Near-infrared spectroscopy (NIRS) is a technology capable of non-invasive, continuous measuring of regional tissue oxygen saturation (StO2). StO2 represents a state of hemodynamic stability, which is influenced by many factors. Extensive research has been done in the field of measuring StO2 of various organs. The current clinical availability of several NIRS-based devices reflects an important development in prevention, detection and correction of discrepancy in oxygen delivery to the brain and vital organs. Managing cerebral ischemia remains a significant issue in the neonatal intensive care units (NICU). Cerebral tissue oxygenation (cStO2) and cerebral fractional tissue extraction (cFTOE) are reported in a large number of clinical studies. This review provides a summary of the concept of function, current variability of NIRS-based devices used in neonatology, clinical applications in continuous cStO2 monitoring, limitations, disadvantages, and the potential of current technology.

• MeSH
• Spectroscopy, Near-Infrared MeSH
• Hyperbaric Oxygenation methods   MeSH
• Brain Ischemia diagnosis   therapy   MeSH
• Intensive Care Units, Neonatal MeSH
• Humans MeSH
• Monitoring, Physiologic instrumentation   methods   MeSH
• Infant, Newborn MeSH
• Oximetry instrumentation   methods   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

BACKGROUND: Decreased cerebral perfusion and oxygenation are common in hemodialysis patients. Magnitude of the arteriovenous fistula involvement in this phenomenon is not known. The aim of this study was to investigate the effect that a short-term arteriovenous fistula flow interruption has on cerebral oxygenation and to review and suggest possible explanations. METHODS: In 19 patients, basic laboratory and clinical data were obtained and arteriovenous fistula flow volume was measured by ultrasonography. Baseline regional cerebral oxygen saturation (rSO2) was measured by near-infrared spectroscopy. Manual pressure was then applied on the fistula, resulting in total blood flow interruption. After 1 min of manual compression, rSO2 and blood pressure values were noted again. The compression-related change in rSO2 was assessed, as well as its association with arteriovenous fistula flow volume, blood pressure, and other parameters. RESULTS: Mean cerebral rSO2 increased after arteriovenous fistula compression (from 53.6% ± 11.4% to 55.6% ± 10.8%; p = 0.000001; 95% confidence interval = 1.39-2.56). The rSO2 increase was higher in patients with lower rSO2 at baseline (r = -0.46; p = 0.045). CONCLUSION: A significant rise in cerebral oxygenation was observed following the manual compression of arteriovenous fistula. Therefore, the arteriovenous fistula could have a role in impaired cerebral oxygenation in hemodialysis patients.

• MeSH
• Arteriovenous Shunt, Surgical * MeSH
• Biomarkers blood   MeSH
• Spectroscopy, Near-Infrared MeSH
• Time Factors MeSH
• Renal Dialysis MeSH
• Oxygen blood   MeSH
• Middle Aged MeSH
• Humans MeSH
• Cerebrovascular Circulation * MeSH
• Regional Blood Flow MeSH
• Blood Flow Velocity MeSH
• Aged MeSH
• Pressure MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Study MeSH

Cévní mozkové příhody a úrazy hlavy jsou jednou z nejčastějších příčin úmrtí a invalidity. Podle statistiky MZ bylo v r. 1999 v ČR hospitalizováno téměř 30 000 zraněných s mozkovou komocí a u 4500 byla mozková komoce součástí polytraumatu. Léčení všech uvedených stavů by se měli účastnit: neurolog, neurochirurg, internista, chirurg a do tohoto multidisciplinárního týmu by se měl zapojit i odborník „hyperbarické medicíny“ pomocí léčebné metody - hyperbarická oxygenoterapie.

Stroke and cerebral injury are leading cause of death and major source of disability. Approximately 30.000 cases of head injuries were hospitalised and 4.500 head coma were component of polytraumas according to Ministry of Health of ČR. This cases have to be treated by: neurologist, neurosurgeon, internist and in this interdisciplinary team the specialist in „hyperbaric medicine“ have to be included through the method - hyperbaric oxygen therapy.

• MeSH
• Stroke pathology   therapy   MeSH
• Hyperbaric Oxygenation MeSH
• Humans MeSH
• Brain Infarction pathology   therapy   MeSH
• Brain Injuries pathology   therapy   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH

• MeSH
• Adult MeSH
• Blood Coagulation Factor Inhibitors therapeutic use   MeSH
• Shock, Cardiogenic complications   therapy   MeSH
• Catheters trends   utilization   MeSH
• Extracorporeal Membrane Oxygenation methods   instrumentation   MeSH
• Monitoring, Physiologic MeSH
• Advanced Trauma Life Support Care MeSH
• Intraoperative Complications MeSH
• Respiratory Insufficiency complications   therapy   MeSH
• Check Tag
• Adult MeSH
• Publication type
• Handbook MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• urgentní lékařství

BACKGROUND: Cerebral oxygenation (crSO2) monitoring is increasingly used in high-risk infants. Monochorionic twins suffer from specific fetal pathologies that can affect cerebral hemodynamics. Limited data are available on crSO2 and blood flow patterns in this population after birth. OBJECTIVE: To evaluate crSO2 changes in preterm monochorionic and dichorionic twins during the first 72 h of life. METHODS: Near-infrared spectroscopy was used to measure crSO2 in 62 infants from 31 twin pregnancies <32 weeks of gestation. The study group was divided into 4 subgroups: donor (1) and recipient (2) monochorionic twins (with twin-twin transfusion syndrome), fetal growth restriction (FGR) infants (3) and twins without fetal compromise (4). RESULTS: There was significant difference in birth weight (p < 0.001) among 4 subgroups. We observed significant variation in crSO2 among the subgroups using mixed model analysis (p < 0.001). The recipient twins exhibited the lowest crSO2 (mean ± SE) throughout the study period (76 ± 0.3%), whereas the FGR and donor twins presented with the highest values (86 ± 0.3% and 83 ± 0.4% respectively). We found no statistically significant differences in neonatal mortality and morbidity among subgroups. CONCLUSION: Our study revealed significant correlation between crSO2 values postnatally and underlying fetal pathology in monochorionic and dichorionic preterm twins.

• MeSH
• Spectroscopy, Near-Infrared MeSH
• Chorion MeSH
• Twins, Dizygotic * MeSH
• Fetofetal Transfusion etiology   MeSH
• Oxygen analysis   MeSH
• Humans MeSH
• Cerebrovascular Circulation * MeSH
• Infant, Premature MeSH
• Infant, Newborn MeSH
• Birth Weight MeSH
• Prospective Studies MeSH
• Fetal Growth Retardation etiology   MeSH
• Pregnancy, Twin * MeSH
• Pregnancy MeSH
• Fetal Development MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH
• Research Support, Non-U.S. Gov't MeSH

The adequacy of cerebral blood flow and the level of regional oxygen saturation during CPR and early post-resuscitation phases assuring favorable neurological outcome are not known. We demonstrate the feasibility of cerebral blood flow and oxygenation monitoring by a continuous transcranial Doppler combined with cerebral oximetry in a patient with refractory cardiac arrest treated by extracorporeal life support.

• MeSH
• Adult MeSH
• Humans MeSH
• Extracorporeal Circulation methods   MeSH
• Cerebrovascular Circulation * MeSH
• Oximetry methods   MeSH
• Blood Flow Velocity MeSH
• Ultrasonography, Doppler, Transcranial methods   MeSH
• Heart Arrest, Induced methods   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Histological Techniques MeSH
• Hypoxia MeSH
• Cerebral Cortex ultrastructure   MeSH
• Synapses ultrastructure   MeSH

• MeSH
• Diagnostic Techniques, Neurological * MeSH
• Humans MeSH
• Brain * physiology   blood supply   MeSH
• Oximetry * methods   MeSH
• Critical Care MeSH
• Spectrophotometry, Infrared methods   MeSH
• Check Tag
• Humans MeSH

BACKGROUND: Mild therapeutic hypothermia (HT) has been implemented in the management of post cardiac arrest (CA) syndrome after the publication of clinical trials comparing HT with common practice (ie, usually hyperthermia). Current evidence on the comparison between therapeutic HT and controlled normothermia (NT) in CA survivors, however, remains insufficient. METHODS: Eight female swine (sus scrofa domestica; body weight 45 kg) were randomly assigned to receive either mild therapeutic HT or controlled NT, with four animals per group. Veno-arterial extracorporeal membrane oxygenation (ECMO) was established and at minimal ECMO flow (0.5 L/min) ventricular fibrillation was induced by rapid ventricular pacing. After 20 min of CA, circulation was restored by increasing the ECMO flow to 4.5 L/min; 90 min of reperfusion followed. Target core temperatures (HT: 33°C; NT: 36.8°C) were maintained using the heat exchanger on the oxygenator. Invasive blood pressure was measured in the aortic arch, and cerebral oxygenation was assessed using near-infrared spectroscopy. After 60 min of reperfusion, up to three defibrillation attempts were performed. After 90 min of reperfusion, blood samples were drawn for the measurement of troponin I (TnI), myoglobin (MGB), creatine-phosphokinase (CPK), alanin-aminotransferase (ALT), neuron-specific enolase (NSE) and cystatin C (CysC) levels. Reactive oxygen metabolite (ROM) levels and biological antioxidant potential (BAP) were also measured. RESULTS: Significantly higher blood pressure and cerebral oxygenation values were observed in the HT group (P<0.05). Sinus rhythm was restored in all of the HT animals and in one from the NT group. The levels of TnI, MGB, CPK, ALT, and ROM were significantly lower in the HT group (P<0.05); levels of NSE, CysC, and BAP were comparable in both groups. CONCLUSIONS: Our results from animal model of cardiac arrest indicate that HT may be superior to NT for the maintenance of blood pressure, cerebral oxygenation, organ protection and oxidative stress suppression following CA.

• MeSH
• Biomarkers blood   MeSH
• Blood Pressure MeSH
• Oxygen metabolism   MeSH
• Extracorporeal Membrane Oxygenation methods   MeSH
• Disease Models, Animal MeSH
• Brain metabolism   MeSH
• Oxidative Stress * MeSH
• Heart Arrest metabolism   MeSH
• Sus scrofa MeSH
• Body Temperature MeSH
• Hypothermia, Induced methods   MeSH
• Animals MeSH
• Check Tag
• Female MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

INTRODUCTION: Data on management of severe accidental hypothermia published from an established high-volume extracorporeal membrane oxygenation centre are scarce. METHODS: A total of 28 patients with intravesical temperature lower than 28°C on admission were either treated with veno-arterial extracorporeal membrane oxygenation or rewarmed conservatively. RESULTS: A total of 10 patients rewarmed on veno-arterial extracorporeal membrane oxygenation (age: 37 ± 12.6 years) and 18 conservatively (age: 55.2 ± 11.2 years) were collected over a course of 5 years. The dominant cause was alcohol intoxication with exposure to cold (39%), 12 patients were resuscitated prior to admission. The admission temperature in the extracorporeal membrane oxygenation group (23.8 ± 2.6°C) was lower than in the non-extracorporeal membrane oxygenation group (26.0 ± 1.5°C, p = 0.01). The peripheral percutaneous veno-arterial extracorporeal membrane oxygenation was always cannulated in malignant arrhythmias causing refractory cardiac arrest. The typical extracorporeal membrane oxygenation blood flow was 3-4 L/minute and sweep gas flow 2 L/minute, the median extracorporeal membrane oxygenation duration was 48.3 (28.1-86.7) hours. The median rates of rewarming did not differ (0.41 (0.35-0.7)°C/hour in extracorporeal membrane oxygenation and 0.77 (0.54-0.98)°C/hour in non-extracorporeal membrane oxygenation, p = 0.46) as well as the admission arterial lactate, pH and potassium. Their development was not different between the groups except for higher pH between the third and ninth hour of rewarming in the extracorporeal membrane oxygenation group. The hospital mortality was 10% in the extracorporeal membrane oxygenation group and 11.1% in the non-extracorporeal membrane oxygenation group with the median last Glasgow Coma Scale 15 and Cerebral Performance Score 1. CONCLUSION: Veno-arterial extracorporeal membrane oxygenation for severe hypothermia shows promising outcome data collected in an extracorporeal membrane oxygenation/extracorporeal cardiopulmonary resuscitation centre located in a European urban area. Except for presence of refractory cardiac arrest, the established hypothermia-related prognostic indicators did not differ between patients in need for extracorporeal membrane oxygenation and those rewarmed without extracorporeal membrane oxygenation.

• MeSH
• Adult MeSH
• Hypothermia etiology   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Extracorporeal Membrane Oxygenation adverse effects   methods   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH