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Continuous Near-Infrared Regional Cerebral Perfusion Monitoring Shows Promise in Stroke Patients

February 3rd, 2012 Jan Sinnige Anesthesiology, Cardiac Surgery, Critical Care, Neurology, Neurosurgery

Researchers at Mayo Clinic in Florida have shown that cerebral optically-based near infra-red spectroscopic oximetry applied to patients who have suffered a stroke can help monitor regional cerebral perfusion in real time, and thus “may serve as a useful, noninvasive, bedside intensive care unit monitoring tool to assess brain oxygenation in a direct manner.” The study looked at the device called Fore-Sight from Casmed of Branford, CT, that measures blood oxygen, similar to a finger clip pulse oximeter. The Mayo study results have been published in Journal of Neurosurgery this month.

Regional cerebral blood flow monitoring devices such as Fore-Sight are already in wide deployment in cardiac surgery, where they are thought to prevent brain ischemia in patients undergoing major surgeries on bypass (valve replacements, aortic arch surgeries, etc.).

In the Fore-Sight device, the sensors stick on like adhesive bandages above each of the patient’s eyebrows. The technique, known as near-infrared spectroscopy (NIRS), emits near-infrared light that penetrates the scalp and underlying brain tissue. The Mayo Clinic team set up a study to compare measurements from NIRS with CT perfusion scanning in eight stroke patients.

More from William Freeman, neuro-critical care specialist and associate professor at Mayo Clinic, who was the senior investigator in this project:

About one-third of stroke patients in the hospital suffer another stroke, and we have few options for constantly monitoring patients for such recurrences. This was a small pilot study initiated at Mayo Clinic’s campus in Florida, but we plan to study this device more extensively and hope that this bedside tool offers significant benefit to patients by helping physicians detect strokes earlier and manage recovery better.

Currently, at most hospitals nurses monitor patients for new strokes and, if one is suspected, patients must be moved to a hospital’s radiology unit for a test known as a CT perfusion scan, which is the standard way to measure blood flow and oxygenation.

Although the results show that both tests offer statistically similar results, NIRS has a more limited field for measuring blood oxygen and flow. According to the researchers, this suggests that perhaps not all patients would benefit from this kind of monitoring.

More from the press release: First-of-its-kind Head Patch Monitors Brain Blood Flow and Oxygen

Abstract in Journal of Neurosurgery: Validation of frontal near-infrared spectroscopy as noninvasive bedside monitoring for regional cerebral blood flow in brain-injured patients

Product page: Fore-Sight from Casmed…

Jan Sinnige

Clinical Microbiologist, MD at Red Cross Burn Center Beverwijk, The Netherlands. PhD Candidate in molecular epidemiology of Vancomycin Resistant Enterococcus faecium (VRE). Living in Amsterdam.

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