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Ambulant monitoring of bladder oxygenation and hemodynamics using wireless near-infrared spectroscopy.

ABSTRACT: INTRODUCTION:Near-infrared spectroscopy (NIRS) non-invasively detects changes in the concentration of the chromophores oxygenated (?O2Hb) and deoxygenated hemoglobin (?HHb) as the bladder detrusor muscle contracts during voiding. Such data provide novel information on bladder oxygenation and hemodynamics. We evaluated the feasibility of monitoring ambulant subjects using a wireless NIRS device. METHODS:The wireless device uses paired light-emitting diodes (wavelengths 760 and 850 nm) and a silicon photodiode detector. We monitored 14 asymptomatic subjects (10 adults, 4 children) and 6 symptomatic children with non-neurogenic lower urinary tract dysfunction (NLUTD) during spontaneous voiding after natural filling. The device was taped to the abdominal skin 2 cm above the symphysis pubis across the midline. The wireless NIRS data (patterns of change in chromophore concentration) were compared between subjects and to the data obtained using a laser-powered instrument. RESULTS:Graphs of ?O2Hb, ?HHb and total hemoglobin (?tHb) were obtained from all 20 patients. Data during uroflow showed reproducible patterns of bladder chromophore change between asymptomatic subjects (rise in ?tHb/?O2Hb), consistent with laser instrument data. In contrast, all 6 symptomatic children had a negative trend in ?tHb, with falls in ?O2Hb. One adult experienced "shy" bladder and changes in hemodynamics/oxygenation occurred while bladder volume was unchanged. CONCLUSIONS:Wireless NIRS bladder monitoring is feasible in ambulant adults and children; wireless and laser-derived data in asymptomatic subjects are comparable. Pilot data suggest that subjects with symptomatic NLUTD have impaired bladder oxygenation/hemodynamics. The fact that chromophore changes occur when bladder volume remains constant supports the concept that NIRS data are a physiologic measure.

SUBMITTER: Macnab AJ

PROVIDER: S-EPMC3650823 | biostudies-other | 2013 Jan-Feb

REPOSITORIES: biostudies-other

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Ambulant monitoring of bladder oxygenation and hemodynamics using wireless near-infrared spectroscopy.

Macnab Andrew John AJ Shadgan Babak B Stothers Lynn L Afshar Kourosh K

Canadian Urological Association journal = Journal de l'Association des urologues du Canada 20130101 1-2

<h4>Introduction</h4>Near-infrared spectroscopy (NIRS) non-invasively detects changes in the concentration of the chromophores oxygenated (ΔO2Hb) and deoxygenated hemoglobin (ΔHHb) as the bladder detrusor muscle contracts during voiding. Such data provide novel information on bladder oxygenation and hemodynamics. We evaluated the feasibility of monitoring ambulant subjects using a wireless NIRS device.<h4>Methods</h4>The wireless device uses paired light-emitting diodes (wavelengths 760 and 850 ...[more]

PMID: 23671516

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Project description:Although being the golden standard for intrapartum fetal surveillance, cardiotocography (CTG) has been shown to have poor specificity for detecting fetal acidosis. Non-invasive near-infrared-spectroscopy (NIRS) monitoring of placental oxygenation during labour has not been studied yet. The objective of the study was to determine whether changes in placental NIRS values during labour could identify intrapartum fetal hypoxia and resulting acidosis. We included 43 healthy women in active stage of labour at term. CTG and NIRS parameters in groups with vs. without neonatal umbilical artery pH ? 7.20 were compared using Mann-Whitney-U. Receiver-operating-characteristics (ROC) curves were used to estimate predictive value of CTG and NIRS parameters for neonatal pH ? 7.20. A computer-based statistical classification was also performed to further evaluate predictive values of CTG and NIRS for neonatal acidosis. Ten (23%) neonates were born with umbilical artery pH ? 7.20. Compared to group with pH > 7.20, fetal acidosis was associated with more episodes of placental NIRS deoxygenation (9 (range 2-37) vs. 2 (range 0-65); p<0.001), higher velocity of placental NIRS deoxygenation (2.31 (range 0-22) vs. 1 (range 0-49) %/s; p = 0.03), more decelerations on CTG (25 (range 3-91) vs. 10 (range 10-60); p = 0.02), and more prolonged decelerations on CTG (2 (range 0-4) vs. 1 (range 0-3); p = 0.04). Number of placental deoxygenations had the highest prognostic value for fetal/neonatal acidosis (area under the ROC curve 0.85 (95% confidence interval 0.70-0.99). Computer-based classification also identified number of placental deoxygenations as the most accurate classifier, with 25% false positive and 93% true positive rate in the training dataset, with 100% accuracy when applied to the testing dataset. Placental deoxygenations during labour measured by NIRS are associated with fetal/neonatal acidosis. Predictive value of placental NIRS for neonatal acidosis was superior to that of CTG.

Dataset Information

Ambulant monitoring of bladder oxygenation and hemodynamics using wireless near-infrared spectroscopy.

Publications

Ambulant monitoring of bladder oxygenation and hemodynamics using wireless near-infrared spectroscopy.

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