Real-time Noninvasive Monitoring of Intracranial Fluid Shifts During Dialysis Using Volumetric Integral Phase-Shift Spectroscopy (VIPS): A Proof-of-Concept Study

Background Cerebral edema, which is associated with increased intracranial fluid, is often a complication of many acute neurological conditions. There is currently no accepted method for real-time monitoring of intracranial fluid volume at the bedside. We evaluated a novel noninvasive technique call...

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Vydáno v:Neurocritical care Ročník 28; číslo 1; s. 117 - 126
Hlavní autoři: Venkatasubba Rao, Chethan P., Bershad, Eric M., Calvillo, Eusebia, Maldonado, Nelson, Damani, Rahul, Mandayam, Sreedhar, Suarez, Jose I.
Médium: Journal Article
Jazyk:angličtina
Vydáno: New York Springer US 01.02.2018
Springer Nature B.V
Témata:
Critical Care Medicine
Cytotoxicity
Edema
Hemodialysis
Hemorrhage
Hypertension
Intensive
Internal Medicine
Ischemia
Medicine
Medicine & Public Health
Monitoring systems
Neurology
Original Article
Patients
Spectrum analysis
Stroke
Traumatic brain injury
Vital signs
ESRD
Noninvasive monitoring
Cerebral edema
VIPS
Intracranial fluid shifts
Dialysis dysequillibrium
ISSN:1541-6933, 1556-0961, 1556-0961
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Shrnutí:Background Cerebral edema, which is associated with increased intracranial fluid, is often a complication of many acute neurological conditions. There is currently no accepted method for real-time monitoring of intracranial fluid volume at the bedside. We evaluated a novel noninvasive technique called “Volumetric Integral Phase-shift Spectroscopy (VIPS)” for detecting intracranial fluid shifts during hemodialysis. Methods Subjects receiving scheduled hemodialysis for end-stage renal disease and without a history of major neurological conditions were enrolled. VIPS monitoring was performed during hemodialysis. Serum osmolarity, electrolytes, and cognitive function with mini-mental state examination (MMSE) were assessed. Results Twenty-one monitoring sessions from 14 subjects (4 women), mean group age 50 (SD 12.6), were analyzed. The serum osmolarity decreased by a mean of 6.4 mOsm/L (SD 6.6) from pre- to post-dialysis and correlated with an increase in the VIPS edema index (E-Dex) of 9.7% (SD 12.9) (Pearson’s correlation r  = 0.46, p  = 0.037). Of the individual determinants of serum osmolarity, changes in serum sodium level correlated best with the VIPS edema index (Pearson’s correlation, r  = 0.46, p  = 0.034). MMSE scores did not change from pre- to post-dialysis. Conclusions We detected an increase in the VIPS edema index during hemodialysis that correlated with decreased serum osmolarity, mainly reflected by changes in serum sodium suggesting shifts in intracranial fluids.
Bibliografie:ObjectType-Article-1
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ISSN:1541-6933
1556-0961
1556-0961
DOI:10.1007/s12028-017-0409-4