Neurophysiological and paraspinal oximetry monitoring to detect spinal cord ischemia in patients during and after descending aortic repair: An international multicenter explorative study

Oostveen, Cheryl N.; Weerwind, Patrick W.; Bergs, Paul P.E.; Schmidli, Jürg; Bühlmann, Roman; Schefold, Joerg C.; Eberle, Balthasar; Consiglio, Jolanda; Schälte, Gereon; Kotelis, Drosos; Hollands, Angelique W.H.; Buhre, Wolfgang F.F.A.; Schurink, Geert Willem H.; Jacobs, Michael J.; van Mook, Walther N.K.A.; Mess, Werner H.; Sutedja, Nadia A. (2020). Neurophysiological and paraspinal oximetry monitoring to detect spinal cord ischemia in patients during and after descending aortic repair: An international multicenter explorative study. Contemporary clinical trials communications, 17(100545), p. 100545. Elsevier 10.1016/j.conctc.2020.100545

[img]
Preview
Text
Neurophysiological and paraspinal oximetry monitoring to detect spinal cord ischemia in patients during and after descending aortic repair an international multicenter explorative study.pdf - Published Version
Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND).

Download (525kB) | Preview

Background: During descending aortic repair, critically decreased blood flow to the myelum can result in ischemic spinal cord injury and transient or permanent paraplegia. Assessment of motor evoked potentials (MEPs) has been shown to be a valuable tool which allows to detect spinal cord ischemia (SCI) intraoperatively within a therapeutic window suitable to prevent progression to paraparesis or paraplegia. MEP monitoring is not feasible during postoperative care in the awakening patient. Therefore, ancillary techniques to monitor integrity of spinal cord function are needed to detect delayed spinal cord ischemia. Objective: The purpose of this study is to evaluate whether assessment of long loop reflexes (LLR; F-waves) and paraspinal muscle oximetry using Near-Infrared Spectroscopy (NIRS) are feasible and valid in detecting delayed SCI. Methods: We aim to include patients from three tertiary referral centers undergoing aortic repair with MEP monitoring in this study.F-wave measurements and paraspinal NIRS oximetry will be operated intra- and postoperatively. Measurement characteristics and feasibility will be assessed in the first 25 patients. Subsequently, a second cohort of 75 patients will be investigated to determine the sensitivity and specificity of F-waves and NIRS in detecting perioperative SCI. In this context for the MEP group SCI is defined intraoperatively as significant MEP changes and postoperatively as newly developed paraplegia. Conclusions: A clinical study design and protocol is proposed to assess if F-waves and/or NIRS-based paraspinal oximetry are feasible and valid in detecting and monitoring for occurrences of delayed SCI.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Schmidli, Jürg; Bühlmann, Roman; Schefold, Jörg Christian; Eberle, Balthasar and Consiglio, Jolanda

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2451-8654

Publisher:

Elsevier

Language:

English

Submitter:

Claudia Stalder

Date Deposited:

29 Apr 2020 11:27

Last Modified:

03 May 2020 02:41

Publisher DOI:

10.1016/j.conctc.2020.100545

PubMed ID:

32181411

BORIS DOI:

10.7892/boris.143452

URI:

https://boris.unibe.ch/id/eprint/143452

Actions (login required)

Edit item Edit item
Provide Feedback