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Neurocritical Care

, Volume 30, Issue 1, pp 201–206 | Cite as

Noninvasive Monitoring of Dynamic Cerebrovascular Autoregulation and ‘Optimal Blood Pressure’ in Normal Adult Subjects

  • Paul Pham
  • Jessica Bindra
  • Anders Aneman
  • Alwin Chuan
  • John M. Worthington
  • Matthias JaegerEmail author
Original Article
  • 194 Downloads

Abstract

Background

Cerebrovascular autoregulation can be continuously monitored from slow fluctuations of arterial blood pressure (ABP) and regional cerebral oxygen saturation (rSO2). The purpose of this study was to evaluate the index of dynamic cerebrovascular autoregulation (TOx) and the associated ‘optimal’ ABP in normal adult healthy subjects.

Methods

Twenty-eight healthy volunteers were studied. TOx was calculated as the moving correlation coefficient between spontaneous fluctuations of ABP and rSO2. ABP was measured with the Finometer photoplethysmograph. The ABP with optimal autoregulation (ABPOPT) was also determined as the ABP level with the lowest associated TOx (opt-TOx).

Results

Average rSO2 and TOx was 72.3 ± 2.9% and 0.05 ± 0.18, respectively. Two subjects had impaired autoregulation with a TOx > 0.3. The opt-TOx was − 0.1 ± 0.26. ABPOPT was 87.0 ± 16.7 mmHg. The difference between ABP and ABPOPT was − 0.3 ± 7.5 mmHg. In total, 44% of subjects had a deviation of ABP from ABPOPT exceeding 5 mmHg. ABPOPT ranged from 57 to 117 mmHg.

Conclusions

TOx in healthy volunteers on average displays intact autoregulation and ABP close to ABPOPT. However, some subjects have possible autoregulatory dysfunction or a significant deviation of ABP from ABPOPT, which may confer a susceptibility to neurological injury.

Keywords

Cerebral autoregulation Optimal cerebral perfusion pressure Near-infrared spectroscopy Neuromonitoring 

Notes

Authors’ Contributions

PP, JB, and AA performed the experiments and data collection. AA, AC, JMW, and MJ planned and designed the study and obtained funding. PP, JB, AA, and MJ analysed the data. PP, JB, AA, AC, JMW, and MJ interpreted the results, drafted and finalized the manuscript.

Source of support

This study was supported by an infrastructure grant from the University of New South Wales.

Compliance with Ethical Standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical Approval

The Human Research Ethics Committee of South Western Sydney Local Health District approved this study (HREC/14/LPOOL/135). Written informed consent was obtained from each participating subject.

References

  1. 1.
    Czosnyka M, Smieleweski P, Kirkpatrick P, Menon DK, Pickard JD. Monitoring of cerebral autoregulation in head-injured patients. Stroke. 1996;27:1829–34.CrossRefGoogle Scholar
  2. 2.
    Jaeger M, Soehle M, Schuhmann MU, Meixensberger J. Clinical significance of impaired cerebrovascular autoregulation after severe aneurysmal subarachnoid hemorrhage. Stroke. 2012;43:2097–101.CrossRefGoogle Scholar
  3. 3.
    Bindra J, Pham P, Chuan A, Jaeger M, Aneman A. Is impaired cerebrovascular autoregulation associated with outcome in patients admitted to the ICU with early septic shock? Crit Care Resusc. 2016;18:95–101.Google Scholar
  4. 4.
    Pham P, Bindra J, Chuan A, Jaeger M, Aneman A. Are changes in cerebrovascular autoregulation following cardiac arrest associated with neurological outcome? Results of a pilot study. Resuscitation. 2015;96:192–8.CrossRefGoogle Scholar
  5. 5.
    Ono M, Joshi B, Brady K, et al. Risks for impaired cerebral autoregulation during cardiopulmonary bypass and postoperative stroke. Br J Anaesth. 2012;109:391–8.CrossRefGoogle Scholar
  6. 6.
    Chuan A, Short TG, Peng AZY, et al. Is cerebrovascular autoregulation associated with outcomes after major non-cardiac surgery? A prospective observational pilot study. Acta Anaesthesiol Scand. 2018.  https://doi.org/10.1111/aas.13223.Google Scholar
  7. 7.
    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.CrossRefGoogle Scholar
  8. 8.
    Steiner LA, Czosnyka M, Piechnik SK, 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.CrossRefGoogle Scholar
  9. 9.
    Aries MJH, Czosnyka M, Budohoski KP, et al. Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit Care Med. 2012;40:2456–63.CrossRefGoogle Scholar
  10. 10.
    Ono M, Brady KM, Easley RB, et al. Duration and magnitude of blood pressure below cerebral autoregulation threshold during cardiopulmonary bypass is associated with major morbidity and operative mortality. J Thorac Cardiovasc Surg. 2014;147:483–9.CrossRefGoogle Scholar
  11. 11.
    Bindra J, Pham P, Aneman A, Chuan A, Jaeger M. Non-invasive monitoring of dynamic cerebrovascular autoregulation using near infrared spectroscopy and the finometer photoplethysmograph. Neurocrit Care. 2016;24:442–7.CrossRefGoogle Scholar
  12. 12.
    Lazaridis C, Smielewski P, Steiner LA, et al. Optimal cerebral perfusion pressure: Are we ready for it? Neurol Res. 2013;35:138–48.CrossRefGoogle Scholar
  13. 13.
    Brady K, Joshi B, Zweifel C, 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.CrossRefGoogle Scholar
  14. 14.
    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.CrossRefGoogle Scholar
  15. 15.
    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.CrossRefGoogle Scholar
  16. 16.
    Rasulo F, Girardini A, Lavinio A, 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.CrossRefGoogle Scholar
  17. 17.
    Jaeger M, Schuhmann MU, Soehle M, Meixensberger J. Continuous assessment of cerebrovascular autoregulation after traumatic brain injury using brain tissue oxygen pressure reactivity. Crit Care Med. 2006;34:1783–8.CrossRefGoogle Scholar
  18. 18.
    Brady KM, Lee JK, Kibler KK, et al. Continuous time-domain analysis of cerebrovascular autoregulation using near-infrared spectroscopy. Stroke. 2007;38:2818–25.CrossRefGoogle Scholar
  19. 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.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  1. 1.South Western Sydney Clinical SchoolUniversity of New South WalesLiverpool BCAustralia
  2. 2.Department of Intensive Care MedicineLiverpool HospitalLiverpoolAustralia
  3. 3.Department of AnaesthesiaLiverpool HospitalLiverpoolAustralia
  4. 4.Department of NeurologyRoyal Prince Alfred HospitalCamperdownAustralia
  5. 5.Department of NeurosurgeryWollongong HospitalWollongongAustralia

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