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 岁以上的个体，手术的危险不仅仅包括手术 并发症：术后谵妄（POD）是一个已确定的问题，报告的发病率 超过 50% 的某些手术，包括心脏手术，有近 390 万老年患者面临手术风险。 单独因心脏手术引起的 POD 与 POD 相关的危险后遗症包括增加。 围手术期发病率、住院时间增加和痴呆风险增加， 尽管进行了大量与 POD 相关的调查，但其成本高达约 1520 亿美元。 令人满意的术中生物标志物或术前预测因子已经出现，可以预防或治愈 功能障碍，暴露出我们对这种情况的症状和影响因素的理解存在严重差距。 需要评估方法来指导外科手术的改变和干预 可减少POD的发生。 对谵妄的研究的一个常见缺陷是缺乏认识和认识 但此类研究不足以了解手术期间的神经认知变化。 确定手术的哪些方面会导致谵妄，并指导改变手术程序 手术期间的神经监测很大程度上限于不确定的脑血氧饱和度。 和脑电图 (EEG) 研究缺乏整个皮层的视角。 手术——脑电图研究缺乏潜在的关键标志物； 此外，当前的工具体积庞大且不可靠。 粘性附件易受运动、移动性限制、安装困难和不一致的影响 由于围手术期工作流程中预期传感器定位的变化，数据质量会受到影响。 相比之下，基于功能近红外光谱 (fNIRS) 的围术期整体监测 皮质将提供更好的空间分辨率、更低的伪影敏感性以及更好的大脑视图 我们提出了一种新型 fNIRS 帽，用于围术期监测以克服这一问题。 当前神经影像技术的可用性和传感局限性将改善我们的能力。 第一代无线 fNIRS 系统 (Bowden) 并利用我们新型颗粒的固定功能 干扰技术（Webster） 在目标 1 中，我们将开发 fNIRS 电子设备，并将其与颗粒集成。 在目标 2 中，我们将进行 i) 人类试点研究。 确认模拟手术室结果的生理有效性和 ii) 嵌套术中飞行员 研究 (Shah) 确认检测与麻醉护理相关的 fNIRS 数据变化的可行性 如果成功，我们的新颖上限将能够对术中贡献者进行更全面的研究。 POD 和其他术后认知障碍指标。