Continuous Monitoring of Cerebrovascular Autoregulation After Subarachnoid Hemorrhage by Brain Tissue Oxygen Pressure Reactivity and Its Relation to Delayed Cerebral Infarction

Jaeger, M.; Schuhmann, Martin U.; Soehle, Martin; Nagel, Christoph; Meixensberger, Jürgen

doi:10.1161/01.str.0000257964.65743.99

Cited by 225 publications

(144 citation statements)

References 17 publications

(18 reference statements)

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“…For indirect monitoring of the cerebral perfusion status, brain tissue PO 2 may serve as a surrogate marker for CBF. 26 Despite a low spatial and temporal resolution with no definite threshold for ischemic injury, recent studies have provided evidence for the prognostic value of brain tissue PO 2 regarding outcome after severe subarachnoid hemorrhage, 16 malignant ischemic stroke, 12 and traumatic brain injury. 15 Nevertheless, it remains a surrogate marker for the true hemodynamic situation, which is best characterized by invasive CBF measurements.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative monitoring of cerebral blood flow by laser speckle contrast analysis

Hecht

Woitzik²,

Dreier

et al. 2009

FOC

109

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Object Currently, reliable low-cost and noninvasive techniques to assess cerebral perfusion in the operating room are not available. The authors report on their first clinical experience with laser speckle contrast analysis (LASCA) as a complementary imaging tool for the noninvasive and dynamic assessment of cerebral blood flow (CBF) during neurovascular surgery. The purpose of this preliminary study was to address the general feasibility of LASCA in terms of handling and image quality and to provide an example of its clinical implications. Methods Laser speckle contrast analysis was performed in patients undergoing cerebral revascularization procedures for the treatment of hemodynamic compromise and complex aneurysms. The portable LASCA device was centered over the surgical field, and continuous 5-minute recordings of relative CBF were obtained. In the case of flow augmentation for hemodynamic compromise, CBF monitoring was performed before and after completion of the anastomosis. In the case of flow replacement for parent artery sacrifice, CBF monitoring was performed during consecutive 30-second test occlusions of the radial artery graft after proximal internal carotid artery sacrifice and the subsequent initiation of blood flow through the bypass. Results In all cases, the authors achieved good visualization of relative CBF in addition to flow imaging in both the bypass graft and the cortical vasculature. During a sudden CBF decrease after test occlusion of the radial artery graft and subsequent flow initiation through the bypass, LASCA allowed immediate visualization and measurement of relative CBF in excellent spatiotemporal resolution. Conclusions In this study LASCA offered noninvasive and rapid intraoperative assessment of relative CBF, which can be used for optimizing neurovascular procedures.

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Section: Discussionmentioning

confidence: 99%

Intraoperative monitoring of cerebral blood flow by laser speckle contrast analysis

Hecht

Woitzik²,

Dreier

et al. 2009

FOC

109

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“…It has been described that cerebral autoregulation may become disturbed after subarachnoid hemorrhage (SAH), [1][2][3][4][5][6][7] which has been associated with development of delayed cerebral ischemia (DCI). 1,2,[5][6][7][8][9] The transient hyperemic response test (THRT) is a transcranial Doppler (TCD) based method, which characterizes the changes in cerebral blood flow velocity (FV) after a brief compression of the common carotid artery. It is a recognized and simple method of testing autoregulation in vivo.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Autoregulation after Subarachnoid Hemorrhage: Comparison of Three Methods

Budohoski

Czosnyka

Smielewski

et al. 2012

J Cereb Blood Flow Metab

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In patients after subarachnoid hemorrhage (SAH) failure of cerebral autoregulation is associated with delayed cerebral ischemia (DCI). Various methods of assessing autoregulation are available, but their predictive values remain unknown. We characterize the relationship between different indices of autoregulation. Patients with SAH within 5 days were included in a prospective study. The relationship between three indices of autoregulation was analyzed: two indices calculated using spontaneous blood pressure fluctuations, Sxa (based on transcranial Doppler) and TOxa (based on near-infrared spectroscopy); and transient hyperemic response test (THRT) where a brief compression of the common carotid artery is used. The predictive value of indices was assessed using data from the first 5 days. Overall there was only moderate correlation between indices. However, both Sxa and TOxa showed good accuracy in predicting impaired autoregulation evidenced by a negative THRT (area under the curve (AUC): 0.788, 95% CI: 0.723 to 0.854 and AUC: 0.827, 95% CI: 0.769 to 0.885, respectively). All indices proved accurate in predicting DCI when 0-to 5-day data were used (AUC: 0.801, 95% CI: 0.660 to 0.942; AUC: 0.857, 95% CI: 0.731 to 0.984, AUC: 0.796, 95% CI: 0.658 to 0.934 for THRT, Sxa, and TOxa, respectively). Combining all three indices had 100% specificity for predicting DCI. While multiple colinearities exist between the assessed methods, multimodal monitoring of cerebral autoregulation can aid in predicting DCI.

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“…These previous evaluations were animal studies using NIRS with indocyanine green in piglets 2,16 and other experiments. 1,5,6,10,19 We believe that our data, although small in number, may validate the use of NIRS as an important noninvasive real-time bedside application for NIRS in critically ill brain-injured patients who are too unstable to transport to a CT scanner for the CT perfusionderived method. Near-infrared spectroscopy has the additional advantage of not exposing patients to radiation, a concern that is significant in patients undergoing numerous CT perfusion scans during prolonged ICU stays.…”

Section: Discussionmentioning

confidence: 68%

“…Near-infrared spectroscopy oximetry has been evaluated in the use of vasospasm, 10 but not directly with CT perfusion CBF. These previous evaluations were animal studies using NIRS with indocyanine green in piglets 2,16 and other experiments.…”

Section: Discussionmentioning

confidence: 99%

Validation of frontal near-infrared spectroscopy as noninvasive bedside monitoring for regional cerebral blood flow in brain-injured patients

Taussky¹,

O'Neal

Daugherty³

et al. 2012

FOC

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Object Near-infrared spectroscopy (NIRS) offers noninvasive bedside measurement of direct regional cerebral arteriovenous (mixed) brain oxygenation. To validate the accuracy of this monitoring technique, the authors analyzed the statistical correlation of NIRS and CT perfusion with respect to regional cerebral blood flow (CBF) measurements. Methods The authors retrospectively reviewed all cases in which NIRS measurements were obtained at a single, academic neurointensive care unit from February 2008 to June 2011 in which CT perfusion was performed at the same time as NIRS data was collected. Regions of interest were obtained 2.5 cm below the NIRS bifrontal scalp probe on CT perfusion with an average volume between 2 and 4 ml, with mean CBF values used for purposes of analysis. Linear regression analysis was performed for NIRS and CBF values. Results The study included 8 patients (2 men, 6 women), 6 of whom suffered subarachnoid hemorrhage, 1 ischemic stroke, and 1 intracerebral hemorrhage and brain edema. Mean CBF measured by CT perfusion was 61 ml/100 g/min for the left side and 60 ml/100 g/min for the right side, while mean NIRS values were 75 on the right and 74 on the left. Linear regression analysis demonstrated a statistically significant probability value (p < 0.0001) comparing NIRS frontal oximetry and CT perfusion–obtained CBF values. Conclusions The authors demonstrated a linear correlation for frontal NIRS cerebral oxygenation measurements compared with regional CBF on CT perfusion imaging. Thus, frontal NIRS cerebral oxygenation measurement may serve as a useful, noninvasive, bedside intensive care unit monitoring tool to assess brain oxygenation in a direct manner.

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Continuous Monitoring of Cerebrovascular Autoregulation After Subarachnoid Hemorrhage by Brain Tissue Oxygen Pressure Reactivity and Its Relation to Delayed Cerebral Infarction

Cited by 225 publications

References 17 publications

Intraoperative monitoring of cerebral blood flow by laser speckle contrast analysis

Intraoperative monitoring of cerebral blood flow by laser speckle contrast analysis

Cerebral Autoregulation after Subarachnoid Hemorrhage: Comparison of Three Methods

Validation of frontal near-infrared spectroscopy as noninvasive bedside monitoring for regional cerebral blood flow in brain-injured patients

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