Why and how to assess cerebral autoregulation?

Moerman, Anneliese; Hert, Stefan De

doi:10.1016/j.bpa.2019.05.007

Cited by 20 publications

(14 citation statements)

References 51 publications

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“…Clinical evidence shows that the diameter of cerebral arteries is related to CBFP ( Zeiler et al, 2020 ). However, the TCD method is difficult to reflect CBFP accurately under this situation ( Moerman & Hert, 2019 ). For this, we propose a comprehensive continuous assessment method of CBFP based on MIPS.…”

Section: Discussionmentioning

confidence: 99%

A noninvasive and comprehensive method for continuous assessment of cerebral blood flow pulsation based on magnetic induction phase shift

Zeng

Zhang

et al. 2022

PeerJ

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Cerebral blood flow (CBF) monitoring is of great significance for treating and preventing strokes. However, there has not been a fully accepted method targeting continuous assessment in clinical practice. In this work, we built a noninvasive continuous assessment system for cerebral blood flow pulsation (CBFP) that is based on magnetic induction phase shift (MIPS) technology and designed a physical model of the middle cerebral artery (MCA). Physical experiments were carried out through different simulations of CBF states. Four healthy volunteers were enrolled to perform the MIPS and ECG synchronously monitoring trials. Then, the components of MIPS related to the blood supply level and CBFP were investigated by signal analysis in time and frequency domain, wavelet decomposition and band-pass filtering. The results show that the time-domain baseline of MIPS increases with blood supply level. A pulse signal was identified in the spectrum (0.2–2 Hz in 200–2,000 ml/h groups, respectively) of MIPS when the simulated blood flow rate was not zero. The pulsation frequency with different simulated blood flow rates is the same as the squeezing frequency of the feeding pump. Similar to pulse waves, the MIPS signals on four healthy volunteers all had periodic change trends with obvious peaks and valleys. Its frequency is close to that of the ECG signal and there is a certain time delay between them. These results indicate that the CBFP component can effectively be extracted from MIPS, through which different blood supply levels can be distinguished. This method has the potential to become a new solution for non-invasive and comprehensive monitoring of CBFP.

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Section: Discussionmentioning

confidence: 99%

A noninvasive and comprehensive method for continuous assessment of cerebral blood flow pulsation based on magnetic induction phase shift

Zeng

Zhang

et al. 2022

PeerJ

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“…Finally, the sPAR status may not be stable over the clinical course of the patient, and may require frequent reassessment [ 50 ]. Several additional tools have been proposed in the assessment of CBF and sPAR, such as transcranial color duplex ultrasonography, near-infrared spectroscopy, and brain perfusion imaging [ 46 , 47 , 52 , 53 ].…”

Section: Tier-two Therapiesmentioning

confidence: 99%

Second- and Third-Tier Therapies for Severe Traumatic Brain Injury

Vrettou

Mentzelopoulos

2022

JCM

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Intracranial hypertension is a common finding in patients with severe traumatic brain injury. These patients need treatment in the intensive care unit, where intracranial pressure monitoring and, whenever possible, multimodal neuromonitoring can be applied. A three-tier approach is suggested in current recommendations, in which higher-tier therapies have more significant side effects. In this review, we explain the rationale for this approach, and analyze the benefits and risks of each therapeutic modality. Finally, we discuss, based on the most recent recommendations, how this approach can be adapted in low- and middle-income countries, where available resources are limited.

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Section: Introductionmentioning

confidence: 99%

“…Cerebral autoregulation (CA) is the mechanism aiming to keep cerebral blood flow constant during blood pressure (BP) fluctuations by constricting or dilating cerebral arterioles in response to BP increases and decreases, respectively (Bayliss 1902 ; Claassen et al 2016 ; Moerman and De Hert 2019 ). CA acts complementary to the process of neurovascular coupling which aims to increase local cerebral blood flow in response to increased neural demand and is dependent on systemic and cerebral CO 2 concentration (Rosengarten et al 2001 ; Meng and Gelb 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Cerebral autoregulation assessed by near-infrared spectroscopy: validation using transcranial Doppler in patients with controlled hypertension, cognitive impairment and controls

et al. 2021

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Purpose Cerebral autoregulation (CA) aims to attenuate the effects of blood pressure variation on cerebral blood flow. This study assessed the criterion validity of CA derived from near-infrared spectroscopy (NIRS) as an alternative for Transcranial Doppler (TCD). Methods Measurements of continuous blood pressure (BP), oxygenated hemoglobin (O2Hb) using NIRS and cerebral blood flow velocity (CBFV) using TCD (gold standard) were performed in 82 controls, 27 patients with hypertension and 94 cognitively impaired patients during supine rest (all individuals) and repeated sit to stand transitions (cognitively impaired patients). The BP-CBFV and BP-O2Hb transfer function phase shifts (TFφ) were computed as CA measures. Spearman correlations (ρ) and Bland Altman limits of agreement (BAloa) between NIRS- and TCD-derived CA measures were computed. BAloa separation < 50° was considered a high absolute agreement. Results NIRS- and TCD-derived CA estimates were significantly correlated during supine rest (ρ = 0.22–0.30, N = 111–120) and repeated sit-to-stand transitions (ρ = 0.46–0.61, N = 19–32). BAloa separation ranged between 87° and 112° (supine rest) and 65°–77° (repeated sit to stand transitions). Conclusion Criterion validity of NIRS-derived CA measures allows for comparison between groups but was insufficient for clinical application in individuals.

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Why and how to assess cerebral autoregulation?

Cited by 20 publications

References 51 publications

A noninvasive and comprehensive method for continuous assessment of cerebral blood flow pulsation based on magnetic induction phase shift

A noninvasive and comprehensive method for continuous assessment of cerebral blood flow pulsation based on magnetic induction phase shift

Second- and Third-Tier Therapies for Severe Traumatic Brain Injury

Cerebral autoregulation assessed by near-infrared spectroscopy: validation using transcranial Doppler in patients with controlled hypertension, cognitive impairment and controls

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