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Non-invasive Monitoring of Dynamic Cerebrovascular Autoregulation Using Near Infrared Spectroscopy and the Finometer Photoplethysmograph

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Abstract

Background

Near infrared spectroscopy (NIRS) enables continuous monitoring of dynamic cerebrovascular autoregulation, but this methodology relies on invasive blood pressure monitoring (iABP). We evaluated the agreement between a NIRS based autoregulation index calculated from invasive blood pressure monitoring, and an entirely non-invasively derived autoregulation index from continuous non-invasive blood pressure monitoring (nABP) using the Finometer photoplethysmograph.

Methods

Autoregulation was calculated as the moving correlation coefficient between iABP and rSO2 (iTOx) or nABP and rSO2 (nTOx). The blood pressure range where autoregulation is optimal was also determined for invasive (iABPOPT) and non-invasive blood pressure measurements (nABPOPT).

Results

102 simultaneous bilateral measurements of iTOx and nTOx were performed in 19 patients (median 2 per patient, range 1–9) with different acute pathologies (sepsis, cardiac arrest, head injury, stroke). Average iTOx was 0.01 ± 0.13 and nTOx was 0.01 ± 0.11. The correlation between iTOx and nTOx was r = 0.87, p < 0.001, 95 % agreement ± 0.12, bias = 0.005. The interhemispheric asymmetry of autoregulation was similarly assessed with iTOx and nTOx (r = 0.81, p < 0.001). Correlation between iABPOPT and nABPOPT was r = 0.47, p = 0.003, 95 % agreement ± 32.1 mmHg, bias = 5.8 mmHg. Coherence in the low frequency spectrum between iABP and nABP was 0.86 ± 0.08 and gain was 1.32 ± 0.77.

Conclusions

The results suggest that dynamic cerebrovascular autoregulation can be continuously assessed entirely non-invasively using nTOx. This allows for autoregulation assessment using spontaneous blood pressure fluctuations in conditions where iABP is not routinely monitored. The nABPOPT might deviate from iABPOPT, likely because of discordance between absolute nABP and iABP readings.

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References

  1. Steiner LA, Czosnyka M, Piechnik SK, Smielewski P, Chatfield D, Menon DK, et al. Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med. 2002;30:733–8.

    Article  PubMed  Google Scholar 

  2. Aries MJH, Czosnyka M, Budohoski KP, Steiner LA, Lavinio A, Kolias AG, et al. Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit Care Med. 2012;40:2456–63.

    Article  PubMed  Google Scholar 

  3. Jaeger M, Dengl M, Meixensberger J, Schuhmann MU. Effects of cerebrovascular pressure reactivity-guided optimization of cerebral perfusion pressure on brain tissue oxygenation after traumatic brain injury. Crit Care Med. 2010;38:1343–7.

    Article  PubMed  Google Scholar 

  4. Steiner LA, Pfister D, Strebel SP, Radolovich D, Smielewski P, Czosnyka M. Near-infrared spectroscopy can monitor dynamic cerebral autoregulation in adults. Neurocrit Care. 2008;10:122–8.

    Article  PubMed  Google Scholar 

  5. Brady K, Joshi B, Zweifel C, Smielewski P, Czosnyka M, Easley RB, et al. Real-time continuous monitoring of cerebral blood flow autoregulation using near-infrared spectroscopy in patients undergoing cardiopulmonary bypass. Stroke. 2010;41:1951–6.

    Article  PubMed  Google Scholar 

  6. Smielewski P, Czosnyka M, Steiner L, Belestri M, Piechnik S, Pickard JD. ICM+: software for on-line analysis of bedside monitoring data after severe head trauma. Acta Neurochir Suppl. 2005;95:43–9.

    Article  CAS  PubMed  Google Scholar 

  7. Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8:135–60.

    Article  CAS  PubMed  Google Scholar 

  8. 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  PubMed  Google Scholar 

  9. Lavinio A, Schmidt EA, Haubrich C, Smielewski P, Pickard JD, Czosnyka M. Noninvasive evaluation of dynamic cerebrovascular autoregulation using finapres plethysmograph and transcranial doppler. Stroke. 2007;38:402–4.

    Article  PubMed  Google Scholar 

  10. Diedler J, Zweifel C, Budohoski KP, Kasprowicz M, Sorrentino E, Haubrich C, et al. The limitations of near-infrared spectroscopy to assess cerebrovascular reactivity. Anesth Analg. 2011;113:849–57.

    Article  PubMed  Google Scholar 

  11. Brady KM, Easley RB, Kibler K, Kaczka DW, Andropoulos D, Fraser CD, et al. Positive end-expiratory pressure oscillation facilitates brain vascular reactivity monitoring. J Appl Physiol. 2012;113:1362–8.

    Article  PubMed  Google Scholar 

  12. Pfister D, Siegemund M, Dell-Kuster S, Smielewski P, Rüegg S, Strebel SP, et al. Cerebral perfusion in sepsis-associated delirium. Crit Care. 2008;12:R63.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Diedler J, Sykora M, Rupp A, Poli S, Karpel-Massler G, Sakowitz O, et al. Impaired cerebral vasomotor activity in spontaneous intracerebral hemorrhage. Stroke. 2009;40:815–9.

    Article  PubMed  Google Scholar 

  14. Reinhard M, Roth M, Guschlbauer B, Harloff A, Timmer J, Czosnyka M, et al. Dynamic cerebral autoregulation in acute ischemic stroke assessed from spontaneous blood pressure fluctuations. Stroke. 2005;36:1684–9.

    Article  CAS  PubMed  Google Scholar 

  15. 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  PubMed  Google Scholar 

  16. Lazaridis C, Smielewski P, Steiner LA, Brady KM, Hutchinson P, Pickard JD, et al. Optimal cerebral perfusion pressure: are we ready for it? Neurol Res. 2013;35:138–48.

    Article  PubMed  Google Scholar 

  17. Rasulo F, Girardini A, Lavinio A, De Peri E, Stefini R, Cenzato M, et al. Are optimal cerebral perfusion pressure and cerebrovascular autoregulation related to long-term outcome in patients with aneurysmal subarachnoid hemorrhage? J Neurosurg Anesthesiol. 2012;24:3–8.

    Article  PubMed  Google Scholar 

  18. Diedler J, Santos E, Poli S, Sykora M. Optimal cerebral perfusion pressure in patients with intracerebral hemorrhage: an observational case series. Crit Care. 2014;18:R51.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Laflam A, Joshi B, Brady K, Yenokyan G, Brown C, Everett A, et al. Shoulder surgery in the beach chair position is associated with diminished cerebral autoregulation but no differences in postoperative cognition or brain injury biomarker levels compared with supine positioning. Anesth Analg. 2015;120:176–85.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

We thankfully acknowledge the support and cooperation of the nursing staff of the intensive care unit at Liverpool Hospital, NSW, Australia. We thank Dr Philip Lewis, BAppSc, PhD, for advice with the transfer function analysis. This study was supported by an infrastructure grant from the University of New South Wales, Australia.

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    Authors and Affiliations

    1. University of New South Wales, South Western Sydney Clinical School, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia

      Jessica Bindra, Paul Pham, Anders Aneman, Alwin Chuan & Matthias Jaeger

    2. Department of Intensive Care Medicine, Liverpool Hospital, Liverpool, NSW, Australia

      Anders Aneman

    3. Department of Anaesthesia, Liverpool Hospital, Liverpool, NSW, Australia

      Alwin Chuan

    4. Department of Neurosurgery, Wollongong Hospital, Wollongong, NSW, Australia

      Matthias Jaeger

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    1. Jessica Bindra
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    2. Paul Pham
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    3. Anders Aneman
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    5. Matthias Jaeger
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    Correspondence to Matthias Jaeger.

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    The authors declare they have no conflict of interest.

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    J. Bindra and P. Pham contributed equally to this work.

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    Bindra, J., Pham, P., Aneman, A. et al. Non-invasive Monitoring of Dynamic Cerebrovascular Autoregulation Using Near Infrared Spectroscopy and the Finometer Photoplethysmograph. Neurocrit Care 24, 442–447 (2016). https://doi.org/10.1007/s12028-015-0200-3

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    • DOI: https://doi.org/10.1007/s12028-015-0200-3

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