Surveillance Of Driveline Infections By Hyperspectral Imaging : Tool Or Toy ?
Martin Oberhoffer, Angela Kornberger, Hazem El Beyrouti, Andres Beiras Fernandez, Christian Friedrich Vahl.
Department of Cardiothoracic and Vascular Surgery, Mainz, Germany.
Background: Driveline infections are serious complications in patients supported by ventricular assist devices (VAD). Diagnosis is commonly made by visual inspection, blood parameters and wound swabs. Hyperspectral Imaging (HSI) is a noninvasive and fast method of displaying tissue perfusion by obtaining hemoglobin oxygenation (StO2), tissue hemoglobin index(THI), near-infrared perfusion index (NIR) and tissue water index(TWI). Its usefulness in wound assessment has been described. We acquired and analyzed differences in HIS of patients on VAD along non-infected and infected drivelines. Methods: Four patients on VAD support had serial acquisition of HSI along the subcutaneous course of the driveline. In 2 of the patients with uncomplicated wound healing images were obtained 5-12 days after VAD implantation, 2 patients were on ambulatory treatment for previously diagnosed driveline infections. We compared HSI data of the non-infected and infected drivelines regarding differences in StO2,THI, NIR and TWI. Results: HSI data of the patients with non-infected drivelines showed elevated values for StO2 and THI exclusively at the surgical incisional sites, NIR and TWI were not different from the surrounding area along the driveline course. In the patients with driveline infection the acquired images revealed highly increased values for StO2,THI, NIR and TWI along the subcutaneous course and at the driveline exit area. NIR proofed to be the most valuable visible parameter to detect areas of inflammation with the highest values at the site of a fistula. Conclusions: In our group of patients on VAD, images acquired by Hyperspectral Imaging demonstrated clearly differences between non-infected and infected drivelines with regard to StO2,THI, NIR and TWI indicating hypervascularization of infected tissue. HSI provides a fast and easy- to- apply tool in the surveillance of drivelines and has the potential for early detection of infections
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