Cerebral Autoregulation Monitoring with Ultrasound-Tagged Near-Infrared Spectroscopy in Cardiac Surgery Patients

Daijiro Hori, Charles W. Hogue, Ashish Shah, Charles Brown, Karin Jane Neufeld, John V. Conte, Joel Price, Christopher Sciortino, Laura Max, Andrew Laflam, Hideo Adachi, Duke E. Cameron, Kaushik Mandal

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalAnesthesia and Analgesia
DOIs
StateAccepted/In press - Sep 2 2015

Fingerprint

Near-Infrared Spectroscopy
Thoracic Surgery
Arterial Pressure
Homeostasis
Cerebrovascular Circulation
Cardiopulmonary Bypass
Blood Flow Velocity
Confidence Intervals
Blood Pressure
Doppler Ultrasonography

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Cerebral Autoregulation Monitoring with Ultrasound-Tagged Near-Infrared Spectroscopy in Cardiac Surgery Patients. / Hori, Daijiro; Hogue, Charles W.; Shah, Ashish; Brown, Charles; Neufeld, Karin Jane; Conte, John V.; Price, Joel; Sciortino, Christopher; Max, Laura; Laflam, Andrew; Adachi, Hideo; Cameron, Duke E.; Mandal, Kaushik.

In: Anesthesia and Analgesia, 02.09.2015.

Research output: Contribution to journalArticle

Hori, Daijiro ; Hogue, Charles W. ; Shah, Ashish ; Brown, Charles ; Neufeld, Karin Jane ; Conte, John V. ; Price, Joel ; Sciortino, Christopher ; Max, Laura ; Laflam, Andrew ; Adachi, Hideo ; Cameron, Duke E. ; Mandal, Kaushik. / Cerebral Autoregulation Monitoring with Ultrasound-Tagged Near-Infrared Spectroscopy in Cardiac Surgery Patients. In: Anesthesia and Analgesia. 2015.
@article{7deca27596aa446cabd587474c079c82,
title = "Cerebral Autoregulation Monitoring with Ultrasound-Tagged Near-Infrared Spectroscopy in Cardiac Surgery Patients",
abstract = "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.",
author = "Daijiro Hori and Hogue, {Charles W.} and Ashish Shah and Charles Brown and Neufeld, {Karin Jane} and Conte, {John V.} and Joel Price and Christopher Sciortino and Laura Max and Andrew Laflam and Hideo Adachi and Cameron, {Duke E.} and Kaushik Mandal",
year = "2015",
month = "9",
day = "2",
doi = "10.1213/ANE.0000000000000930",
language = "English (US)",
journal = "Anesthesia and Analgesia",
issn = "0003-2999",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Cerebral Autoregulation Monitoring with Ultrasound-Tagged Near-Infrared Spectroscopy in Cardiac Surgery Patients

AU - Hori, Daijiro

AU - Hogue, Charles W.

AU - Shah, Ashish

AU - Brown, Charles

AU - Neufeld, Karin Jane

AU - Conte, John V.

AU - Price, Joel

AU - Sciortino, Christopher

AU - Max, Laura

AU - Laflam, Andrew

AU - Adachi, Hideo

AU - Cameron, Duke E.

AU - Mandal, Kaushik

PY - 2015/9/2

Y1 - 2015/9/2

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84944339594&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84944339594&partnerID=8YFLogxK

U2 - 10.1213/ANE.0000000000000930

DO - 10.1213/ANE.0000000000000930

M3 - Article

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

SN - 0003-2999

ER -