A whole-cortex fNIRS system to shine light on the problem of post-operative delirium

全皮质 fNIRS 系统可解决术后谵妄问题

• 批准号: 10373814
• 负责人: Audrey Kynsella Bowden
• 金额: $ 19.8万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10373814
• 关键词: Acute; Adhesives; Affect; Age-Years; Anesthesia procedures; Atrial Fibrillation; Awareness; Biological Markers; Brain; Brain region; COVID-19; Cardiac Surgery procedures; Caring; Cerebrovascular Circulation; Cerebrum; Clinical; Clinical assessments; Cognition Disorders; Confusion; Dangerousness; Data; Delirium; Dementia; Devices; Diabetes Mellitus; Disease; Elderly; Electroencephalography; Electronics; Event; Forehead; Functional disorder; Future; Generations; Hair; Head; Health Care Costs; Hospitalization; Human; Image; Immobilization; Incidence; Individual; Intervention; Investigation; Knowledge; Light; Measurement; Measures; Mechanics; Methods; Modeling; Monitor; Morbidity - disease rate; Morphologic artifacts; Motion; Motivation; Movement; Near-Infrared Spectroscopy; Needs Assessment; Neurocognitive; Operating Rooms; Operative Surgical Procedures; Optics; Oxygen saturation measurement; Patients; Perfusion; Perioperative; Physiological; Pilot Projects; Positioning Attribute; Postoperative Period; Predisposition; Prefrontal Cortex; Records; Reperfusion Therapy; Reporting; Research; Resolution; Risk; Scientist; Secure; Serum Albumin; Signal Transduction; Supination; Surgeon; Surgical complication; System; Technology; Testing; Time; Tissues; Training; United States National Institutes of Health; Vacuum; Validity of Results; Variant; Wireless Technology; Work; base; brain dysfunction; brain tissue; cerebral oxygenation; combat; cost; course development; data quality; dementia risk; design; feasibility testing; high risk; human old age (65+); improved; inattention; innovation; neuroimaging; new technology; novel; older patient; patient subsets; perioperative morbidity; postoperative delirium; prevent; real time monitoring; research study; sensor; side effect; tool; usability

PROJECT SUMMARY: For individuals > 60 years of age, the dangers of surgery include more than surgical complications: postoperative delirium (POD) is an established concern with reported incidence rates that exceed 50% for certain surgeries, including cardiac surgery. Nearly 3.9 million elderly patients are at risk for POD due to cardiac surgery alone. The dangerous sequelae associated with POD include increased perioperative morbidity, increased duration of hospitalization and increased risk of dementia, the additional costs of which amount to ~$152 billion. Despite the large number of investigations related to POD, no satisfactory intraoperative biomarkers or preoperative predictors have emerged that can prevent or curtail the dysfunction, exposing a critical gap in our understanding of signs and contributors to the condition. New methods of assessment are needed to guide changes and interventions in surgical procedures that can reduce the incidence of POD. A common shortcoming in research studies on delirium has been the lack of awareness and understanding of neurocognitive changes during surgery. Consequently, such studies are inadequate to identify what aspects of surgery contribute to delirium and to guide changes to surgical procedures that can possibly prevent it. Neuromonitoring during surgery has been largely limited to inconclusive cerebral oximetry and electroencephalography (EEG) studies. Cerebral oximetry lacks perspective of the whole cortex during surgery – missing potentially critical landmarks for delirium biomarkers; EEG studies suffer from low spatial resolution and high susceptibility to signal artifacts. Moreover, current tools are bulky and have unreliable adhesive attachments that imbue susceptibility to motion, mobility limitations, setup difficulty and inconsistency in data quality due to changes in sensor positioning expected during the perioperative workflow. In contrast, functional near infrared spectroscopy (fNIRS)-based perioperative monitoring of the whole cortex would offer better spatial resolution, lower susceptibility to artifacts, and a better view of the brain before, during and after surgery. We propose a novel fNIRS cap for perioperative monitoring to overcome the usability and sensing limitations of current neuroimaging technologies. This cap will improve on our first-generation wireless fNIRS system (Bowden) and leverage the immobilizing features of our novel granular jamming technology (Webster). In Aim 1 we will develop the fNIRS electronics, integrate them with granular jamming and perform mechanical and electrical testing. In Aim 2 we will perform i) a human pilot study to confirm the physiological validity of the results in a mock operating room and ii) a nested intraoperative pilot study (Shah) to confirm the feasibility to detect changes in fNIRS data correlated with the anesthesia care record. If successful, our novel cap will enable more comprehensive study of intraoperative contributors to and indicators of POD and other postoperative cognitive disorders.

项目摘要：对于60岁以上的个人，手术的危险不仅仅包括手术 并发症：术后ir妄（POD）是对事件率的既定关注 某些手术（包括心脏手术）超过50％。将近390万老年患者有风险 仅由于心脏手术而引起的豆荚。与Pod相关的危险后遗症包括增加 围手术期发病率，住院持续时间增加和痴呆风险增加，额外 费用约为1.52亿美元。尽管与POD相关的投资数量大量，但 令人满意的术中生物标志物或术前预测因素已经出现，可以预防或削减 功能障碍，在我们对迹象的理解和贡献者的理解中揭示了一个危险的差距。新的 需要评估方法来指导外科手术程序的变化和干预措施 可以减少POD的事件。 关于ir妄的研究的一个普遍缺点是缺乏意识和 了解手术过程中神经认知的变化。因此，这样的研究不足 确定手术的哪些方面有助于del妄，并指导可以进行外科手术的更改 可能会阻止它。手术期间的神经监测术在很大程度上仅限于不确定的脑血氧饱和度。 和脑电图（EEG）研究。脑血氧仪缺乏整个皮质的视角 手术 - del妄生物标志物缺失潜在的至关重要的地标；脑电图研究的空间低 分辨率和对信号伪像的高敏感性。此外，当前工具是笨重的，不可靠 具有对运动易感性，移动性限制，设置难度和不一致的粘合剂附件 由于周期性工作流程期间预期的传感器定位变化而导致的数据质量。 相比之下，基于整个红外光谱（FNIRS）的功能性周期性监测 皮层将提供更好的空间分辨率，对人工制品的敏感性较低，并且可以更好地看待大脑 手术前，期间和之后。我们提出了一个新颖的FNIRS盖，以定期监测以克服 当前神经影像技术的可用性和灵敏度限制。这个上限将改善我们的 第一代无线FNIRS系统（Bowden）并利用了我们的新颖颗粒的固定特征 干扰技术（Webster）。在AIM 1中，我们将开发FNIRS电子产品，将它们与颗粒状集成在一起 干扰并执行机械和电测试。在AIM 2中，我们将执行i）人类的试点研究 在模拟手术室和ii）嵌套术中飞行员中确认结果的身体有效性 研究（SHAH）确认检测FNIRS数据变化与麻醉护理相关的可行性 记录。如果成功的话，我们的新颖上限将使对术中贡献者的更全面研究和 POD和其他术后认知障碍的指标。