Continuous Time-Domain Analysis of Cerebrovascular Autoregulation Using Near-Infrared Spectroscopy
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- 1 October 2007
- journal article
- research article
- Published by Wolters Kluwer Health in Stroke
- Vol. 38 (10), 2818-2825
- https://doi.org/10.1161/strokeaha.107.485706
Abstract
Background and Purpose— Assessment of autoregulation in the time domain is a promising monitoring method for actively optimizating cerebral perfusion pressure (CPP) in critically ill patients. The ability to detect loss of autoregulatory vasoreactivity to spontaneous fluctuations in CPP was tested with a new time-domain method that used near-infrared spectroscopic measurements of tissue oxyhemoglobin saturation in an infant animal model. Methods— Piglets were made progressively hypotensive over 4 to 5 hours by inflation of a balloon catheter in the inferior vena cava, and the breakpoint of autoregulation was determined using laser-Doppler flowmetry. The cerebral oximetry index (COx) was determined as a moving linear correlation coefficient between CPP and INVOS cerebral oximeter waveforms during 300-second periods. A laser-Doppler derived time-domain analysis of spontaneous autoregulation with the same parameters (LDx) was also determined. Results— An increase in the correlation coefficient between cerebral oximetry values and dynamic CPP fluctuations, indicative of a pressure-passive relationship, occurred when CPP was below the steady state autoregulatory breakpoint. This COx had 92% sensitivity (73% to 99%) and 63% specificity (48% to 76%) for detecting loss of autoregulation attributable to hypotension when COx was above a threshold of 0.36. The area under the receiver-operator characteristics curve for the COx was 0.89. COx correlated with LDx when values were sorted and averaged according to the CPP at which they were obtained (r=0.67). Conclusions— The COx is sensitive for loss of autoregulation attributable to hypotension and is a promising monitoring tool for determining optimal CPP for patients with acute brain injury.Keywords
This publication has 22 references indexed in Scilit:
- Impaired Cerebral Autoregulation and 6-Month Outcome in Children with Severe Traumatic Brain Injury: Preliminary FindingsDevelopmental Neuroscience, 2006
- Continuous assessment of cerebrovascular autoregulation after traumatic brain injury using brain tissue oxygen pressure reactivity*Critical Care Medicine, 2006
- Predictive value of initial computerized tomography scan, intracranial pressure, and state of autoregulation in patients with traumatic brain injuryJournal of Neurosurgery, 2006
- Tissue oxygen reactivity and cerebral autoregulation after severe traumatic brain injury*Critical Care Medicine, 2003
- Nitric oxide, prostaglandins, and impaired cerebral blood flow autoregulation in group B streptococcal neonatal meningitisCanadian Journal of Physiology and Pharmacology, 2000
- Neonatal cerebral oxygen regulation after hypothermic cardiopulmonary bypass and circulatory arrestCritical Care Medicine, 2000
- Monitoring of autoregulation using laser Doppler flowmetry in patients with head injuryJournal of Neurosurgery, 1997
- Monitoring of Cerebral Autoregulation in Head-Injured PatientsStroke, 1996
- Cerebral blood flow and metabolism in severely head-injured childrenJournal of Neurosurgery, 1989
- Cerebral autoregulation dynamics in humans.Stroke, 1989