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 J.
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
N1 - Funding Information:
From the *Division of Cardiac Surgery, Department of Surgery, †Department of Anesthesiology and Critical Care Medicine, and ‡Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; and §Division of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan. Accepted for publication June 3, 2015. Funding: Funded, in part, by grant from Ornim, Inc., Kfar Saba, Israel (Kaushik Mandal, Karin Neufeld) and Japan Heart Association/Bayer Yakuhin Grant for Abroad (Daijiro Hori). Dr. Hogue is the principal investigator on a grant from the National Institutes of Health (RO1 095529). Conflict of Interest: See Disclosures at the end of the article.
Funding Information:
Name: Karin J. Neufeld, MD. Contribution: This author helped with study design, IRB application, and preparation of the manuscript. Attestation: Karin J. Neufeld attests to the integrity of the original data and the analysis reported in this manuscript and approves the submitted manuscript. Conflicts of Interest: This author was funded, in part, by a grant from Ornim, Inc., Kfar Saba, Israel. Name: John V. Conte, MD. Contribution: This author contributed to data collection, quality control, and preparation of the manuscript. Attestation: John V. Conte attests to the integrity of the original data and the analysis reported in this manuscript and approves the submitted manuscript. Conflicts of Interest: This author has no conflicts of interest to declare. Name: Joel Price, MD, MPH. Contribution: This author contributed to data collection, quality control, and preparation of the manuscript. Attestation: Joel Price attests to the integrity of the original data and the analysis reported in this manuscript and approves the submitted manuscript. Conflicts of Interest: This author has no conflicts of interest to declare. Name: Christopher Sciortino, MD, PhD. Contribution: This author contributed to data collection, quality control, and preparation of the manuscript. Attestation: Christopher Sciortino attests to the integrity of the original data and the analysis reported in this manuscript and approves the submitted manuscript. Conflicts of Interest: This author has no conflicts of interest to declare. Name: Laura Max, BA. Contribution: This author is the second archival author and contributed to data collection, quality control, and preparation of the manuscript. Attestation: Laura Max attests to the integrity of the original data in this manuscript and approves the submitted manuscript. Conflicts of Interest: This author has no conflicts of interest to declare. Name: Andrew Laflam, BSc. Contribution: This author contributed to data collection, quality control, and preparation of the manuscript. Attestation: Andrew Laflam attests to the integrity of the original data in this manuscript and approves the submitted manuscript. Conflicts of Interest: This author has no conflicts of interest to declare. Name: Hideo Adachi, MD, PhD. Contribution: This author contributed to quality control and preparation of the manuscript. Attestation: Hideo Adachi approves the submitted manuscript. Conflicts of Interest: This author has no conflicts of interest to declare. Name: Duke E. Cameron, MD. Contribution: This author contributed to data collection, quality control, and analysis and preparation of the manuscript. Attestation: Duke E. Cameron attests to the integrity of the original data and the analysis reported in this manuscript and approves the submitted manuscript. Conflicts of Interest: This author has no conflicts of interest to declare.
Funding Information:
Name: Kaushik Mandal, MD, MPH, FRCS (CTh). Contribution: This author helped with study design, IRB application, data collection, quality control, and analysis and preparation of the manuscript. Attestation: Kaushik Mandal attests to the integrity of the original data and the analysis reported in this manuscript and approves the submitted manuscript. Conflicts of Interest: This author is the principal investigator of the study and was funded, in part, by a grant from Ornim, Inc., Kfar Saba, Israel.
PY - 2015/11/1
Y1 - 2015/11/1
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. Timeaveraged 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. Timeaveraged 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.
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U2 - 10.1213/ANE.0000000000000930
DO - 10.1213/ANE.0000000000000930
M3 - Article
C2 - 26334746
AN - SCOPUS:84944339594
VL - 121
SP - 1187
EP - 1193
JO - Anesthesia and Analgesia
JF - Anesthesia and Analgesia
SN - 0003-2999
IS - 5
ER -