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Near-Infrared Spectroscopy can Monitor Dynamic Cerebral Autoregulation in Adults

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Abstract

Objective

To study the correlation between a dynamic index of cerebral autoregulation assessed with blood flow velocity (FV) using transcranial Doppler, and a tissue oxygenation index (TOI) recorded with near-infrared spectroscopy (NIRS).

Methods

Twenty-three patients with sepsis, severe sepsis, or septic shock were monitored daily on up to four consecutive days. FV, TOI, and mean arterial blood pressure (ABP) were recorded for 60 min every day. An index of autoregulation (Mx) was calculated as the moving correlation coefficient between 10-s averaged values of FV and ABP over moving 5 min time-windows. The index Tox was evaluated as the correlation coefficient between TOI and ABP in the same way. The indices Mx and Tox, ABP and arterial partial pressure of CO2 were averaged for each patient.

Results

Synchronized slow waves, presenting with periods from 20 s to 2 min, were seen in the TOI and FV of most patients, with a reasonable coherence between the signals in this bandwidth (coherence >0.5). The indices, Mx and Tox, demonstrated good correlation with each other (R = 0.81; P < 0.0001) in the whole group of patients. Both indices showed a significant (P < 0.05) tendency to indicate weaker autoregulation in the state of vasodilatation associated with greater values of arterial partial pressure of CO2 or lower values of ABP.

Conclusion

NIRS shows promise for the continuous assessment of cerebral autoregulation in adults.

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Abbreviations

ABP:

Mean arterial blood pressure

CBF:

Cerebral blood flow

FV:

Mean blood flow velocity

Mx:

Mean flow velocity index of dynamic autoregulation

NIRS:

Near-infrared spectroscopy

PaCO2 :

Arterial blood partial pressure of carbon dioxide

TCD:

Transcranial Doppler

TOI:

Tissue oxygenation index

Tox:

Tissue oxygenation index of dynamic autoregulation

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Acknowledgments

We thank Allison Dwileski for assistance in preparation of this manuscript.

Competing Interests

The ICM+ software (www.neurosurg.cam.ac.uk/icmplus) used for data recording and analysis is licensed by Cambridge Enterprise Ltd, Cambridge, UK. PS and MC have an interest in a part of the licensing fee.

Funding

This project was funded exclusively by the Society for Research in Anaesthesia and Critical Care Medicine of the Department of Anaesthesia, University Hospital Basel, Switzerland.

Author information

Authors and Affiliations

  1. Department of Anaesthesia, University Hospital Basel, CH-4031, Basel, Switzerland

    Luzius A. Steiner, David Pfister & Stephan P. Strebel

  2. Academic Neurosurgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    Danila Radolovich, Peter Smielewski & Marek Czosnyka

  3. Department of Anaesthesia, University of Pavia, Pavia, Italy

    Danila Radolovich

Authors
  1. Luzius A. Steiner
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  2. David Pfister
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  3. Stephan P. Strebel
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  4. Danila Radolovich
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  6. Marek Czosnyka
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Correspondence to Luzius A. Steiner.

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Steiner, L.A., Pfister, D., Strebel, S.P. et al. Near-Infrared Spectroscopy can Monitor Dynamic Cerebral Autoregulation in Adults. Neurocrit Care 10, 122–128 (2009). https://doi.org/10.1007/s12028-008-9140-5

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  • DOI: https://doi.org/10.1007/s12028-008-9140-5

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