BACKGROUND: Individualizing mean arterial blood pressure (MAP) based on cerebral blood flow (CBF) autoregulation monitoring during cardiopulmonary bypass (CPB) holds promise as a strategy to optimize organ perfusion. The purpose of this study was to evaluate the accuracy of cerebral autoregulation monitoring using microcirculatory flow measured with innovative ultrasound-tagged near-infrared spectroscopy (UT-NIRS) noninvasive technology compared with transcranial Doppler (TCD). METHODS: Sixty-four patients undergoing CPB were monitored with TCD and UT-NIRS (CerOx™). The mean velocity index (Mx) was calculated as a moving, linear correlation coefficient between slow waves of TCD-measured CBF velocity and MAP. The cerebral flow velocity index (CFVx) was calculated as a similar coefficient between slow waves of cerebral flow index measured using UT-NIRS and MAP. When MAP is outside the autoregulation range, Mx is progressively more positive. Optimal blood pressure was defined as the MAP with the lowest Mx and CFVx. The right- and left-sided optimal MAP values were averaged to define the individual optimal MAP and were the variables used for analysis. RESULTS: The Mx for the left side was 0.31 ± 0.17 and for the right side was 0.32 ± 0.17. The mean CFVx for the left side was 0.33 ± 0.19 and for the right side was 0.35 ± 0.19. Time-averaged Mx and CFVx during CPB had a statistically significant "among-subject" correlation (r = 0.39; 95% confidence interval [CI], 0.22-0.53; P < 0.001) but had only a modest agreement within subjects (bias 0.03 ± 0.20; 95% prediction interval for the difference between Mx and CFVx, -0.37 to 0.42). The MAP with the lowest Mx and CFVx ("optimal blood pressure") was correlated (r = 0.71; 95% CI, 0.56-0.81; P < 0.0001) and was in modest within-subject agreement (bias -2.85 ± 8.54; 95% limits of agreement for MAP predicted by Mx and CFVx, -19.60 to 13.89). Coherence between ipsilateral middle CBF velocity and cerebral flow index values averaged 0.61 ± 0.07 (95% CI, 0.59-0.63). CONCLUSIONS: There was a statistically significant correlation and agreement between CBF autoregulation monitored by CerOx compared with TCD-based Mx.
BACKGROUND: Individualizing mean arterial blood pressure (MAP) based on cerebral blood flow (CBF) autoregulation monitoring during cardiopulmonary bypass (CPB) holds promise as a strategy to optimize organ perfusion. The purpose of this study was to evaluate the accuracy of cerebral autoregulation monitoring using microcirculatory flow measured with innovative ultrasound-tagged near-infrared spectroscopy (UT-NIRS) noninvasive technology compared with transcranial Doppler (TCD). METHODS: Sixty-four patients undergoing CPB were monitored with TCD and UT-NIRS (CerOx™). The mean velocity index (Mx) was calculated as a moving, linear correlation coefficient between slow waves of TCD-measured CBF velocity and MAP. The cerebral flow velocity index (CFVx) was calculated as a similar coefficient between slow waves of cerebral flow index measured using UT-NIRS and MAP. When MAP is outside the autoregulation range, Mx is progressively more positive. Optimal blood pressure was defined as the MAP with the lowest Mx and CFVx. The right- and left-sided optimal MAP values were averaged to define the individual optimal MAP and were the variables used for analysis. RESULTS: The Mx for the left side was 0.31 ± 0.17 and for the right side was 0.32 ± 0.17. The mean CFVx for the left side was 0.33 ± 0.19 and for the right side was 0.35 ± 0.19. Time-averaged Mx and CFVx during CPB had a statistically significant "among-subject" correlation (r = 0.39; 95% confidence interval [CI], 0.22-0.53; P < 0.001) but had only a modest agreement within subjects (bias 0.03 ± 0.20; 95% prediction interval for the difference between Mx and CFVx, -0.37 to 0.42). The MAP with the lowest Mx and CFVx ("optimal blood pressure") was correlated (r = 0.71; 95% CI, 0.56-0.81; P < 0.0001) and was in modest within-subject agreement (bias -2.85 ± 8.54; 95% limits of agreement for MAP predicted by Mx and CFVx, -19.60 to 13.89). Coherence between ipsilateral middle CBF velocity and cerebral flow index values averaged 0.61 ± 0.07 (95% CI, 0.59-0.63). CONCLUSIONS: There was a statistically significant correlation and agreement between CBF autoregulation monitored by CerOx compared with TCD-based Mx.
Authors: Henrik W Schytz; Song Guo; Lars T Jensen; Moshe Kamar; Asaph Nini; Daryl R Gress; Messoud Ashina Journal: Neurocrit Care Date: 2012-08 Impact factor: 3.210
Authors: D Hori; C Brown; M Ono; T Rappold; F Sieber; A Gottschalk; K J Neufeld; R Gottesman; H Adachi; C W Hogue Journal: Br J Anaesth Date: 2014-09-25 Impact factor: 9.166
Authors: R Blaine Easley; Kathleen K Kibler; Kenneth M Brady; Brijen Joshi; Masahiro Ono; Charles Brown; Charles W Hogue Journal: Neurol Res Date: 2013-05 Impact factor: 2.448
Authors: Masahiro Ono; Kenneth Brady; R Blaine Easley; Charles Brown; Michael Kraut; Rebecca F Gottesman; Charles W Hogue Journal: J Thorac Cardiovasc Surg Date: 2013-09-26 Impact factor: 5.209
Authors: Masahiro Ono; George J Arnaoutakis; Derek M Fine; Kenneth Brady; R Blaine Easley; Yueying Zheng; Charles Brown; Nevin M Katz; Morgan E Grams; Charles W Hogue Journal: Crit Care Med Date: 2013-02 Impact factor: 7.598
Authors: Daijiro Hori; Laura Max; Andrew Laflam; Charles Brown; Karin J Neufeld; Hideo Adachi; Christopher Sciortino; John V Conte; Duke E Cameron; Charles W Hogue; Kaushik Mandal Journal: J Cardiothorac Vasc Anesth Date: 2016-01-12 Impact factor: 2.628
Authors: Daijiro Hori; Charles Hogue; Hideo Adachi; Laura Max; Joel Price; Christopher Sciortino; Kenton Zehr; John Conte; Duke Cameron; Kaushik Mandal Journal: Interact Cardiovasc Thorac Surg Date: 2016-01-12