Abstract
Cerebrovascular pressure autoregulation (CPA) regulates cerebral blood flow (CBF) in relation to changes in mean arterial blood pressure (MAP). Identification of a pressure-passive cerebral perfusion and the potentially modifiable physiologic factors underlying it has been difficult to achieve in sick infants. We previously validated the near-infrared spectroscopy–derived hemoglobin difference (HbD) signal (cerebral oxyhemoglobin − deoxyhemoglobin) as a reliable measure of changes in CBF in animal models. We now sought to determine whether continuous measurements of ΔHbD would correlate to middle cerebral artery flow velocity (CBFV), allow identification and quantification of pressure-passive state, and help to delineate potentially modifiable factors. We enrolled 43 infants (2 d to 7 mo old) who were undergoing open cardiac surgery and cardiopulmonary bypass. At 6 and 20 h after surgery, we measured changes in HbD, CBFV (by transcranial Doppler), and MAP at different end-tidal CO2 levels. We assigned a pressure-passive index (PPI) to each study on the basis of the relative duration of significant coherence between ΔMAP and ΔHbD. We found a significant relationship between ΔHbD and ΔCBFV at both time points. At 6 h after surgery, we showed high concordance (coherence >0.5; PPI ≥41%) between ΔMAP and ΔHbD, consistent with disturbed CPA in 13% of infants. End-tidal CO2 values ≥40 mm Hg and higher MAP variability both were associated with increased odds (p < 0.001) of autoregulatory failure. This approach provides a means to identify and quantify disturbances of CPA. High CO2 levels and fluctuating MAP are two important preventable factors associated with disturbed CPA.
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Abbreviations
- CBF:
-
cerebral blood flow
- CBFV:
-
cerebral blood flow velocity
- CI:
-
confidence interval
- CPA:
-
cerebrovascular pressure autoregulation
- CV:
-
coefficient of variation
- ET-CO2:
-
end-tidal CO2
- HbD:
-
hemoglobin difference (oxyhemoglobin − deoxyhemoglobin)
- HbT:
-
hemoglobin total (oxyhemoglobin + deoxyhemoglobin)
- ICU:
-
intensive care unit
- MAP:
-
mean arterial blood pressure
- NIRS:
-
near-infrared spectroscopy
- OR:
-
odds ratio
- PPI:
-
pressure-passive index (% time pressure passive state)
- RI:
-
resistive index
- Sao2:
-
arterial oxygen saturation
- TCD:
-
transcranial Doppler
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Acknowledgements
We gratefully acknowledge Dr. Joseph J. Volpe for critical review of our manuscript. We also thank Jody Bartlett and Ellen McGrath for research coordination and Shaye Moore and Michelle Mercadante for help in manuscript preparation. Many thanks to the children and their families for participating in this study.
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This study was supported by a grant from the LifeBridge Fund and grant HL 063411 from the National Heart, Lung, and Blood Institute.
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Bassan, H., Gauvreau, K., Newburger, J. et al. Identification of Pressure Passive Cerebral Perfusion and Its Mediators after Infant Cardiac Surgery. Pediatr Res 57, 35–41 (2005). https://doi.org/10.1203/01.PDR.0000147576.84092.F9
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DOI: https://doi.org/10.1203/01.PDR.0000147576.84092.F9
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