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

Neurocritical Care volume 28, pages 117–126 (2018)Cite this article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

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

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Authors and Affiliations

  1. Department of Neurology, Section of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, One Baylor Plaza, MS, NB 122, Houston, TX, 77030, USA

    Chethan P. Venkatasubba Rao, Eric M. Bershad, Eusebia Calvillo, Nelson Maldonado, Rahul Damani & Jose I. Suarez

  2. Department of Nephrology, Baylor College of Medicine, Houston, TX, USA

    Sreedhar Mandayam

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  1. Chethan P. Venkatasubba Rao
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Correspondence to Chethan P. Venkatasubba Rao.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplement Fig. 1a

Cerebrotech Monitoring System: CMS 4000. Version lacking the external connecting cables (JPEG 484 kb)

Supplement Fig. 1b

Cerenbrotech Monitoring System: CMS 5000. Improvised system with advanced head frame (JPEG 2453 kb)

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Venkatasubba Rao, C.P., Bershad, E.M., Calvillo, E. et al. Real-time Noninvasive Monitoring of Intracranial Fluid Shifts During Dialysis Using Volumetric Integral Phase-Shift Spectroscopy (VIPS): A Proof-of-Concept Study. Neurocrit Care 28, 117–126 (2018). https://doi.org/10.1007/s12028-017-0409-4

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Keywords

  • Noninvasive monitoring
  • Cerebral edema
  • Dialysis dysequillibrium
  • ESRD
  • VIPS
  • Intracranial fluid shifts