Neurocritical Care

, Volume 28, Issue 1, pp 117–126 | Cite as

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

  • Chethan P. Venkatasubba Rao
  • Eric M. Bershad
  • Eusebia Calvillo
  • Nelson Maldonado
  • Rahul Damani
  • Sreedhar Mandayam
  • Jose I. Suarez
Original Article



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.


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.


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.


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.


Noninvasive monitoring Cerebral edema Dialysis dysequillibrium ESRD VIPS Intracranial fluid shifts 



Dr. Venkatasubba Rao received funding from Cerebrotech Medical Systems for this investigator initiated study.

Supplementary material

12028_2017_409_MOESM1_ESM.jpg (484 kb)
Supplement Fig. 1a Cerebrotech Monitoring System: CMS 4000. Version lacking the external connecting cables (JPEG 484 kb)
12028_2017_409_MOESM2_ESM.jpg (2.4 mb)
Supplement Fig. 1b Cerenbrotech Monitoring System: CMS 5000. Improvised system with advanced head frame (JPEG 2453 kb)


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Chethan P. Venkatasubba Rao
    • 1
  • Eric M. Bershad
    • 1
  • Eusebia Calvillo
    • 1
  • Nelson Maldonado
    • 1
  • Rahul Damani
    • 1
  • Sreedhar Mandayam
    • 2
  • Jose I. Suarez
    • 1
  1. 1.Department of Neurology, Section of Vascular Neurology and Neurocritical CareBaylor College of MedicineHoustonUSA
  2. 2.Department of NephrologyBaylor College of MedicineHoustonUSA

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