Real-time evaluation of tissue vitality by monitoring of microcirculatory blood flow, HbO2, and mitochondrial NADH redox state

Monitoring of tissue vitality (oxygen supply/demand) in real time is very rare in clinical practice although its use as an early warning alarming system, for clinical care medicine, is very practical. In our previous communication (SPIE 2003) we described the Tissue Spectroscope - TiSpec02, by which tissue microcirculatory blood flow (TBF) and mitochondrial NADH fluorescence were measured using a single light source (390nm). In order to improve the measurement capabilities as well as to decrease dramatically the size and cost of this clinical device, we have changed the TiSpec02 into a multi-wavelength illumination system in the new TiSpec03. In order to measure microcirculatory blood flow by laser Doppler flowmetry we used a 785nm laser diode. For mitochondrial NADH fluorescence measurement we adopted the 370nm LED. For the determination of the oxygenation level of hemoglobin (HbO2) we used the 2-wavelength reflectance technique. This new monitored parameter that was added to the TiSpec03 increases the accuracy of the diagnosis of tissue vitality. The bundle of optical fibers used to connect the tissue to the TiSpec03, was integrated into a special anchoring methodology depending on the monitored tissue or organ. In order to test the performance of the improved TiSpec we have used it in experimental animals brain models exposed to various pathophysiological conditions. Rats and gerbils were anesthetized and the fiber optic probe was located epidurally used dental acrylic cement. During anoxia and ischemia the lack of O2 led to a clear decrease in TBF and HbO2 while NADH shows a large elevation. When brain activation was induced by cortical spreading depression (SD), the elevated O2 consumption was recorded as a large oxidation (decrease) of mitochondrial NADH while TBF increase dramatically. Blood HbO2 was not affected significantly by the SD wave.