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
AbstractIn 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.
|Journal series||Journal of Cerebral Blood Flow & Metabolism, ISSN 0271-678X|
|Publication size in sheets||0.5|
|Keywords in English||cerebral autoregulation; delayed cerebral ischemia; near-infrared spectroscopy; neuromonitoring; subarachnoid hemorrhage; transcranial Doppler|
|ASJC Classification||; ;|
|Score|| = 40.0, 30-01-2020, ArticleFromJournal|
= 40.0, 30-01-2020, ArticleFromJournal
|Publication indicators||= 35; = 46; : 2013 = 1.742; : 2013 = 5.339 (2) - 2013=5.373 (5)|
|Citation count*||14 (2015-02-03)|
* presented citation count is obtained through Internet information analysis and it is close to the number calculated by the Publish or Perish system.