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Detection of impaired cerebral autoregulation improves by increasing arterial blood pressure variability

Detection of impaired cerebral autoregulation improves by increasing arterial blood pressure variability
Detection of impaired cerebral autoregulation improves by increasing arterial blood pressure variability
Although the assessment of dynamic cerebral autoregulation (CA) based on measurements of spontaneous fluctuations in arterial blood pressure (ABP) and cerebral blood flow (CBF) is a convenient and much used method, there remains uncertainty about its reliability. We tested the effects of increasing ABP variability, provoked by a modification of the thigh cuff method, on the ability of the autoregulation index to discriminate between normal and impaired CA, using hypercapnia as a surrogate for dynamic CA impairment. In 30 healthy volunteers, ABP (Finapres) and CBF velocity (CBFV, transcranial Doppler) were recorded at rest and during 5% CO(2) breathing, with and without pseudo-random sequence inflation and deflation of bilateral thigh cuffs. The application of thigh cuffs increased ABP and CBFV variabilities and was not associated with a distortion of the CBFV step response estimates for both normocapnic and hypercapnic conditions (P=0.59 and P=0.96, respectively). Sensitivity and specificity of CA impairment detection were improved with the thigh cuff method, with the area under the receiver-operator curve increasing from 0.746 to 0.859 (P=0.031). We conclude that the new method is a safe, efficient, and appealing alternative to currently existing assessment methods for the investigation of the status of CA.
arterial blood pressure, cerebral autoregulation, cerebral blood flow, pseudo-random binary sequences
0271-678X
519-523
Katsogridakis, Emmanuel
863d80d0-d656-453d-98fe-70f2c16aaaf9
Bush, Glen
cfea4e31-c324-480d-8308-72356a501af1
Fan, Lingke
f5684ccc-f5ef-4613-89bb-1b61ec6f74b6
Birch, Anthony A.
0a31c6be-d058-4ca4-a332-8dcff4a470ab
Simpson, David M.
53674880-f381-4cc9-8505-6a97eeac3c2a
Allen, Robert
956a918f-278c-48ef-8e19-65aa463f199a
Potter, John F.
b49c726b-7954-429e-bc1c-37639a39e428
Panerai, Ronney B.
7acaf714-a17c-4df2-a1f3-b148c1445517
Katsogridakis, Emmanuel
863d80d0-d656-453d-98fe-70f2c16aaaf9
Bush, Glen
cfea4e31-c324-480d-8308-72356a501af1
Fan, Lingke
f5684ccc-f5ef-4613-89bb-1b61ec6f74b6
Birch, Anthony A.
0a31c6be-d058-4ca4-a332-8dcff4a470ab
Simpson, David M.
53674880-f381-4cc9-8505-6a97eeac3c2a
Allen, Robert
956a918f-278c-48ef-8e19-65aa463f199a
Potter, John F.
b49c726b-7954-429e-bc1c-37639a39e428
Panerai, Ronney B.
7acaf714-a17c-4df2-a1f3-b148c1445517

Katsogridakis, Emmanuel, Bush, Glen, Fan, Lingke, Birch, Anthony A., Simpson, David M., Allen, Robert, Potter, John F. and Panerai, Ronney B. (2013) Detection of impaired cerebral autoregulation improves by increasing arterial blood pressure variability. Journal of Cerebral Blood Flow & Metabolism, 33 (4), 519-523. (doi:10.1038/jcbfm.2012.191).

Record type: Article

Abstract

Although the assessment of dynamic cerebral autoregulation (CA) based on measurements of spontaneous fluctuations in arterial blood pressure (ABP) and cerebral blood flow (CBF) is a convenient and much used method, there remains uncertainty about its reliability. We tested the effects of increasing ABP variability, provoked by a modification of the thigh cuff method, on the ability of the autoregulation index to discriminate between normal and impaired CA, using hypercapnia as a surrogate for dynamic CA impairment. In 30 healthy volunteers, ABP (Finapres) and CBF velocity (CBFV, transcranial Doppler) were recorded at rest and during 5% CO(2) breathing, with and without pseudo-random sequence inflation and deflation of bilateral thigh cuffs. The application of thigh cuffs increased ABP and CBFV variabilities and was not associated with a distortion of the CBFV step response estimates for both normocapnic and hypercapnic conditions (P=0.59 and P=0.96, respectively). Sensitivity and specificity of CA impairment detection were improved with the thigh cuff method, with the area under the receiver-operator curve increasing from 0.746 to 0.859 (P=0.031). We conclude that the new method is a safe, efficient, and appealing alternative to currently existing assessment methods for the investigation of the status of CA.

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e-pub ahead of print date: 12 December 2012
Published date: April 2013
Keywords: arterial blood pressure, cerebral autoregulation, cerebral blood flow, pseudo-random binary sequences
Organisations: Faculty of Medicine, Signal Processing & Control Grp

Identifiers

Local EPrints ID: 361384
URI: http://eprints.soton.ac.uk/id/eprint/361384
ISSN: 0271-678X
PURE UUID: 57339253-e7b9-4aaa-a6f2-5cee14c002e9

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Date deposited: 22 Jan 2014 15:49
Last modified: 28 Oct 2019 21:01

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