measurement-tissue-oxygenation-using-near-infrared-spectroscopy

Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis

Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in ...

Jichi Medical University

Together with Nikkiso in Shizuoka, Japan, we developed a new method for measuring the rate of vascular access recirculation by the blood volume monitor. This measurement is performed via a method of dilution that employs a marker produced by rapid ultrafiltration using a dialysis machine. In this paper, we evaluate the reliability and safety of this machine, in vitro and in vivo. The safety of this method was evaluated by investigating hemolysis after rapid ultrafiltration. The measurement of free hemoglobin, potassium and haptoglobin in the circulating blood were performed before and after rapid ultrafiltration. No data was found to indicate hemolysis in vivo, detected by an increase in potassium or a decrease in haptoglobin. Evaluation of reliability in an experimental system was also performed on an in vitro recirculation system at a rate of 0, 10, 25, 50, and 70%. Almost all of the measured rates were within ± 10% of the theoretical rate. We performed 20 hemodialysis experiments with vascular access recirculation applying this monitor and simultaneous urea and creatinine dilution methods, which were the recommended standard measurements for vascular recirculation. In 53 measurements of standard vascular shunts with no postural change, differences of the results between the monitor and both dilution methods were only 4.0% and 3.2%, respectively. Regression analysis showed a significant and positive correlation between them (P < 0.0001). We conclude that this new method for measuring vascular access recirculation is applicable in terms of both accuracy and ease of operation.

Evaluation of a new method for measuring vascular access recirculation.

Hemodialysis (HD) patients frequently suffer from severe anemia caused by various hemorrhagic disorders in addition to renal anemia. Intradialytic blood transfusion is sometimes performed; however, the cerebral oxygenation changes associated with this procedure remain unclear.

Changes in Cerebral Oxygenation Associated with Intradialytic Blood Transfusion in Patients with Severe Anemia Undergoing Hemodialysis.

Blood transfusion during haemodialysis improves systemic tissue oxygenation: A case report.

Near-infrared spectroscopy has been used to measure regional saturation of oxygen (rSO) based on the total hemoglobin (t-Hb) signal strength. To date, few studies have investigated the changes of systemic oxygenation and t-Hb signal strength during hemodialysis (HD). This study aimed to (1) monitor rSO and t-Hb signal strength in the brain, liver, and lower-limb muscle during HD and (2) clarify the differences in rSO and t-Hb signal strength in each compartment. Fifty-three patients receiving 4-h HD were included and divided into three groups according to the compartments in which tissue oxygenation was measured as follows: brain (n = 44), liver (n = 42), and lower-limb muscle (n = 40). The rSO and t-Hb signal strength was monitored using an INVOS 5100c (Covidien Japan, Tokyo, Japan). The rSO levels were significantly lower in the brain than in the liver from HD initiation to the end (HD initiation: rSO in the brain and liver, 46.5 ± 1.3 and 52.4 ± 1.7%, respectively, p = 0.031). Furthermore, compared to the t-Hb signal strength ratio [value at t (min) during HD/initial value before HD] in the brain during HD, there were significant increases in the liver and lower-limb muscle, respectively. In conclusion, deterioration of cerebral oxygenation was remarkable compared to the hepatic oxygenation in HD patients. Our results, which revealed significant differences among the t-Hb signal strength ratios in the brain, liver, and lower-limb muscle during HD, might reflect the non-uniform body-fluid reduction within systemic tissues induced by ultrafiltration.

Differences in tissue oxygenation and changes in total hemoglobin signal strength in the brain, liver, and lower-limb muscle during hemodialysis.

Near-infrared spectroscopy revealed that the regional saturation of oxygen (rSO) in cerebral tissue is lower in hemodialysis (HD) patients than in healthy subjects. However, no study has examined the changes in cerebral oxygenation by aortic arch calcification (AAC) progression in HD patients.

Deterioration of Cerebral Oxygenation by Aortic Arch Calcification Progression in Patients Undergoing Hemodialysis: A Cross-Sectional Study.

Improvement of bilateral lower-limb muscle oxygenation by low-density lipoprotein apheresis in a patient with peripheral artery disease undergoing hemodialysis.

Hemodialysis (HD) patients frequently experience severe anemia, requiring intradialytic blood transfusion. Severe anemia leads to deterioration of systemic tissue oxygenation. However, few reports have examined the effect of intradialytic blood transfusion on tissue oxygenation changes. This study aimed to (i) monitor the differences in tissue oxygenation in the brain and liver during intradialytic blood transfusion, and (ii) elucidate the clinical factors affecting cerebral and hepatic oxygenation. Thirty-eight HD patients with severe anemia requiring intradialytic blood transfusion were included (27 men, 11 women; mean age, 70.2 ± 1.6 years). Cerebral and hepatic regional oxygen saturation (rSO) values were monitored using near-infrared spectroscopy (INVOS 5100c oxygen saturation monitor). Cerebral and hepatic rSO were significantly higher after than before blood transfusion (p < 0.001, both). Furthermore, hepatic rSO was significantly higher than cerebral rSO after transfusion (p = 0.004). In multivariable linear regression analysis, cerebral rSO changes were independently associated with the natural logarithm of hemoglobin (Hb) ratio (Hb after/before transfusion) (standardized coefficient: 0.367, p = 0.023), whereas hepatic rSO changes were independently associated with the natural logarithm of [Hb ratio/colloid osmotic pressure ratio (colloid osmotic pressure after/before transfusion)] (standardized coefficient: 0.378, p = 0.019). In conclusion, throughout intradialytic blood transfusion, brain and liver tissue oxygenation improved. Hepatic rSO was significantly higher than cerebral rSO at the end of HD. Furthermore, cerebral oxygenation changes were associated with only transfusion-induced Hb increase, whereas hepatic oxygenation changes were associated with both transfusion-induced Hb increase (positive changes) and ultrafiltration-induced colloid osmotic pressure increase (negative changes).

Differences in cerebral and hepatic oxygenation in response to intradialytic blood transfusion in patients undergoing hemodialysis.

Endotoxin contamination of dialysate has serious adverse effects on patients undergoing hemodialysis. Therefore, endotoxin activity in dialysate is closely monitored. Limulus amebocyte lysate (LAL) has been used as a reagent to measure endotoxin activity. Here, we investigated the efficacy of an automatic LAL kinetic turbidimetric test (Toxinometer ET-mini) for screening endotoxin activity in dialysate.

Utility Of An Automatic Limulus Amebocyte Lysate Kinetic Turbidimetric Test For Endotoxin Screening Of Dialysate Samples.

A 76-year-old woman on hemodialysis (HD) for diabetic nephropathy was admitted to our hospital with occasional intradialytic hypotension (IDH). We continuously monitored the regional oxygen saturation (rSO) in the brain, liver, and lower limb muscle during HD. The time course of changes in rSO ratios in each region was evaluated throughout HD. The rSO ratio was defined as the ratio of rSO value at t (min) during HD to the rSO value before HD. During the early phase of HD, blood pressure (BP) gradually decreased and both hepatic and lower limb muscle rSO ratios decreased with changes in BP, whereas the cerebral rSO ratio was relatively maintained. At around 90 min after HD initiation, the BP decreased to 71/46 mmHg (mean BP, 54 mmHg) and the previously maintained cerebral rSO ratio also suddenly decreased. Soon after the onset of IDH, ultrafiltration was stopped, normal saline was infused, and intravenous noradrenaline infusion was started. After the BP recovered, cerebral and hepatic rSO ratios improved, but the lower limb muscle rSO ratio remained low. After restarting ultrafiltration, improvement in the lower limb muscle rSO ratio was delayed, although cerebral and hepatic oxygenation were maintained. This observation aids in our understanding of the effect of IDH on regional tissue oxygenation.

Changes in tissue oxygenation in response to sudden intradialytic hypotension.

A 71-year-old man undergoing hemodialysis (HD) was admitted to our hospital with congestive heart failure (CHF) and pneumonia. After admission, ultrafiltration with HD was urgently performed because of a lack of respiratory improvement despite the use of noninvasive positive pressure ventilation. During HD, cerebral regional saturation of oxygen (rSO) was monitored by INVOS 5100c oxygen saturation monitor (Covidien Japan, Japan) to evaluate changes in tissue oxygenation. At HD initiation, cerebral rSO was very low at 34% under the fraction of inspiratory oxygen (FiO) of 0.4. Ultrafiltration was performed at the rate of 0.5 L/h thereafter, cerebral rSO gradually improved even as inhaling oxygen concentration decreased. At the end of HD, cerebral rSO improved at 40% under a FiO of 0.28 as excess body fluid was removed. After pneumonia and CHF improved, he was discharged. Reports of the association between cerebral oxygenation and acute CHF status in patients undergoing HD are limited; therefore, in our experience with this case, cerebral oxygenation deteriorated with the CHF status but was improved by adequate body-fluid management during HD.

Continuous monitoring of changes in cerebral oxygenation during hemodialysis in a patient with acute congestive heart failure.

Near-infrared spectroscopy has been used to measure the regional oxygen saturation (rSO) of the brain, and decreases in cerebral rSO have been reported to lead to cognitive impairment in patients undergoing hemodialysis. However, reports about the association between changes in cerebral oxygenation and clinical parameters at hemodialysis initiation, including hemoglobin level, are lacking.

Cerebral oxygenation improvement is associated with hemoglobin increase after hemodialysis initiation.

Hemoglobin (Hb) is associated with cerebral oxygenation status owing to its important role of carrying oxygen to systemic tissues. However, data concerning the associations between Hb levels and cerebral regional oxygen saturation (rSO2) of hemodialysis (HD) patients is limited. We aimed to identify these associations to consider a target Hb level for renal anemia management. This study included 375 HD patients. Cerebral rSO2 before HD was monitored using the INVOS 5100c oxygen saturation monitor. Multivariable linear regression analysis showed that cerebral rSO2 was independently associated with natural logarithm (Ln)-HD duration (standardized coefficient: -0.36), mean blood pressure (standardized coefficient: 0.13), pH (standardized coefficient: -0.10), serum albumin (standardized coefficient: 0.14), presence of diabetes mellitus (standardized coefficient: -0.20), and Hb level (standardized coefficient: 0.29). Furthermore, a generalized linear model with restricted cubic spline function was used to investigate the non-linear association between cerebral rSO2 and Hb levels. In the multivariable analysis for the adjustment with Ln-HD duration, mean blood pressure, pH, serum albumin, and presence of diabetes mellitus, a linear relationship was demonstrated between the two variables (p for linearity = 0.79). Hb levels revealed the positive and significant association with cerebral rSO2 in this study. Moreover, the relationship between cerebral rSO2 and Hb level was proven to be linear. Therefore, the target Hb level in renal anemia management would be considered to be the upper limits for the appropriate management of renal anemia by previous guidelines and position statement from the viewpoint of maintaining cerebral oxygenation in HD patients.

Article	Year
Evaluation of a new method for measuring vascular access recirculation. Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy\| PubMed ID: 21624084	2011
Changes in Cerebral Oxygenation Associated with Intradialytic Blood Transfusion in Patients with Severe Anemia Undergoing Hemodialysis. Nephron extra\| PubMed ID: 28559914	2017
Blood transfusion during haemodialysis improves systemic tissue oxygenation: A case report. Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia\| PubMed ID: 28750878	2017
Differences in tissue oxygenation and changes in total hemoglobin signal strength in the brain, liver, and lower-limb muscle during hemodialysis. Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs\| PubMed ID: 28785828	2018
Deterioration of Cerebral Oxygenation by Aortic Arch Calcification Progression in Patients Undergoing Hemodialysis: A Cross-Sectional Study. BioMed research international\| PubMed ID: 29109958	2017
Improvement of bilateral lower-limb muscle oxygenation by low-density lipoprotein apheresis in a patient with peripheral artery disease undergoing hemodialysis. Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia\| PubMed ID: 29422296	2019
Differences in cerebral and hepatic oxygenation in response to intradialytic blood transfusion in patients undergoing hemodialysis. Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs\| PubMed ID: 31342286	2019
Utility Of An Automatic Limulus Amebocyte Lysate Kinetic Turbidimetric Test For Endotoxin Screening Of Dialysate Samples. Medical devices (Auckland, N.Z.)\| PubMed ID: 31632161	2019
Changes in tissue oxygenation in response to sudden intradialytic hypotension. Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs\| PubMed ID: 31760517	2020
Continuous monitoring of changes in cerebral oxygenation during hemodialysis in a patient with acute congestive heart failure. Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs\| PubMed ID: 31858302	2019
Cerebral oxygenation improvement is associated with hemoglobin increase after hemodialysis initiation. The International journal of artificial organs\| PubMed ID: 32141374	2020
Associations of cerebral oxygenation with hemoglobin levels evaluated by near-infrared spectroscopy in hemodialysis patients. PloS one\| PubMed ID: 32776946	2020

Takayuki Uchida

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