Gomez Alwyn, Dian Joshua, Froese Logan, Zeiler Frederick Adam
Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada.
JMIR Res Protoc. 2020 Aug 12;9(8):e18740. doi: 10.2196/18740.
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 in the long-term, and if such measures are associated with clinical phenotype at those points in time.
We describe a prospective pilot study to assess the use of near-infrared spectroscopy (NIRS) to derive continuous measures of cerebrovascular reactivity during the acute and long-term phases of TBI in adults.
Over 2 years, we will recruit up to 80 adults with moderate/severe TBI admitted to the intensive care unit (ICU) with 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 noninvasive NIRS and ABP monitoring in the clinic at 3, 6, and 12 months post-injury. Outcomes will be assessed via the 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 multivariate and time-series statistical methodologies.
Study recruitment began at the end of February 2020, with data collection ongoing and three patients enrolled at the time of writing. The expected duration of data collection will be from February 2020 to January 2022, as per our local research ethics board approval (B2018:103). Support for this work has been obtained through the National Institutes of Health (NIH) through the National Institute of Neurological Disorders and Stroke (NINDS) (R03NS114335), funded in January 2020.
With the application of NIRS technology for monitoring of patients with TBI, we expect to be able to outline core relationships between noninvasively measured aspects of cerebral physiology and invasive measures, as well as patient outcomes. Documenting these relationships carries the potential to revolutionize the way we monitor patients with TBI, moving to more noninvasive techniques.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/18740.
成人创伤性脑损伤（TBI）后脑血管反应性受损正逐渐成为一个重要的预后因素，与6个月的预后有着强烈的独立关联。迄今为止，尚不清楚急性期脑血管反应性受损是否与长期持续测量的脑血管反应性持续受损相关，以及这些测量指标是否与当时的临床表型相关。
我们描述一项前瞻性试点研究，以评估在成人TBI的急性期和长期阶段使用近红外光谱（NIRS）来获取脑血管反应性的连续测量值。
在2年时间里，我们将招募多达80名入住重症监护病房（ICU）并进行有创颅内压（ICP）监测的中度/重度TBI成人患者。这些患者将在护理的前5天接受ICP、动脉血压（ABP）和NIRS的高频数据采集。然后，患者将在受伤后3、6和12个月在门诊接受30分钟的无创NIRS和ABP监测。结局将通过格拉斯哥预后量表和简明健康调查问卷12进行评估。将使用生物医学信号处理技术以及多变量和时间序列统计方法评估NIRS与基于ICP的脑血管反应性指标及相关结局之间的各种关系。
研究招募于2020年2月底开始，数据收集正在进行中，撰写本文时已有3名患者入组。根据我们当地研究伦理委员会的批准（B2018:103），预计数据收集时间为2020年2月至2022年1月。这项工作已通过美国国立卫生研究院（NIH）下属的国立神经疾病和中风研究所（NINDS）获得支持（R03NS114335），于2020年1月获得资助。
通过应用NIRS技术监测TBI患者，我们期望能够勾勒出脑生理学的无创测量方面与有创测量以及患者结局之间的核心关系。记录这些关系有可能彻底改变我们监测TBI患者的方式，转向更多的无创技术。
国际注册报告识别码（IRRID）：DERR1-10.2196/18740。
