Key Technologies• Laser Spectroscopy
• White Light Spectrometry
• Glas Fibre Technology
• Optical Sensors (worldwide patents)
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Title
Determination of oxygenmetabolism in tissues by combinedwhite light spectrometry and laserspectroscopy – an overview aboutmethod and study results.
O2C (oxygen to see)• Laser- and White-light spectroscopy• contineuous monitoring of• blood flow (capillary microcirculation)• venular oxygen saturation (hypoxia)• capillar-venular filling with blood
(venous congestion)• 50 ms measurement time• depth selectiv (e.g. skin,
muscle, bone) 100 µm - 15 mm
• No imagesDisadvantages
Schematicpath ofphotons intissue
White lightWhite lightFlow
VelocityVelocity
020406080
500 540 580 620
I
λ
SO2
relHb
Changed in color and intensity
Tissue
Blood vessels
Changed in frequency (f2=f1+∆f )
Erythrocytes
Fibre probe
f1 f2
Laser-light Colored light
LightScattering onMitochondria
Tissue Spectroscopy and -SpectrometryLaser-light
0
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Tiss
ue p
O2
[mm
Hg]
0
20
40
60
80
100
SO2
[%],
Blo
odvo
lum
e [%
]
Arteriole Capillaries Venule
11 % 16 % 73 %
exponential pO2 Gradients
linear Haemoglobin Saturation (SO2)
Lethal CornerLast meadow
3 % physically solved oxygen
1,8 %
1,5 %
1,2 %
Measurementarea pO2electrode
Measurementarea O2C
(oxygen to see)
Comparison: tcpO2 and O2C
The Impact of O2C for the Quantification of Tissue Ischemia inDiabetic Foot Ulcers (Diabetes Care, Vol. 27, Dec. 2004)
• Patient lying on his back• Start of measurement after 10 minutes rest• Definition of constant measurement t ime• Opsite®-Film between wound and probe• Same applicat ion pressure of the probe by fixat ion of theprobe with Opsite®-Film of constant size• No movement of the extremities during measurement
S. Beckert, A. Königsrainer, M. Witte, S. CoerperUniversitätsklinikum Tübingen, Klinik für Allgemeine Chirurgie
Fig. 2: Probe Application
“The O2C is a reliable and valid method, for theasscessment of tissue microperfusion.Measurements are easy to perform and not timeconsuming. Results are acccurate .. . detectclinical ly relevant ischemia earlier, predict thefuture healing process and choose appropriatetreatment schedule”
0
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SO2 rHb Flow Velocity
SO2
[%],
rHb
[AU
], Fl
ow[A
U],
Velo
city
[AU
]
70
50
70
150
35
50
2015
heal
er
heal
er
heal
er
heal
er
non-
heal
e r
non-
heal
er
n-h
n-h
diabetes patient, tcpO2 < 30 mmHg,
nonpalpable peripheral pulse, grad I ulcers,
measures at the wound site, significant at all parameters
Amputation level assessment using lightguidespectrophotometry
Prosthet Orthot Int 1995 Dec;19(3):139-47Amputation level assessment using lightguidespectrophotometry.Harrison DK, McCollum PT, Newton DJ, Hickman P,Jain AS
Investigation sheme on the lower leg,• 10 locations on a circle and
• 10 locations in a row
Critirea for ampuation due to insufficient woundhealing• Mean value smaller than 30% in SO2and• Lowest values below 10% SO2 more than 3 out of20 values.
The combination of these criteria gave asensitivity and selectivity of 1.0 for prediction ofa successful outcome of transtibial amputations.
Parameters of Microcirculation and Healing Time of BurnWounds
The groups marked by � are showing a significant reduction(p<0,05) of flow and velocity values compared to the othergroups. The haemoglobin concentration and oxygensaturation of the operated group were significant lower to thegroup with 2-3 weeks healing. Neither flow, velocity, Hbconcentration nor oxygen saturation were showingsignificant changes between the measurements on the firstand the third day after burn.
On 15 patient 86 burn wounds were examined. Thewounds were clinically evaluated and examined additionallywith the O2C (LEA Medizintechnik GmbH). Themeasurements were conducted within 24 hours and 3 daysafter the day of burn. The wounds were divided into 4groups (healing time 1-2 weeks, 2-3 weeks, >3 weeks andoperated wounds).
M.Pfau, K.Merz, H.O.Rennekampff,H.E.SchallerKlinik für Hand-, Plastische-, Rekonstruktive- undVerbrennungschirurgie der BG-Unfallklinik Tübingen an derEberhard-Karls-Universität Tübingen
Healing Time vs Flow(<24 h after burn)
1-2 Weeks operated0
50
100
150
200
250
300
350
400
rela
tive
Flow
[Uni
ts]
�
�
2-3 Weeks > 3 Weeks
P2P1
7th day after burnClear healing tendency on P1, delayed healing on P2
“Retrospective analysis shows a correlation betweenhealing time and flow and velocity.
B. Brell, B. Temmesfeld-Wollbrück, et. Al. Department ofInternal Medicine/ Infection Diseases, University Medicine
Berlin, GermanyCrit. Care Med. 2005 Vol. 33, No.4 pp 819-826
Adrenomedullin reduces Staphylococcus aureus α-toxin-induced rat ileum microcirculatory damage
Meausures in mucosashow good correlationbetween perfusionpressure (SMA-Pressure)andmucosal oxygensaturation SO2(mHbO2) measured byO2C Measures on mucosa
show good correlatonbetween
• amout of hemoglobinrel.Hbcon
and• gain in weight of the
gut
-> (venous congestion,edema)
Increase microvascular permeability and perfusion mismatch arehallmarks of sepis and spetical shock
Oxygen Saturation of mucosa of stomach inhealthy persons (A) and patients with sepsis (B) taken from
(10) recorded by O2C(oxygen to see)
(10) Am J Respir Crit Care Med 1998 May;157(5 t 1):1586-92 Abnormalities of gastric mucosal oxygenation in septic shock: artial responsiveness to
dopexamine.Temmesfeld-Wollbruck B, Szalay A, Mayer K, Olschewski H, Seeger W, Grimminger F.
AGE-reiche Mahlzeit (HAGE): 15.100 kU AGEgebacken/gebraten - 220ºC, 20 Min
AGE-arme Mahlzeit (LAGE): 2750 kU AGEgekocht/gedünstet - 100ºC, 10 Min
Methoden:
Postprandiale Dysfunktion der Mikrozirkulation nach einer Mahlzeitreich an Advanced Glycation Endproducts (AGE) bei Patienten mitTyp 2 Diabetes mellitus - protektive Rolle von Benfotiamin
Postprandiale Veränderung der RH HAGE undLAGE
4,8
1,5
2,2
4,4
3,1
3,8
0
1
2
3
4
5
6
0 2 6Zeit [h]
Rea
ktiv
e H
yper
amie
(RH
) Quo
tient
des
Blu
tflus
ses
HAGELAGE
Postprandiale Veränderung der RH, HAGE und HAGWE-Benfo
3,4
1,4 1,4
3
1,9
3,2
0
0,5
1
1,5
2
2,5
3
3,5
4
0 2 6Zeit [h]
Rea
ktiv
e H
yper
oxie
(RH
) Quo
tient
des
Blu
tflus
ses
HAGEHAGE+Benfo
Stirban A., et. al.; Bad Oeynhausen,Poster, 40. Jahrestagung DDG, Berlin 5/2005
• Eine AGE-reiche, Mahlzeit führt zueinem signifikanten Abfall derGefäßfunktion der Mikrozirkulation(O2C oxygen to see), der mindestens 6Stunden anhält und ausgeprägter ist alsnach einer AGE-armen Mahlzeit• Benfotiamin kann diesen negativenEffekt reduzieren
MYOCARDIAL MICROCIRCULATION DURING ISCHEMICPRECONDITIONING IN OFF-PUMP BYPASS SURGERY
Tissue SO2 increased going from the first to the thirdocclusion from 75±11% to 83±8% (p<0.001). rHb as a markerof postcapillary venous haemoglobin concentration increasedsignificantly (77±8 vs. 85±6, p=0.002). Superficial and deepmyocardial blood flow decreased significantly (317±17 vs.308±36, p <0.001; 402±56 vs. 350±50, p < 0.001;respectively).
Methods: 21 patients (14 males) scheduled for OPCABwere enrolled in the study. Intraoperatively, the LAD wasoccluded for 2 min followed by a 2 min reperfusion interval.The procedure was repeated three times.
A. Lichtenberg, K. Knobloch, M. Pichlmaier,St. Ringes-Lichtenberg, H. Mertsching, U. Klima, A.HaverichThoracic and Cardiovascular SurgeryMedizinische Hochschule Hannover, Germany
0
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base
line
first is
chem
ia2n
d isc
hemia
3rd is
chem
ia
SO2[
%]
SO2
“Oxygen-to-see system is capable ofdetecting myocardial microcirculation invivo real time.
30
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90 100 110 120 130 140 150 160 170 180NADH fluorescence (aU)
Sinu
soid
al h
emog
lobi
n O
2 sat
urat
ion
(%)
y = 116.05 - 0.44 xr2 = 0.94p < 0.005
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90
0 50 100 150 200 250 300 350 400 450
Sinu
soid
al h
emog
lobi
n O
2 sat
urat
ion
(%)
y = 71.037 - 0.0729 xr2 = 0.867p < 0.001
Lethal hepatocyte injury (PI-labeled nuclei / 10-1 mm3)
C. Wunder, R. Brock, A. Krug, N. Roewer,O. EichelbrönnerAnesthesiology, University of Würzburg, GermanyDepartment of Pharmacology & Toxicology,University of Arkansas, USA
Conclusions
Remission spectroscopy (O2C)represents a simple and reliable methodfor hepatic sinosoidal SO2determination. Significant reduction in hepatic SO2during early stages of systemicinflammation in parallel an increasing NAD(P)Hautofluorescence (=inadequate oxygensupply)
in parallel an increasing marker of liver
A remission spectroscopy system for in vivo monitoring ofhemoglobin oxygen saturation in murine hepatic sinusoids, in early
systemic inflammation (Comparative Hepatology 2005, 4:1 doi:10.1186/1476-5926-4-1)
O2C (oxygen to see) Monitoringon mouth mucosa during
bypass surgery
•Stop of HLM (8 sec.)
•Bolus of NO
•Spreading of thorax
O2C Sonde an Mundmukosa, Teilausschnitt des Zeitverlaufs während NO-Bolusgabe
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17:19:03 17:20:42 17:22:22 17:24:01 17:25:41 17:27:23 17:29:03 17:30:43 Time [hh:mm:ss]
SO2
[%],
rHb
[AU
],
0
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Blo
odFl
ow [A
U]
SO2 P1SrHb P1SMarkFlow P1S
O2C Sonde an Mundmukosa, Teilausschnitt des Zeitverlaufs während Maschinenstopp
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18:25:51 18:27:30 18:29:12 18:30:52 18:32:32Time [hh:mm:ss]
SO2
[%],
rHb
[AU
],
0
50
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250
Bloo
dFlo
w [A
U]
SO2 P1SrHb P1SMarkFlow P1S
Aorta
auf
, Mam
mar
ia a
nnae
hen
gekl
emm
t
Mas
chin
e lä
uft w
iede
r
Mas
chin
e st
eht
O2C Sonde an Mundmukosa, Teilausschnitt des Zeitverlaufs während Spreizung des Thorax
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6 :37 :1 26 :38 :5 36 :40 :3 26 :42 :1 26 :43 :5 26 :45 :3 16 :47 :1 26 :48 :5 26 :50 :3 26 :52 :1 26 :53 :5 26 :55 :3 26 :57 :1 26 :58 :5 47 :00 :3 27 :02 :1 37 :03 :5 37 :05 :3 47 :07 :1 37 :08 :5 37 :10 :3 37 :12 :1 37 :13 :5 37 :15 :3 27 :17 :1 47 :18 :5 4
Ti [hh ]
SO2
[%],
rHb
[AU]
,
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Bloo
dFlo
w [A
U]
SO2 P1SrHb P1SMarkFlow P1S
Thor
axsp
reiz
ung
Thor
axsp
reiz
ung
,
Thor
axs p
reiz
ung
Thor
axer
öffn
ung
O2C (oxygen to see) probe in rectum,Bad Oeynhausen,
Patient on HLM, Hypothermia 30 C
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13:33:11 13:46:30 13:59:50 14:13:10 14:26:31 14:39:50 14:53:11 15:06:33 15:19:52 Time [hh:mm:ss]
SO2
[%],
rHb
[AU]
,
0
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800
Bloo
dFlo
w [A
U]
MarkSO2 P1SrHb P1SFlow P1S50 Per. Gleitender Durchschnitt (Flow P1S)50 Per. Gleitender Durchschnitt (SO2 P1S)50 Per. Gleitender Durchschnitt (rHb P1S)
an H
LM u
nd A
orta
zu
OP
End
e
Byp
ass
End
e
Aor
ta o
ffen
aufw
ärm
en
Her
z st
eht
Influence of haemorrhagicshock on fracture healingM. Bumann, T. Henke, H.Gerngross, L. Claes, P. Augat,Department of OrthopaedicResearch and Biomechanics, UniUlm, GermanyLangenbecks Arch Surg. 2003,Oct.,388(5):331-8.
Measurement at the level offracture (tibia), 1cmdistal/proximal and soft tissuewith O2C(oxygen to see)Shock group with volumeresuscitationControl group without
Shock group with volumesubstituion has no reduction inblood flow in the distal andsoft tissue regionsandshows a better fracture healingoutcome.
Flexural rigidity
shock group control group
shock group control group
4 x in fractured bones
3 x in fractured bones
Failure load
Tibia
Muscle
Skin
w/o
hai
r
Acral skin (no hair)
Skeletal muscle
Mouth mucosa
Stomach mucosa
Inte
stin
e muc
osa
Rect
al m
ucos
a
Brain
Myocard
Liver
KidneysSple
enSer
osa
Mus
cula
ris
Lungs
Monitoring of regional cirulatory system- on a functional basis
Bone
Probetypes- Flat probes for skin and muscle (e.g 2 and 8 mm depth)- Muscle probe 15 mm depth- Micro-probes 0.8 mm and 2.3 mm diameter- Redong probe for buried flapsand transplants (monitoring)
Thank you
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