Name: measurement of tissue oxygenation using near-infrared spectroscopy in patients undergoing hemodialysis
Uploaded: 2020-10-02T13:00:00
Description: Watch this Scientific Journal Video about Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis at JoVE.com

Vi takker dialysestabe og medlemmer af afdelingen for nefrologi i Saitama medical center på Jichi Medical University. Vi vil gerne takke Editage (www.editage.com) for engelsksproget redigering.

Alle deltagere gav skriftligt informeret samtykke. Undersøgelsen blev godkendt af Institutional Review Board for Saitama Medical Center, Jichi Medical University, Japan (RIN 15–104).
1. Udstyr til overvågning af rSO2
<ol><li>Forbered en NIRS-enhed til måling af iltning af væv. Denne enhed har fire kanaler og kan udføre måling i op til fire organer på samme tid.</li>
	<li>Forbered en målesensor til NIRS-overvågning for at evaluere rSO2-værdier i hvert organ v...

<ol>
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D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Central+venous+oxygen+saturation+and+thoracic+admittance+during+dialysis:+new+approaches+to+hemodynamic+monitoring.">Central venous oxygen saturation and thoracic admittance during dialysis: new approaches to hemodynamic monitoring.</a> Hemodialysis International. 12 (3), 369-377 (2008).</li><li>Kamijo, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Continuous+monitoring+of+blood+pressure+by+analyzing+the+blood+flow+sound+of+arteriovenous+fistula+in+hemodialysis+patients.">Continuous monitoring of blood pressure by analyzing the blood flow sound of arteriovenous fistula in hemodialysis patients.</a> Clinical and Experimental Nephrology. 22 (3), 677-683 (2018).</li><li>Ito, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Factors+affecting+cerebral+oxygenation+in+hemodialysis+patients:+cerebral+oxygenation+associates+with+pH,+hemodialysis+duration,+serum+albumin+concentration,+and+diabetes+mellitus.">Factors affecting cerebral oxygenation in hemodialysis patients: cerebral oxygenation associates with pH, hemodialysis duration, serum albumin concentration, and diabetes mellitus.</a> PLoS One. 10 (2), 0117474 (2015).</li><li>Imai, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deterioration+of+Hepatic+Oxygenation+Precedes+an+Onset+of+Intradialytic+Hypotension+with+Little+Change+in+Blood+Volume+during+Hemodialysis.">Deterioration of Hepatic Oxygenation Precedes an Onset of Intradialytic Hypotension with Little Change in Blood Volume during Hemodialysis.</a> Blood Purification. 45 (4), 345-346 (2018).</li><li>Cho, A. R., Kwon, J. Y., Kim, C., Hong, J. M., Kang, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+sensor+location+on+regional+cerebral+oxygen+saturation+measured+by+INVOS+5100+in+on-pump+cardiac+surgery.">Effect of sensor location on regional cerebral oxygen saturation measured by INVOS 5100 in on-pump cardiac surgery.</a> Journal of Anesthesia. 31 (2), 178-184 (2017).</li><li>Ito, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deterioration+of+cerebral+oxygenation+by+aortic+arch+calcification+progression+in+patients+undergoing+hemodialysis:+A+cross-sectional+study.">Deterioration of cerebral oxygenation by aortic arch calcification progression in patients undergoing hemodialysis: A cross-sectional study.</a> BioMed Research International. , 2852514 (2017).</li><li>Ito, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Blood+transfusion+during+haemodialysis+improves+systemic+tissue+oxygenation:+A+case+report.">Blood transfusion during haemodialysis improves systemic tissue oxygenation: A case report.</a> Nefrologia. 37 (4), 435-437 (2017).</li><li>Ito, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improvement+of+bilateral+lower-limb+muscle+oxygenation+by+low-density+lipoprotein+apheresis+in+a+patient+with+peripheral+artery+disease+undergoing+hemodialysis.">Improvement of bilateral lower-limb muscle oxygenation by low-density lipoprotein apheresis in a patient with peripheral artery disease undergoing hemodialysis.</a> Nefrologia. 39 (1), 90-92 (2019).</li><li>Kitano, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Changes+in+tissue+oxygenation+in+response+to+sudden+intradialytic+hypotension.">Changes in tissue oxygenation in response to sudden intradialytic hypotension.</a> Journal of Artificial Organs. 23 (2), 187-190 (2020).</li><li>Lemmers, P. 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NIRS-overvågning er hovedsageligt blevet brugt til at evaluere cerebral rSO2, især i kardiovaskulære eller cerebrovaskulære operationer, som kræver ekstrakorporal cirkulation. Under ekstrakorporal cirkulation, herunder HS-terapi, kunne nogle organer vise relativ iskæmi 7,17,18; Det er dog stadig uklart, om iltningen af vævet bliver lav eller ej. Muskelkramper eller mavesmerter under HS kan være et af symptomer...

Nær-infrarød spektroskopi (NIRS) er blevet brugt til at evaluere regional iltmætning (rSO 2), en markør for iltning af væv, især cerebral iltning i forskellige kliniske indstillinger 1,2,3 og er for nylig blevet anvendt på patienter, der gennemgår hæmodialyse (HD)4,5,6,7,8,9,10, 11. Cerebral rSO2 er angiveligt forbundet med kognitiv funktion hos patienter, der gennemgår HS eller patienter med ikke-dialyseret kronisk nyresygdom (CKD)11,12. Indtil videre har brugen af NIRS-overvågning imidlertid været begrænset hos patienter med CKD.
Da NIRS-overvågning er realtidsovervågning og ikke-invasiv, vurderede vi dens anvendelighed som overvågningsenhed hos patienter, der gennemgår HS. Selvom NIRS hovedsageligt bruges til at måle cerebral rSO 2, undersøgte vi også rSO 2-værdier i andre organer under HS. Specifikt blev rSO 2-målesensorerne fastgjort til panden, højre hypokondrium og underbenene for at evaluere rSO 2 i henholdsvis hjernen, leveren og nedre muskler. Resultaterne viste, at NIRS-overvågning kunne være en ny tilgang til at afklare ændringer i organoxygenering under HS eller faktorer, der påvirker iltning af væv hos CKD-patienter.
Til dato er kontinuerlig monitorering blevet udført under HS, overvågning af blodvolumen, central venøs iltmætning, thoraxindlæggelse og elektronisk stetoskopstyret estimeret blodtryk (BP) i kliniske omgivelser13,14,15; Der er dog begrænsninger for forudsigelse af hypotension eller den brede anvendelse af enheder. I modsætning hertil kan den nye ikke-invasive tilgang her give realtidsinformation om intradialytisk iltdynamik i individuelle organer. Derfor kan denne overvågningsmetode gøre det muligt at påvise forbigående organiskæmi i de tidlige faser af intradialytisk hypotension og kan også muliggøre sikker udførelse af HS. Denne artikel beskriver en protokol til måling af vævsoxygenering repræsenteret ved rSO2, som anvendes til patienter, der gennemgår HS.

<table>
	<tbody>
		<tr>
			<td>DBB-100NX</td>
			<td>Nikkiso</td>
			<td>DBB-100NX</td>
			<td>Dialysis machine</td>
		</tr>
		<tr>
			<td>INVOS 5100c</td>
			<td>Covidien Japan</td>
			<td>INVOSTM 5100c</td>
			<td>tissue oxygenation device</td>
		</tr>
		<tr>
			<td>SOMASENSER</td>
			<td>Covidien Japan</td>
			<td>CV-SAFB-SM/INTL</td>
			<td>NIRS sensor</td>
		</tr>
	</tbody>
</table>

measurement of tissue oxygenation using near-infrared spectroscopy in patients undergoing hemodialysis

Nær-infrarød spektroskopi (NIRS) er for nylig blevet anvendt som et værktøj til måling af regional iltmætning (rSO2), en markør for iltning af væv, i kliniske omgivelser, herunder kardiovaskulær og hjernekirurgi, neonatal overvågning og præhospital medicin. NIRS-overvågningsenhederne er realtids- og ikke-invasive og er hovedsageligt blevet brugt til evaluering af cerebral iltning hos kritisk syge patienter under en operation eller intensiv pleje. Indtil videre har brugen af NIRS-overvågning hos patienter med kronisk nyresygdom (CKD), herunder hæmodialyse (HS), været begrænset; Derfor undersøgte vi rSO2-værdier i nogle organer under HS. Vi overvågede rSO 2-værdier ved hjælp af en NIRS-enhed, der transmitterede nær-infrarødt lys ved2 bølgelængder af vedhæftning. HS-patienterne blev placeret i liggende stilling med rSO 2-målesensorer fastgjort til panden, den rigtige hypokondrium og underbenene for at evaluere rSO2 i henholdsvis hjerne-, lever- og underbensmusklerne. NIRS-overvågning kan være en ny tilgang til at afklare ændringer i organoxygenering under HS eller faktorer, der påvirker iltning af væv hos CKD-patienter. Denne artikel beskriver en protokol til måling af vævsoxygenering repræsenteret ved rSO2 som anvendt i HS-patienter.

Cerebrale rSO 2-værdier før HS var lavere end hos raske forsøgspersoner, og cerebral rSO2 hos HS-patienter med diabetes mellitus (DM) var lavere end hos HS-patienter uden DM (figur 1)16. Selvom iltningen af væv fortsætter uden et fald i BP under HS, observerede vi i øvrigt ændringer i cerebral og hepatisk rSO 2 på grund af intradialytisk hypotension (figur 2). På grund af den kontinuerlige overvå...

Watch this Scientific Journal Video about Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis at JoVE.com

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

Vi præsenterer en protokol til måling af regional iltmætning (rSO2) hos hæmodialysepatienter (HS) ved hjælp af en nær-infrarød spektroskopimonitor. rSO2-værdien er et indeks for iltning af væv. Denne ikke-invasive overvågning i realtid kan være nyttig til at bekræfte ændringer i iltning af organer under HS.

Måling af vævsoxygenering ved hjælp af nær-infrarød spektroskopi hos patienter, der gennemgår hæmodialyse

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

Using this method, we can understand oxygen dynamics of organ during hemodialysis. Prior to the development of this protocol, we could not confirm changes in regional oxygen of each organ. This simple technique can evaluate regional oxygen saturation, non-invasive and in real-time.In dialysis patients, such monitoring might detect intradyalitic hypertension or length ischemia dry during HD.This neuro system has been used in several areas. Cardiovascular and cerebrovascular surgery, neonatal, intensive care, and prehospital emergency. We hope this monitoring will be used in other areas in the future.For example, diagnosis of cognitive impairment. Begin by preparing a near-infrared spectroscopy or NIRS device for measuring tissue oxygenation. This device has four channels and can perform measurement in up to four organs at the same time.In addition, prepare measurement sensors for NIRS monitoring to evaluate regional oxygen saturation values in each organ, by a transmitting near-infrared light at two wavelengths of attachment. Allow the patient to rest in a supine position for at least five minutes before hemodialysis. Then attach measurement sensors to the forehead, the right hypochondrium and lower legs to evaluate regional oxygen saturation in the brain, liver, and lower leg muscles, respectively.For cerebral regional oxygen saturation measurement, attach the sensors to the forehead of the dominant hemisphere. For hepatic measurements, measure the depth of the patient's liver from the body surface, and confirm that this measurement is within 20 to 30 millimeters. Next, attach the measurement sensors to the right hypochondrium.To monitor muscle oxygenation, attach measurement sensors to the right or bilateral lower legs. Connect each sensor to the leads from the device. Then, turn on the device and start measuring oxygenation.Puncture the patient's dialysis shunt to start hemodialysis therapy. Measure blood pressure using a digital blood pressure monitor equipped with the dialysis machine, and collect blood samples using syringes. After starting therapy, start monitoring the tissue oxygenation of the three organs.In addition to the usual monitoring performed during hemodialysis, observe changes in regional oxygen saturation values of each organ and measure blood pressure regularly. Confirm the attachment area and connection between the sensors and leads. Cerebral oxygen saturation values of hemodialysis patients before hemodialysis were lower than those of healthy subjects.The saturation values of hemodialysis patients with diabetes mellitus were lower than those in hemodialysis patients without diabetes. Although tissue oxygenation continues without a decrease of blood pressure during hemodialysis, changes in cerebral and hepatic regional oxygen saturation due to intradyalitic hypotension were observed. When attempting this protocol, it is important to compound the location measurement sensors and to apply the sensors'registry.The new system itself is not a new technique. However, the application of this monitoring system to hemodialysis is another and it is very useful to evaluate changes in organ oxygenation during hemodialysis.

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