 (COx) 计算 ABP 和 NIRS 之间的 MA 相关指数。曲线拟合算法得出相关指数值最低的 MAP,即 MAPopt:结果:成功计算出所有患者各相关指数的 MAPopt 值,且经常(77%)高于 65 mm Hg。在所有相关指数中,中位时间大大高于受损的 MA 阈值(24.5%-34.9%),低于目标 MAPopt 值(9.0%-78.6%)。肌肉和大脑 MAPopt 显示出中度相关性(MVx-THx r = 0.76,p < 0.001;MOx-COx r = 0.69,p = 0.005),中位差异为-1.27 毫米汞柱(-9.85 至-0.18 毫米汞柱)和 0.05 毫米汞柱(-7.05 至 2.68 毫米汞柱):本研究首次证明了利用近红外光谱计算骨骼肌 MA 指数和 MAPopt 的可行性。未来的研究应探讨骨骼肌 MA受损、ICU预后以及MA和MAPopt阈值器官特异性差异之间的关联。
Microvascular Autoregulation in Skeletal Muscle Using Near-Infrared Spectroscopy and Derivation of Optimal Mean Arterial Pressure in the ICU: Pilot Study and Comparison With Cerebral Near-Infrared Spectroscopy.
Importance: Microvascular autoregulation (MA) maintains adequate tissue perfusion over a range of arterial blood pressure (ABP) and is frequently impaired in critical illness. MA has been studied in the brain to derive personalized hemodynamic targets after brain injury. The ability to measure MA in other organs is not known, which may inform individualized management during shock.
Objectives: This study determines the feasibility of measuring MA in skeletal muscle using near-infrared spectroscopy (NIRS) as a marker of tissue perfusion, the derivation of optimal mean arterial pressure (MAPopt), and comparison with indices from the brain.
Design: Prospective observational study.
Setting: Medical and surgical ICU in a tertiary academic hospital.
Participants: Adult critically ill patients requiring vasoactive support on the first day of ICU admission.
Main outcomes and measures: Fifteen critically ill patients were enrolled. NIRS was applied simultaneously to skeletal muscle (brachioradialis) and brain (frontal cortex) while ABP was measured continuously via invasive catheter. MA correlation indices were calculated between ABP and NIRS from skeletal muscle total hemoglobin (MVx), muscle tissue saturation index (MOx), brain total hemoglobin (THx), and brain tissue saturation index (COx). Curve fitting algorithms derive the MAP with the lowest correlation index value, which is the MAPopt.
Results: MAPopt values were successfully calculated for each correlation index for all patients and were frequently (77%) above 65 mm Hg. For all correlation indices, median time was substantially above impaired MA threshold (24.5-34.9%) and below target MAPopt (9.0-78.6%). Muscle and brain MAPopt show moderate correlation (MVx-THx r = 0.76, p < 0.001; MOx-COx r = 0.69, p = 0.005), with a median difference of -1.27 mm Hg (-9.85 to -0.18 mm Hg) and 0.05 mm Hg (-7.05 to 2.68 mm Hg).
Conclusions and relevance: This study demonstrates, for the first time, the feasibility of calculating MA indices and MAPopt in skeletal muscle using NIRS. Future studies should explore the association between impaired skeletal muscle MA, ICU outcomes, and organ-specific differences in MA and MAPopt thresholds.