RESUMO
Background: Post thyroidectomy hemorrhage is a potentially life-threatening complication. As the mechanism leading to hypoxemic brain damage and death is still unknown, our aim was to examine the underlaying pathophysiology in an animal model. Methods: A series of experiments was performed in our established model for post thyroidectomy hemorrhage in 6 pigs. First, post thyroidectomy hemorrhage was simulated with an artificial increase of cervical compartment pressure. Second, spontaneous bleeding into the cervical compartment was initiated. Primary outcome measure is the correlation between cerebral oxygenation and cervical compartment pressure. Results: With an increase in cervical compartment pressure apnea could be detected in all experiments. A significant 24.2% (9.5-34.4%) decrease of cerebral oxygenation at time of apnea (47.0%; 38.0-65.0%) compared to baseline values (63.5%; 56.0-74.0%; P=0.043) occurred due increase of cervical compartment pressure concurrent with an impaired cerebral perfusion. Apnea occurred about 200 sec after a 10% decrease of cerebral oxygenation, but 35 sec before a 10% decrease of peripheral oxygenation. Spontaneous bleeding into the cervical compartment causes an increase of cervical compartment pressure reaching levels of the mean arterial blood pressure 56.0 (35.0-72.0) mmHg. Conclusions: Peripheral hypoxemia occurs with relevant delay in time after decrease of cerebral perfusion and cerebral hypoxemia, therefore cerebral hypoxemia seems to be causal for a central apnea. With this evidence of impaired cerebral perfusion and cerebral hypoxemia due to an increased cervical compartment pressure we can disprove the historic theory of tracheal collapse due to a compressive hematoma in post thyroidectomy hemorrhage. A cervical compartment syndrome seems to be causal, not only for brain hypoxemia but also an additional laryngo-pharyngeal mucosal edema.
RESUMO
Joint applications of virtual reality (VR) systems and electroencephalography (EEG) offer numerous new possibilities ranging from behavioral science to therapy. VR systems allow for highly controlled experimental environments, while EEG offers a non-invasive window to brain activity with a millisecond-ranged temporal resolution. However, EEG measurements are highly susceptible to electromagnetic (EM) noise and the influence of EM noise of head-mounted-displays (HMDs) on EEG signal quality has not been conclusively investigated. In this paper, we propose a structured approach to test HMDs for EM noise potentially harmful to EEG measures. The approach verifies the impact of HMDs on the frequency- and time-domain of the EEG signal recorded in healthy subjects. The verification task includes a comparison of conditions with and without an HMD during (i) an eyes-open vs. eyes-closed task, and (ii) with respect to the sensory- evoked brain activity. The approach is developed and tested to derive potential effects of two commercial HMDs, the Oculus Rift and the HTC Vive Pro, on the quality of 64-channel EEG measurements. The results show that the HMDs consistently introduce artifacts, especially at the line hum of 50 Hz and the HMD refresh rate of 90 Hz, respectively, and their harmonics. The frequency range that is typically most important in non-invasive EEG research and applications (<50 Hz) however, remained largely unaffected. Hence, our findings demonstrate that high-quality EEG recordings, at least in the frequency range up to 50 Hz, can be obtained with the two tested HMDs. However, the number of commercially available HMDs is constantly rising. We strongly suggest to thoroughly test such devices upfront since each HMD will most likely have its own EM footprint and this article provides a structured approach to implement such tests with arbitrary devices.
