| Real-time continuous monitoring of cerebral blood flow autoregulation using near-infrared spectroscopy in patients undergoing cardiopulmonary bypass. | |
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MedLine Citation:
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PMID: 20651274 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Individualizing mean arterial blood pressure targets to a patient's cerebral blood flow autoregulatory range might prevent brain ischemia for patients undergoing cardiopulmonary bypass (CPB). This study compares the accuracy of real-time cerebral blood flow autoregulation monitoring using near-infrared spectroscopy with that of transcranial Doppler. METHODS: Sixty adult patients undergoing CPB had transcranial Doppler monitoring of middle cerebral artery blood flow velocity and near-infrared spectroscopy monitoring. The mean velocity index (Mx) was calculated as a moving, linear correlation coefficient between slow waves of middle cerebral artery blood flow velocity and mean arterial blood pressure. The cerebral oximetry index was calculated as a similar coefficient between slow waves of cerebral oximetry and mean arterial blood pressure. When cerebral blood flow is autoregulated, Mx and cerebral oximetry index vary around zero. Loss of autoregulation results in progressively more positive Mx and cerebral oximetry index. RESULTS: Mx and cerebral oximetry index showed significant correlation (r=0.55, P<0.0001) and good agreement (bias, 0.08+/-0.18, 95% limits of agreement: -0.27 to 0.43) during CPB. Autoregulation was disturbed in this cohort during CPB (average Mx 0.38, 95% CI 0.34 to 0.43). The lower cerebral blood flow autoregulatory threshold (defined as incremental increase in Mx >0.45) during CPB ranged from 45 to 80 mm Hg. CONCLUSIONS: Cerebral blood flow autoregulation can be monitored continuously with near-infrared spectroscopy in adult patients undergoing CPB. Real-time autoregulation monitoring may have a role in preventing injurious hypotension during CPB. Clinical Trials Registration- at www.clinicaltrials.gov (NCT00769691). |
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Authors:
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Kenneth Brady; Brijen Joshi; Christian Zweifel; Peter Smielewski; Marek Czosnyka; R Blaine Easley; Charles W Hogue |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2010-07-22 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 41 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-31 Completed Date: 2010-09-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 1951-6 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA. kbrady5@jhmi.edu |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00769691 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Blood Flow Velocity / physiology Blood Pressure / physiology Cardiopulmonary Bypass / instrumentation* Cerebrovascular Circulation / physiology* Female Homeostasis / physiology* Humans Male Middle Aged Monitoring, Intraoperative / methods* Oximetry Spectroscopy, Near-Infrared / methods* |
| Grant Support | |
ID/Acronym/Agency:
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R01HL092259/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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