Cerebral autoregulation after subarachnoid hemorrhage: comparison of three methods

Karol P. Budohoski , Marek Czosnyka , Peter Smielewski , Georgios V Varsos , Magdalena Kasprowicz , Ken M Brady , John D Pickard , Peter J Kirkpatrick


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.
Author Karol P. Budohoski - [University of Cambridge]
Karol P. Budohoski,,
, Marek Czosnyka (FEIT / PE)
Marek Czosnyka,,
- The Institute of Electronic Systems
, Peter Smielewski - [University of Cambridge]
Peter Smielewski,,
, Georgios V Varsos - [University of Cambridge]
Georgios V Varsos,,
, Magdalena Kasprowicz - [University of Cambridge]
Magdalena Kasprowicz,,
, Ken M Brady - [Baylor College of Medicine]
Ken M Brady,,
, John D Pickard - [University of Cambridge]
John D Pickard,,
, Peter J Kirkpatrick - [University of Cambridge]
Peter J Kirkpatrick,,
Journal seriesJournal of Cerebral Blood Flow & Metabolism, ISSN 0271-678X
Issue year2013
Publication size in sheets0.5
Keywords in Englishcerebral autoregulation; delayed cerebral ischemia; near-infrared spectroscopy; neuromonitoring; subarachnoid hemorrhage; transcranial Doppler
ASJC Classification2705 Cardiology and Cardiovascular Medicine; 2728 Clinical Neurology; 2808 Neurology
URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587818/
Languageen angielski
jcbfm.2012.189.pdf 449.65 KB
Score (nominal)40
Score sourcejournalList
ScoreMinisterial score = 40.0, 30-01-2020, ArticleFromJournal
Ministerial score (2013-2016) = 40.0, 30-01-2020, ArticleFromJournal
Publication indicators WoS Citations = 35; Scopus Citations = 46; Scopus SNIP (Source Normalised Impact per Paper): 2013 = 1.742; WoS Impact Factor: 2013 = 5.339 (2) - 2013=5.373 (5)
Citation count*14 (2015-02-03)
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* presented citation count is obtained through Internet information analysis and it is close to the number calculated by the Publish or Perish system.
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