Skip to main content

Advertisement

SpringerLink
Log in

Continuous and entirely non-invasive method for cerebrovascular reactivity assessment: technique and implications

  • Brief Communication
  • Published:
Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

Continuous cerebrovascular reactivity assessment in traumatic brain injury (TBI) has been limited by the need for invasive monitoring of either cerebral physiology or arterial blood pressure (ABP). This restricts the application of continuous measures to the acute phase of care, typically in the intensive care unit. It remains unknown if ongoing impairment of cerebrovascular reactivity occurs in the subacute and long-term phase, and if it drives ongoing morbidity in TBI. We describe an entirely non-invasive method for continuous assessment of cerebrovascular reactivity. We describe the technique for entirely non-invasive continuous assessment of cerebrovascular reactivity utilizing near-infrared spectroscopy (NIRS) and robotic transcranial Doppler (rTCD) technology, with details provided for NIRS. Recent advances in continuous high-frequency non-invasive ABP measurement, combined with NIRS or rTCD, can be employed to derive continuous and entirely non-invasive cerebrovascular reactivity metrics. Such non-invasive measures can be obtained during any aspect of patient care post-TBI, and even during outpatient follow-up, avoiding classical intermittent techniques and costly neuroimaging based metrics obtained only at specialized centers. This combination of technology and signal analytic techniques creates avenues for future investigation of the long-term consequences of cerebrovascular reactivity, integrating high-frequency non-invasive cerebral physiology, neuroimaging, proteomics and clinical phenotype at various stages post-injury.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Czosnyka M, Smielewski P, Kirkpatrick P, Laing RJ, Menon D, Pickard JD. Continuous assessment of the cerebral vasomotor reactivity in head injury. Neurosurgery. 1997;41:11–7.

    Article  CAS  Google Scholar 

  2. Zeiler FA, Donnelly J, Calviello L, Smielewski P, Menon DK, Czosnyka M. Pressure autoregulation measurement techniques in adult traumatic brain injury, part II: a scoping review of continuous methods. J Neurotrauma. 2017;34:3224–377.

    Article  Google Scholar 

  3. Le Roux P, Menon DK, Citerio G, Vespa P, Bader MK, Brophy GM, et al. Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care : a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40:1189–209.

    Article  Google Scholar 

  4. Le Roux P, Menon DK, Citerio G, Vespa P, Bader MK, Brophy G, et al. The International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: evidentiary tables: a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine. Neurocrit Care. 2014;21(Suppl 2):S297–361.

    Article  Google Scholar 

  5. Czosnyka M, Miller C. Participants in the multimodality monitoring monitoring of cerebral autoregulation. Neurocrit Care. 2014;21(Suppl 2):S95–102.

    Article  Google Scholar 

  6. Sorrentino E, Diedler J, Kasprowicz M, Budohoski KP, Haubrich C, Smielewski P, et al. Critical thresholds for cerebrovascular reactivity after traumatic brain injury. Neurocrit Care. 2012;16:258–66.

    Article  CAS  Google Scholar 

  7. Zeiler FA, Donnelly J, Smielewski P, Menon DK, Hutchinson PJ, Czosnyka M. Critical thresholds of intracranial pressure-derived continuous cerebrovascular reactivity indices for outcome prediction in noncraniectomized patients with traumatic brain injury. J Neurotrauma. 2018;35:1107–15.

    Article  Google Scholar 

  8. Donnelly J, Czosnyka M, Adams H, Cardim D, Kolias AG, Zeiler FA, et al. Twenty-five years of intracranial pressure monitoring after severe traumatic brain injury: a retrospective single-center analysis. Neurosurgery. 2019;85:E75–82.

    Article  Google Scholar 

  9. Zeiler FA, Ercole A, Cabeleira M, Zoerle T, Stocchetti N, Menon DK, et al. Univariate comparison of performance of different cerebrovascular reactivity indices for outcome association in adult TBI: a CENTER-TBI study. Acta Neurochir (Wien). 2019;161:1217–27.

    Article  Google Scholar 

  10. Needham E, McFadyen C, Newcombe V, Synnot AJ, Czosnyka M, Menon D. Cerebral perfusion pressure targets individualized to pressure-reactivity index in moderate to severe traumatic brain injury: a systematic review. J Neurotrauma. 2017;34:963–70.

    Article  Google Scholar 

  11. Mutch WAC, Ellis MJ, Ryner LN, Morissette MP, Pries PJ, Dufault B, et al. Longitudinal brain magnetic resonance imaging CO2 stress testing in individual adolescent sports-related concussion patients: a pilot study. Front Neurol. 2016;7:107.

    Article  Google Scholar 

  12. Ellis MJ, Ryner LN, Sobczyk O, Fierstra J, Mikulis DJ, Fisher JA, et al. Neuroimaging assessment of cerebrovascular reactivity in concussion: current concepts, methodological considerations, and review of the literature. Front Neurol. 2016;7:61.

    PubMed  PubMed Central  Google Scholar 

  13. Mutch WAC, Ellis MJ, Ryner LN, McDonald PJ, Morissette MP, Pries P, et al. Patient-specific alterations in CO2 cerebrovascular responsiveness in acute and sub-acute sports-related concussion. Front Neurol. 2018;9:23.

    Article  Google Scholar 

  14. Zeiler FA, Donnelly J, Calviello L, Menon DK, Smielewski P, Czosnyka M. Pressure autoregulation measurement techniques in adult traumatic brain injury, part I: a scoping review of intermittent/semi-intermittent methods. J Neurotrauma. 2017;34:3207–23.

    Article  Google Scholar 

  15. Zweifel C, Castellani G, Czosnyka M, Helmy A, Manktelow A, Carrera E, et al. Noninvasive monitoring of cerebrovascular reactivity with near infrared spectroscopy in head-injured patients. J Neurotrauma. 2010;27:1951–8.

    Article  Google Scholar 

  16. Zeiler FA, Donnelly J, Menon DK, Smielewski P, Zweifel C, Brady K, et al. Continuous autoregulatory indices derived from multi-modal monitoring: each one is not like the other. J Neurotrauma. 2017;34:3070–80.

    Article  Google Scholar 

  17. Budohoski KP, Reinhard M, Aries MJH, Czosnyka Z, Smielewski P, Pickard JD, et al. Monitoring cerebral autoregulation after head injury. Which component of transcranial Doppler flow velocity is optimal? Neurocrit Care. 2012;17:211–8.

    Article  Google Scholar 

  18. Sorrentino E, Budohoski KP, Kasprowicz M, Smielewski P, Matta B, Pickard JD, et al. Critical thresholds for transcranial Doppler indices of cerebral autoregulation in traumatic brain injury. Neurocrit Care. 2011;14:188–93.

    Article  Google Scholar 

  19. Brady KM, Lee JK, Kibler KK, Easley RB, Koehler RC, Shaffner DH. Continuous measurement of autoregulation by spontaneous fluctuations in cerebral perfusion pressure: comparison of 3 methods. Stroke. 2008;39:2531–7.

    Article  Google Scholar 

  20. Zeiler FA, Donnelly J, Calviello L, Lee JK, Smielewski P, Brady K, et al. Validation of pressure reactivity and pulse amplitude indices against the lower limit of autoregulation, part I: experimental intracranial hypertension. J Neurotrauma. 2018;35:2803–11.

    Article  Google Scholar 

  21. Lee JK, Kibler KK, Benni PB, Easley RB, Czosnyka M, Smielewski P, et al. Cerebrovascular reactivity measured by near-infrared spectroscopy. Stroke. 2009;40:1820–6.

    Article  Google Scholar 

  22. Zeiler FA, Cardim D, Donnelly J, Menon DK, Czosnyka M, Smielewski P. Transcranial Doppler systolic flow index and ICP-derived cerebrovascular reactivity indices in traumatic brain injury. J Neurotrauma. 2018;35:314–22.

    Article  Google Scholar 

  23. Zeiler FA, Donnelly J, Cardim D, Menon DK, Smielewski P, Czosnyka M. ICP versus laser Doppler cerebrovascular reactivity indices to assess brain autoregulatory capacity. Neurocrit Care. 2018;28:194–202.

    Article  CAS  Google Scholar 

  24. Zeiler FA, Smielewski P, Donnelly J, Czosnyka M, Menon DK, Ercole A. Estimating pressure reactivity using noninvasive doppler-based systolic flow index. J Neurotrauma. 2018;35:1559–688.

    Article  Google Scholar 

  25. Zeiler FA, Smielewski P, Stevens A, Czosnyka M, Menon DK, Ercole A. Non-invasive pressure reactivity index using Doppler systolic flow parameters: a pilot analysis. J Neurotrauma. 2019;36:713–20.

    Article  Google Scholar 

  26. Zeiler FA, Smielewski P. Application of robotic transcranial Doppler for extended duration recording in moderate/severe traumatic brain injury: first experiences. Crit Ultrasound J. 2018;10:16.

    Article  CAS  Google Scholar 

  27. Zeiler FA, Czosnyka M, Smielewski P. Optimal cerebral perfusion pressure via transcranial Doppler in TBI: application of robotic technology. Acta Neurochir (Wien). 2018;160:2149–57.

    Article  Google Scholar 

  28. Davie SN, Grocott HP. Impact of extracranial contamination on regional cerebral oxygen saturation: a comparison of three cerebral oximetry technologies. Anesthesiology. 2012;116:834–40.

    Article  CAS  Google Scholar 

  29. Schmidt EA, Czosnyka M, Steiner LA, Balestreri M, Smielewski P, Piechnik SK, et al. Asymmetry of pressure autoregulation after traumatic brain injury. J Neurosurg. 2003;99:991–8.

    Article  Google Scholar 

  30. Budohoski KP, Czosnyka M, Kirkpatrick PJ, Smielewski P, Steiner LA, Pickard JD. Clinical relevance of cerebral autoregulation following subarachnoid haemorrhage. Nat Rev Neurol. 2013;9:152–63.

    Article  CAS  Google Scholar 

  31. Budohoski KP, Czosnyka M, Smielewski P, Kasprowicz M, Helmy A, Bulters D, et al. Impairment of cerebral autoregulation predicts delayed cerebral ischemia after subarachnoid hemorrhage: a prospective observational study. Stroke. 2012;43:3230–7.

    Article  Google Scholar 

  32. Budohoski KP, Czosnyka M, Kirkpatrick PJ. The role of monitoring cerebral autoregulation after subarachnoid hemorrhage. Neurosurgery. 2015;62(Suppl 1):180–4.

    Article  Google Scholar 

  33. Budohoski KP, Czosnyka M, Smielewski P, Varsos GV, Kasprowicz M, Brady KM, et al. Cerebral autoregulation after subarachnoid hemorrhage: comparison of three methods. J Cereb Blood Flow Metab. 2013;33:449–56.

    Article  Google Scholar 

  34. Sharma S, Lubrica RJ, Song M, Vandse R, Boling W, Pillai P. The role of transcranial Doppler in cerebral vasospasm: a literature review. Acta Neurochir Suppl. 2020;127:201–5.

    Article  Google Scholar 

  35. Li K, Barras CD, Chandra RV, Kok HK, Maingard JT, Carter NS, et al. A review of the management of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. World Neurosurg. 2019;126:513–27.

    Article  Google Scholar 

  36. Zeiler FA, Ercole A, Beqiri E, Cabeleira M, Thelin EP, Stocchetti N, et al. Association between cerebrovascular reactivity monitoring and mortality is preserved when adjusting for baseline admission characteristics in Adult TBI: A CENTER-TBI Study. J Neurotrauma. 2019. https://doi.org/10.1089/neu.2019.6808.

    Article  PubMed  Google Scholar 

  37. Zeiler FA, Ercole A, Beqiri E, Cabeleira M, Aries M, Zoerle T, et al. Cerebrovascular reactivity is not associated with therapeutic intensity in adult traumatic brain injury: a CENTER-TBI Analysis. Acta Neurochir. 2019;161:1955–64.

    Article  Google Scholar 

  38. Lyons VH, Moore M, Guiney R, Ayyagari RC, Thompson L, Rivara FP, et al. Strategies to address unmet needs and facilitate return to learn guideline adoption following concussion. J Sch Health. 2017;87:416–26.

    Article  Google Scholar 

  39. McLeod TCV, Lewis JH, Whelihan K, Bacon CEW. Rest and return to activity after sport-related concussion: a systematic review of the literature. J Athl Train. 2017;52:262–87.

    Article  Google Scholar 

Download references

Acknowledgements

This work is supported by the National Institutes of Health NIH R03 project grant (R03 NS114335-01), through the National Institute of Neurological Disease and Stroke (NINDS). FAZ is also supported by the University of Manitoba VPRI Research Investment Fund (RIF), University of Manitoba Rudy Falk Clinician-Scientist Professorship, the Health Sciences Centre Foundation (HSCF) Winnipeg.

Author information

Authors and Affiliations

  1. Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    A. Gomez, J. Dian & F. A. Zeiler

  2. Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada

    F. A. Zeiler

  3. Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, Canada

    F. A. Zeiler

  4. Division of Anaesthesia, Department of Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    F. A. Zeiler

Authors
  1. A. Gomez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Dian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. A. Zeiler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. A. Zeiler.

Ethics declarations

Conflict of interest

The authors have no conflict to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gomez, A., Dian, J. & Zeiler, F.A. Continuous and entirely non-invasive method for cerebrovascular reactivity assessment: technique and implications. J Clin Monit Comput 35, 307–315 (2021). https://doi.org/10.1007/s10877-020-00472-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-020-00472-4

Keywords

Search

Navigation