Head unit: A unique blood supply meter will help save stroke patients
Russian scientists have created a software and hardware complex that has no analogues in the world, capable of monitoring the blood supply to the brain in patients with traumatic brain injuries or strokes in real time. Currently, it takes doctors several hours to process this data, so they cannot take this indicator into account in emergency cases, when time plays a key role in the success of therapy. Thanks to the development, specialists will receive another important indicator of bedside monitoring, which will make treatment more personalized. According to intensive care specialists, now they have to focus only on the general condition of the patient, the new development will increase the efficiency of ambulance care.
A device for measuring pressure in the brain
Specialists from the V.A. Almazov National Medical Research Center and Peter the Great St. Petersburg Polytechnic University have created a device for monitoring blood supply to the brain in real time. The hardware and software complex evaluates the state of cerebral autoregulation (CA), a protective mechanism that maintains stable blood flow in blood vessels even with pressure fluctuations in the body. Previously, it took several hours to calculate this indicator. Thanks to the invention, doctors will be able to adjust treatment in a timely manner, which will help to provide faster care to the most severe patients with stroke or traumatic brain injury.
— In intensive care, the use of a complex for rapid assessment of the state of blood supply to the brain in patients with severe lesions makes it possible to speed up the decision-making process by doctors. This is important for timely correction of pressure in the organ, which is necessary for effective treatment of cerebral edema, secondary ischemia and other pathologies," said Professor Vladimir Semenyutin, Head of the Research Laboratory of Cerebral Circulation Pathology at the Almazov National Research Medical Center of the Ministry of Health of the Russian Federation.
Cerebral autoregulation maintains stable blood flow in the vessels of the brain, despite a decrease or increase in human blood pressure. But it can fail, for example, after a stroke or severe traumatic brain injury. Modern non-invasive methods for assessing autoregulation require post-processing of data, which takes 2-3 hours to collect, transform, and analyze information. In emergency situations, it is important to monitor this indicator in real time in order to record the dynamics of function and effectively monitor the condition of patients.
The principle of operation of the complex is based on monitoring very slow, spontaneous fluctuations in blood pressure and linear blood flow velocity in the middle cerebral arteries. The key indicator is the phase shift, that is, the difference in rhythms between these two "pulses" in a special low—frequency range, the scientists said. The main know-how is special mathematical algorithms that analyze these signals not after, but right during the study. All processing takes place so quickly that the result is displayed on the screen almost instantly.
— The developed complex has demonstrated high efficiency and informative value. It can be used both to diagnose the condition of central nervous system in patients in real time, and to study the mechanisms of regulation of cerebral circulation in healthy people. The proposed algorithms minimize the risk of methodological errors and significantly reduce the time required to obtain information, which is especially important for making urgent decisions," said Galina Malykhina, professor at the Graduate School of Computer Technology and Information Systems at the Institute of Computer Science and Cybersecurity at St. Petersburg State University.
Improving the efficiency of the ambulance service
Today, dozens of indicators are monitored in intensive care units in real time: blood pressure, pulse, blood oxygen saturation, and intracranial pressure. However, the adequacy of the blood supply to the brain remained "behind the scenes" due to the difficulty of its instant assessment, the developers said. The new complex is integrated into this system and provides doctors with a reliable tool for personalized management of cerebral perfusion pressure (the difference between blood pressure in blood vessels and pressure in organ tissues). This will allow, for example, to select drugs to increase or decrease blood pressure not according to average standards, but according to accurate data on how the vessels of a particular patient protect his brain at a given moment, they stressed.
As Sergey Senchukov, an emergency room resuscitator, told Izvestia, now the indicators of cerebral autoregulation are not taken into account in any way when providing emergency support, since they cannot be measured. Doctors can only monitor the general condition of the patient. If doctors have a tool for monitoring this indicator, it will significantly increase the effectiveness of treatment.
— Such a device would help in the work of doctors, but for an unambiguous assessment it is necessary to test it in practice, — said Sergey Senchukov.
The new development will overcome the fundamental limitations of all existing non—invasive approaches - the time lag for analysis, says Alexander Zakharov, director of the Research Institute of Neuroscience at SamSMU of the Russian Ministry of Health, an expert at the NTI Center based at SamSMU and the NTI Helsnet market. Algorithms transform the CA assessment from a research methodology into a full-fledged clinical bedside monitoring tool.
— It is difficult to overestimate the prospects of introducing this technology into clinical practice. It opens the era of personalized pathogenetically based management of cerebral blood supply in critical neurological and neurosurgical patients. The doctor gets the opportunity, not empirically, but on the basis of objective physiological data, to select and adjust therapy in real time. This is a qualitatively new level of neuro—intensive care," said the doctor.
Determining the viability and safety of the mechanisms of autoregulation of cerebral blood flow in strokes, traumatic brain injuries and other severe cerebral lesions is an important task for assessing the condition of patients, the effectiveness of therapy and predicting the outcomes of the acute period of the disease. The doctor needs to receive data about this parameter in real time. The development opens up new opportunities for diagnosing the condition of patients and preventing the development of complications, says Marina Petrova, Deputy Director for Scientific and Clinical Activities at the FNCC RR, Head of the Department of Anesthesiology and Intensive Care with a course of medical rehabilitation at the RUDN University Medical Institute.
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