Critical Thresholds for Transcranial Doppler Indices of Cerebral Autoregulation in Traumatic Brain Injury

Sorrentino, Enrico; Budohoski, Karol P.; Kasprowicz, Magdalena; Smielewski, Peter; Matta, Basil F.; Pickard, John D.; Czosnyka, Marek

doi:10.1007/s12028-010-9492-5

Cited by 124 publications

(83 citation statements)

References 29 publications

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“…The composite autoregulation index (rCBFx) over this range of CPPs exhibited a U-shaped curve with increasing rCBFx values at both the lower and upper CPP extremes (Fig. 2b), crossing a threshold of 0.3 that has been used previously to indicate impaired autoregulation [5,24,25]. Over the range of CPPs with intact autoregulation (50-90 mmHg), the Based on the composite data, the CPP with the lowest autoregulation index (CPP opt ) is 55-60 mmHg (indicated by #).…”

Section: Composite Autoregulation Curvesupporting

confidence: 51%

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Assessment of Cerebrovascular Autoregulation Using Regional Cerebral Blood Flow in Surgically Managed Brain Trauma Patients

et al. 2015

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Section: Composite Autoregulation Curvesupporting

confidence: 51%

“…1). Based on previous studies using the PRx and Mx [5,24,25], we considered correlation coefficients of >0.3 to indicate impaired autoregulation. Measures of rCBFx were computed off-line.…”

Section: Data Acquisition and Analysismentioning

confidence: 99%

Assessment of Cerebrovascular Autoregulation Using Regional Cerebral Blood Flow in Surgically Managed Brain Trauma Patients

et al. 2015

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“…Although better discriminatory value of invasive indices has been demonstrated in head injury, 24,33 patients with SAH do not routinely receive intracranial monitoring.…”

Section: Discussionmentioning

confidence: 99%

Impairment of Cerebral Autoregulation Predicts Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

Budohoski

Czosnyka

Smielewski

et al. 2012

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Background and Purpose-Delayed cerebral ischemia (DCI) is a recognized contributor to unfavorable outcome after subarachnoid hemorrhage (SAH). Recent data challenge the concept of vasospasm as the sole cause of ischemia and suggest a multifactorial process with dysfunctional cerebral autoregulation as a component. We tested the hypothesis that early autoregulatory failure, detected using near-infrared spectroscopy-based index, TOxa and transcranial Dopplerbased index, Sxa, can predict DCI. Methods-In this prospective observational study we enrolled consecutive patients with aneurysmal SAH that occurred <5 days from admission.

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“…In each patient, we adjusted this cut-off value for ETCO 2 according to the protocol published by Piechnik et al [21]. In practice, for an ETCO 2 of 3.8 kPa, the cut-off value was set at 0.3; for each additional kPa, the cut-off value was increased by 0.2 [21,25]. The individual CBF autoregulation curves were then classified into six categories according to shape criteria explained in Table 1.…”

Section: Data Sources and Analysismentioning

confidence: 99%

Monitoring of cerebral blood flow autoregulation in adults undergoing sevoflurane anesthesia: a prospective cohort study of two age groups

Goettel

Patet

Rossi

et al. 2015

J Clin Monit Comput

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Autoregulation of blood flow is a key feature of the human cerebral vascular system to assure adequate oxygenation and metabolism of the brain under changing physiological conditions. The impact of advanced age and anesthesia on cerebral autoregulation remains unclear. The primary objective of this study was to determine the effect of sevoflurane anesthesia on cerebral autoregulation in two different age groups. This is a follow-up analysis of data acquired in a prospective observational cohort study. One hundred thirty-three patients aged 18-40 and ≥65 years scheduled for major noncardiac surgery under general anesthesia were included. Cerebral autoregulation indices, limits, and ranges were compared in young and elderly patient groups. Forty-nine patients (37 %) aged 18-40 years and 84 patients (63 %) aged ≥65 years were included in the study. Age-adjusted minimum alveolar concentrations of sevoflurane were 0.89 ± 0.07 in young and 0.99 ± 0.14 in older subjects (P < 0.001). Effective autoregulation was found in a blood pressure range of 13.8 ± 9.8 mmHg in young and 10.2 ± 8.6 mmHg in older patients (P = 0.079). The lower limit of autoregulation was 66 ± 12 mmHg and 73 ± 14 mmHg in young and older patients, respectively (P = 0.075). The association between sevoflurane concentrations and autoregulatory capacity was similar in both age groups. Our data suggests that the autoregulatory plateau is shortened in both young and older patients under sevoflurane anesthesia with approximately 1 MAC. Lower and upper limits of cerebral blood flow autoregulation, as well as the autoregulatory range, are not influenced by the age of anesthetized patients. Trial registration ClinicalTrials.gov (NCT00512200).

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Critical Thresholds for Transcranial Doppler Indices of Cerebral Autoregulation in Traumatic Brain Injury

Abstract: We propose that Mx greater than 0.3 indicates definitely disturbed autoregulation and lower than 0.05 good autoregulation. For values between 0.05 and 0.3 the state of autoregulation is uncertain.

Cited by 124 publications

References 29 publications

Assessment of Cerebrovascular Autoregulation Using Regional Cerebral Blood Flow in Surgically Managed Brain Trauma Patients

Assessment of Cerebrovascular Autoregulation Using Regional Cerebral Blood Flow in Surgically Managed Brain Trauma Patients

Impairment of Cerebral Autoregulation Predicts Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

Monitoring of cerebral blood flow autoregulation in adults undergoing sevoflurane anesthesia: a prospective cohort study of two age groups

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