Optimal blood pressure during cardiopulmonary bypass defined by cerebral autoregulation monitoring

Daijiro Hori, Yohei Nomura, Masahiro Ono, Brijen Joshi, Kaushik Mandal, Duke Cameron, Masha Kocherginsky, Charles Wallace Hogue*

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives: We sought to define the lower and upper limits of cerebral blood flow autoregulation and the optimal blood pressure during cardiopulmonary bypass. We further sought to identify variables predictive of these autoregulation end points. Methods: Cerebral autoregulation was monitored continuously with transcranial Doppler in 614 patients during cardiopulmonary bypass enrolled in 3 investigations. A moving Pearson's correlation coefficient was calculated between cerebral blood flow velocity and mean arterial pressure to generate the variable mean velocity index. Optimal mean arterial pressure was defined as the mean arterial pressure with the lowest mean velocity index indicating the best autoregulation. The lower and upper limits of cerebral blood flow autoregulation were defined as the mean arterial pressure at which mean velocity index was increasingly pressure passive (ie, mean velocity index ≥0.4) with declining or increasing blood pressure, respectively. Results: The mean (± standard deviation) lower and upper limits of cerebral blood flow autoregulation, and optimal mean arterial pressure were 65 ± 12 mm Hg, 84 ± 11 mm Hg, and 78 ± 11 mm Hg, respectively, after adjusting for study enrollment. In 17% of patients, though, the lower limit of cerebral autoregulation was above this optimal mean arterial pressure, whereas in 29% of patients the upper limit of autoregulation was below the population optimal mean arterial pressure. Variables associated with optimal mean arterial pressure based on multivariate regression analysis were nonwhite race (increased 2.7 mm Hg; P =.034), diuretics use (decreased 1.9 mm Hg; P =.049), prior carotid endarterectomy (decreased 5.5 mm Hg; P =.019), and duration of cardiopulmonary bypass (decreased 1.28 per 60 minutes of cardiopulmonary bypass). The product of the duration and magnitude that mean arterial pressure during cardiopulmonary bypass was below the lower limit of cerebral autoregulation was associated with the risk for stroke (P =.02). Conclusions: Real-time monitoring of autoregulation may improve individualizing mean arterial pressure during cardiopulmonary bypass and improving patient outcomes.

Original languageEnglish (US)
Pages (from-to)1590-1598.e2
JournalJournal of Thoracic and Cardiovascular Surgery
Volume154
Issue number5
DOIs
StatePublished - Nov 1 2017

Fingerprint

Cardiopulmonary Bypass
Arterial Pressure
Homeostasis
Blood Pressure
Cerebrovascular Circulation
Blood Flow Velocity
Carotid Endarterectomy
Diuretics
Multivariate Analysis
Stroke
Regression Analysis
Pressure

Keywords

  • blood pressure
  • cardiopulmonary bypass
  • cerebral autoregulation

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Hori, Daijiro ; Nomura, Yohei ; Ono, Masahiro ; Joshi, Brijen ; Mandal, Kaushik ; Cameron, Duke ; Kocherginsky, Masha ; Hogue, Charles Wallace. / Optimal blood pressure during cardiopulmonary bypass defined by cerebral autoregulation monitoring. In: Journal of Thoracic and Cardiovascular Surgery. 2017 ; Vol. 154, No. 5. pp. 1590-1598.e2.
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abstract = "Objectives: We sought to define the lower and upper limits of cerebral blood flow autoregulation and the optimal blood pressure during cardiopulmonary bypass. We further sought to identify variables predictive of these autoregulation end points. Methods: Cerebral autoregulation was monitored continuously with transcranial Doppler in 614 patients during cardiopulmonary bypass enrolled in 3 investigations. A moving Pearson's correlation coefficient was calculated between cerebral blood flow velocity and mean arterial pressure to generate the variable mean velocity index. Optimal mean arterial pressure was defined as the mean arterial pressure with the lowest mean velocity index indicating the best autoregulation. The lower and upper limits of cerebral blood flow autoregulation were defined as the mean arterial pressure at which mean velocity index was increasingly pressure passive (ie, mean velocity index ≥0.4) with declining or increasing blood pressure, respectively. Results: The mean (± standard deviation) lower and upper limits of cerebral blood flow autoregulation, and optimal mean arterial pressure were 65 ± 12 mm Hg, 84 ± 11 mm Hg, and 78 ± 11 mm Hg, respectively, after adjusting for study enrollment. In 17{\%} of patients, though, the lower limit of cerebral autoregulation was above this optimal mean arterial pressure, whereas in 29{\%} of patients the upper limit of autoregulation was below the population optimal mean arterial pressure. Variables associated with optimal mean arterial pressure based on multivariate regression analysis were nonwhite race (increased 2.7 mm Hg; P =.034), diuretics use (decreased 1.9 mm Hg; P =.049), prior carotid endarterectomy (decreased 5.5 mm Hg; P =.019), and duration of cardiopulmonary bypass (decreased 1.28 per 60 minutes of cardiopulmonary bypass). The product of the duration and magnitude that mean arterial pressure during cardiopulmonary bypass was below the lower limit of cerebral autoregulation was associated with the risk for stroke (P =.02). Conclusions: Real-time monitoring of autoregulation may improve individualizing mean arterial pressure during cardiopulmonary bypass and improving patient outcomes.",
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Optimal blood pressure during cardiopulmonary bypass defined by cerebral autoregulation monitoring. / Hori, Daijiro; Nomura, Yohei; Ono, Masahiro; Joshi, Brijen; Mandal, Kaushik; Cameron, Duke; Kocherginsky, Masha; Hogue, Charles Wallace.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 154, No. 5, 01.11.2017, p. 1590-1598.e2.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Optimal blood pressure during cardiopulmonary bypass defined by cerebral autoregulation monitoring

AU - Hori, Daijiro

AU - Nomura, Yohei

AU - Ono, Masahiro

AU - Joshi, Brijen

AU - Mandal, Kaushik

AU - Cameron, Duke

AU - Kocherginsky, Masha

AU - Hogue, Charles Wallace

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Objectives: We sought to define the lower and upper limits of cerebral blood flow autoregulation and the optimal blood pressure during cardiopulmonary bypass. We further sought to identify variables predictive of these autoregulation end points. Methods: Cerebral autoregulation was monitored continuously with transcranial Doppler in 614 patients during cardiopulmonary bypass enrolled in 3 investigations. A moving Pearson's correlation coefficient was calculated between cerebral blood flow velocity and mean arterial pressure to generate the variable mean velocity index. Optimal mean arterial pressure was defined as the mean arterial pressure with the lowest mean velocity index indicating the best autoregulation. The lower and upper limits of cerebral blood flow autoregulation were defined as the mean arterial pressure at which mean velocity index was increasingly pressure passive (ie, mean velocity index ≥0.4) with declining or increasing blood pressure, respectively. Results: The mean (± standard deviation) lower and upper limits of cerebral blood flow autoregulation, and optimal mean arterial pressure were 65 ± 12 mm Hg, 84 ± 11 mm Hg, and 78 ± 11 mm Hg, respectively, after adjusting for study enrollment. In 17% of patients, though, the lower limit of cerebral autoregulation was above this optimal mean arterial pressure, whereas in 29% of patients the upper limit of autoregulation was below the population optimal mean arterial pressure. Variables associated with optimal mean arterial pressure based on multivariate regression analysis were nonwhite race (increased 2.7 mm Hg; P =.034), diuretics use (decreased 1.9 mm Hg; P =.049), prior carotid endarterectomy (decreased 5.5 mm Hg; P =.019), and duration of cardiopulmonary bypass (decreased 1.28 per 60 minutes of cardiopulmonary bypass). The product of the duration and magnitude that mean arterial pressure during cardiopulmonary bypass was below the lower limit of cerebral autoregulation was associated with the risk for stroke (P =.02). Conclusions: Real-time monitoring of autoregulation may improve individualizing mean arterial pressure during cardiopulmonary bypass and improving patient outcomes.

AB - Objectives: We sought to define the lower and upper limits of cerebral blood flow autoregulation and the optimal blood pressure during cardiopulmonary bypass. We further sought to identify variables predictive of these autoregulation end points. Methods: Cerebral autoregulation was monitored continuously with transcranial Doppler in 614 patients during cardiopulmonary bypass enrolled in 3 investigations. A moving Pearson's correlation coefficient was calculated between cerebral blood flow velocity and mean arterial pressure to generate the variable mean velocity index. Optimal mean arterial pressure was defined as the mean arterial pressure with the lowest mean velocity index indicating the best autoregulation. The lower and upper limits of cerebral blood flow autoregulation were defined as the mean arterial pressure at which mean velocity index was increasingly pressure passive (ie, mean velocity index ≥0.4) with declining or increasing blood pressure, respectively. Results: The mean (± standard deviation) lower and upper limits of cerebral blood flow autoregulation, and optimal mean arterial pressure were 65 ± 12 mm Hg, 84 ± 11 mm Hg, and 78 ± 11 mm Hg, respectively, after adjusting for study enrollment. In 17% of patients, though, the lower limit of cerebral autoregulation was above this optimal mean arterial pressure, whereas in 29% of patients the upper limit of autoregulation was below the population optimal mean arterial pressure. Variables associated with optimal mean arterial pressure based on multivariate regression analysis were nonwhite race (increased 2.7 mm Hg; P =.034), diuretics use (decreased 1.9 mm Hg; P =.049), prior carotid endarterectomy (decreased 5.5 mm Hg; P =.019), and duration of cardiopulmonary bypass (decreased 1.28 per 60 minutes of cardiopulmonary bypass). The product of the duration and magnitude that mean arterial pressure during cardiopulmonary bypass was below the lower limit of cerebral autoregulation was associated with the risk for stroke (P =.02). Conclusions: Real-time monitoring of autoregulation may improve individualizing mean arterial pressure during cardiopulmonary bypass and improving patient outcomes.

KW - blood pressure

KW - cardiopulmonary bypass

KW - cerebral autoregulation

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