Noninvasive Autoregulation Monitoring with and without Intracranial Pressure in the Naïve Piglet Brain
Cerebrovascular autoregulation monitoring is often desirable for critically ill patients in whom intracranial pressure (ICP) is not measured directly. Without ICP, arterial blood pressure (ABP) is a substitute for cerebral perfusion pressure (CPP) to gauge the constraint of cerebral blood flow acros...
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Published in | Anesthesia and analgesia Vol. 111; no. 1; pp. 191 - 195 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Hagerstown, MD
International Anesthesia Research Society
01.07.2010
Lippincott Williams & Wilkins |
Subjects | |
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Abstract | Cerebrovascular autoregulation monitoring is often desirable for critically ill patients in whom intracranial pressure (ICP) is not measured directly. Without ICP, arterial blood pressure (ABP) is a substitute for cerebral perfusion pressure (CPP) to gauge the constraint of cerebral blood flow across pressure changes. We compared the use of ABP versus CPP to measure autoregulation in a piglet model of arterial hypotension.
Our database of neonatal piglet (5-7 days old) experiments was queried for animals with naïve ICP that were made lethally hypotensive to determine the lower limit of autoregulation (LLA). Twenty-five piglets were identified, each with continuous recordings of ICP, regional cerebral oximetry (rSo2), and cortical red cell flux (laser Doppler). Autoregulation was assessed with the cerebral oximetry index (COx) in 2 ways: linear correlation between ABP and rSo2 (COx(ABP)) and between CPP and rSo2 (COx(CPP)). The lower limits of autoregulation were determined from plots of red cell flux versus ABP. Averaged values of COx(ABP) and COx(CPP) from 5 mm Hg ABP bins were used to show receiver operating characteristics for the 2 methods.
COx(ABP) and COx(CPP) yielded identical receiver operating characteristic curve areas of 0.91 (95% confidence interval [CI], 0.88-0.95) for determining the LLA. However, the thresholds for the 2 methods differed: a threshold COx(ABP) of 0.5 was 89% sensitive (95% CI, 81%-94%) and 81% specific (95% CI, 73%-88%) for detecting ABP below the LLA. A threshold COx(CPP) of 0.42 gave the same 89% sensitivity (95% CI, 81%-94%) with 77% specificity (95% CI, 69%-84%).
The use of ABP instead of CPP for autoregulation monitoring in the naïve brain with COx results in a higher threshold value to discriminate ABP above from ABP below the LLA. However, accuracy was similar with the 2 methods. These findings support and refine the use of near-infrared spectroscopy to monitor autoregulation in patients without ICP monitors. |
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AbstractList | BACKGROUNDCerebrovascular autoregulation monitoring is often desirable for critically ill patients in whom intracranial pressure (ICP) is not measured directly. Without ICP, arterial blood pressure (ABP) is a substitute for cerebral perfusion pressure (CPP) to gauge the constraint of cerebral blood flow across pressure changes. We compared the use of ABP versus CPP to measure autoregulation in a piglet model of arterial hypotension. METHODSOur database of neonatal piglet (5-7 days old) experiments was queried for animals with naïve ICP that were made lethally hypotensive to determine the lower limit of autoregulation (LLA). Twenty-five piglets were identified, each with continuous recordings of ICP, regional cerebral oximetry (rSo2), and cortical red cell flux (laser Doppler). Autoregulation was assessed with the cerebral oximetry index (COx) in 2 ways: linear correlation between ABP and rSo2 (COx(ABP)) and between CPP and rSo2 (COx(CPP)). The lower limits of autoregulation were determined from plots of red cell flux versus ABP. Averaged values of COx(ABP) and COx(CPP) from 5 mm Hg ABP bins were used to show receiver operating characteristics for the 2 methods. RESULTSCOx(ABP) and COx(CPP) yielded identical receiver operating characteristic curve areas of 0.91 (95% confidence interval [CI], 0.88-0.95) for determining the LLA. However, the thresholds for the 2 methods differed: a threshold COx(ABP) of 0.5 was 89% sensitive (95% CI, 81%-94%) and 81% specific (95% CI, 73%-88%) for detecting ABP below the LLA. A threshold COx(CPP) of 0.42 gave the same 89% sensitivity (95% CI, 81%-94%) with 77% specificity (95% CI, 69%-84%). CONCLUSIONSThe use of ABP instead of CPP for autoregulation monitoring in the naïve brain with COx results in a higher threshold value to discriminate ABP above from ABP below the LLA. However, accuracy was similar with the 2 methods. These findings support and refine the use of near-infrared spectroscopy to monitor autoregulation in patients without ICP monitors. Cerebrovascular autoregulation monitoring is often desirable for critically ill patients in whom intracranial pressure (ICP) is not measured directly. Without ICP, arterial blood pressure (ABP) is a substitute for cerebral perfusion pressure (CPP) to gauge the constraint of cerebral blood flow across pressure changes. We compared the use of ABP versus CPP to measure autoregulation in a piglet model of arterial hypotension. Our database of neonatal piglet (5-7 days old) experiments was queried for animals with naïve ICP that were made lethally hypotensive to determine the lower limit of autoregulation (LLA). Twenty-five piglets were identified, each with continuous recordings of ICP, regional cerebral oximetry (rSo2), and cortical red cell flux (laser Doppler). Autoregulation was assessed with the cerebral oximetry index (COx) in 2 ways: linear correlation between ABP and rSo2 (COx(ABP)) and between CPP and rSo2 (COx(CPP)). The lower limits of autoregulation were determined from plots of red cell flux versus ABP. Averaged values of COx(ABP) and COx(CPP) from 5 mm Hg ABP bins were used to show receiver operating characteristics for the 2 methods. COx(ABP) and COx(CPP) yielded identical receiver operating characteristic curve areas of 0.91 (95% confidence interval [CI], 0.88-0.95) for determining the LLA. However, the thresholds for the 2 methods differed: a threshold COx(ABP) of 0.5 was 89% sensitive (95% CI, 81%-94%) and 81% specific (95% CI, 73%-88%) for detecting ABP below the LLA. A threshold COx(CPP) of 0.42 gave the same 89% sensitivity (95% CI, 81%-94%) with 77% specificity (95% CI, 69%-84%). The use of ABP instead of CPP for autoregulation monitoring in the naïve brain with COx results in a higher threshold value to discriminate ABP above from ABP below the LLA. However, accuracy was similar with the 2 methods. These findings support and refine the use of near-infrared spectroscopy to monitor autoregulation in patients without ICP monitors. |
Author | Kibler, Kathleen K. Lee, Jennifer K. Brady, Ken M. Easley, R. Blaine Smielewski, Peter Mytar, Jennifer O. Hogue, Charles W. Czosnyka, Marek |
AuthorAffiliation | From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland; and Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom |
AuthorAffiliation_xml | – name: From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland; and Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom – name: Department of Academic Neurosurgery, Addenbrooke’s Hospital, Cambridge, United Kingdom – name: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland |
Author_xml | – sequence: 1 givenname: Ken surname: Brady middlename: M. fullname: Brady, Ken M. organization: From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland; and Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom – sequence: 2 givenname: Jennifer surname: Mytar middlename: O. fullname: Mytar, Jennifer O. – sequence: 3 givenname: Kathleen surname: Kibler middlename: K. fullname: Kibler, Kathleen K. – sequence: 4 givenname: Charles surname: Hogue middlename: W. fullname: Hogue, Charles W. – sequence: 5 givenname: Jennifer surname: Lee middlename: K. fullname: Lee, Jennifer K. – sequence: 6 givenname: Marek surname: Czosnyka fullname: Czosnyka, Marek – sequence: 7 givenname: Peter surname: Smielewski fullname: Smielewski, Peter – sequence: 8 givenname: R. surname: Easley middlename: Blaine fullname: Easley, R. Blaine |
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Snippet | Cerebrovascular autoregulation monitoring is often desirable for critically ill patients in whom intracranial pressure (ICP) is not measured directly. Without... BACKGROUNDCerebrovascular autoregulation monitoring is often desirable for critically ill patients in whom intracranial pressure (ICP) is not measured... |
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SubjectTerms | Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Animals Biological and medical sciences Blood Pressure - physiology Brain - physiology Catheterization Cerebrovascular Circulation - physiology Data Interpretation, Statistical Homeostasis - physiology Intracranial Pressure - physiology Likelihood Functions Linear Models Medical sciences Monitoring, Physiologic - methods Oximetry Oxygen - blood ROC Curve Swine |
Title | Noninvasive Autoregulation Monitoring with and without Intracranial Pressure in the Naïve Piglet Brain |
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