Noninvasive monitoring of cerebrovascular reactivity with near infrared spectroscopy in head-injured patients

Christian Zweifel*, Gianluca Castellani, Marek Czosnyka, Adel Helmy, Anne Manktelow, Emmanuel Carrera, Kenneth Martin Brady, Peter J.A. Hutchinson, David K. Menon, John D. Pickard, Peter Smielewski

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

100 Scopus citations

Abstract

Monitoring of cerebrovascular pressure reactivity (PRx) has diagnostic and prognostic value in head-injured patients, but requires invasive monitoring of intracranial pressure (ICP). Near infrared spectroscopy (NIRS) is a noninvasive method that is suitable for continuous detection of cerebral blood volume changes. We compared a NIRS-based index of cerebrovascular reactivity, called total hemoglobin reactivity (THx), against standard measurements of PRx in a prospective observational study. Forty patients with closed-head injury were monitored daily with arterial blood pressure (ABP), ICP, and a NIRS-based total hemoglobin index. PRx and THx were calculated as the moving correlation coefficients using 5-min time windows between 10-sec averaged values of ICP and ABP, and total hemoglobin index and ABP, respectively. A total of 120 recordings were performed between the median first (IQR 0.75-2) and fourth (IQR 2-6) day after head injury, giving a total duration of 1760 hours. PRx and THx demonstrated a significant association across averaged individual recordings (r=0.49, p<0.0001), and across patients (r=0.56, p=0.0002). Assessment of optimal cerebral perfusion pressure (CPP) and ABP using THx was possible in about 50% of recordings, and showed a significant agreement with the optimal CPP and ABP assessed with PRx. THx may be of diagnostic value to optimize therapy oriented toward restoration and continuity of cerebrovascular reactivity, especially in patients for whom direct ICP monitoring is not feasible.

Original languageEnglish (US)
Pages (from-to)1951-1958
Number of pages8
JournalJournal of neurotrauma
Volume27
Issue number11
DOIs
StatePublished - Nov 1 2010

Keywords

  • cerebrovascular pressure reactivity
  • near infrared spectroscopy
  • optimal arterial blood pressure
  • optimal cerebral perfusion pressure
  • total hemoglobin reactivity

ASJC Scopus subject areas

  • Clinical Neurology

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