Journal article
Comparison of non-invasive and invasive arterial blood pressure measurement for assessment of dynamic cerebral autoregulation
Neurocritical care, Vol.20(1), pp.60-68
02/2014
DOI: 10.1007/s12028-013-9898-y
PMCID: PMC4049542
PMID: 24233812
Abstract
Background
There is a growing interest in measuring cerebral autoregulation in patients with acute brain injury. Non-invasive finger photo-plethysmography (Finapres) is the method of choice to relate arterial blood pressure to changes in cerebral blood flow. Among acutely ill patients, however, peripheral vasoconstriction often limits the use of Finapres requiring direct intravascular blood pressure measurement. We evaluated how these two different forms of blood pressure monitoring affect the parameters of dynamic cerebral autoregulation (DCA).
Methods
We performed 37 simultaneous recordings of BP and cerebral blood flow velocity in 15 patients with acute brain injury. DCA was estimated in the frequency domain using transfer function analysis to calculate phase shift, gain, and coherence. In addition the mean velocity index (Mx) was calculated for assessment of DCA in the time domain.
Results
The mean patient age was 58.1 ± 15.9 years, 80 % (n = 12) were women. We found good inter-method agreement between Finapres and direct intravascular measurement using Bland–Altman and correlation analyses. Finapres gives higher values for the efficiency of dynamic CA compared with values derived from radial artery catheter, as indicated by biases in the phase (26.3 ± 11.6° vs. 21.7 ± 10.5°, p = 0.001) and Mx (0.571 ± 0.137 vs. 0.649 ± 0.128, p < 0.001). Gain in the low frequency range did not significantly differ between the two arterial blood pressure methods. The average coherence between CBFV and ABP was higher when BP was measured with arterial catheter for frequencies above 0.05 Hz (0.8 vs. 0.73, p < 0.001).
Conclusion
Overall, both methods yield similar results and can be used for the assessment of DCA. However, there was a small but significant difference for both mean Mx and phase shift, which would need to be adjusted for during monitoring of patients when using both methods. When available, invasive arterial blood pressure monitoring may improve accuracy and thus should be the preferred method for DCA assessment in the ICU.
Details
- Title: Subtitle
- Comparison of non-invasive and invasive arterial blood pressure measurement for assessment of dynamic cerebral autoregulation
- Creators
- Nils H Petersen - Department of Neurology, Stroke Division, Columbia University, New York, NYSantiago Ortega-Gutierrez - Department of Neurology, Stroke Division, Columbia University, New York, NYAndres Reccius - Department of Critical Care, Clinica Alemana, Universidad del Desarrollocation, Santiago, ChileArjun Masurkar - Department of Neurology, Stroke Division, Columbia University, New York, NYAmy Huang - Department of Neurology, Stroke Division, Columbia University, New York, NYRandolph S Marshall - Department of Neurology, Stroke Division, Columbia University, New York, NY
- Resource Type
- Journal article
- Publication Details
- Neurocritical care, Vol.20(1), pp.60-68
- DOI
- 10.1007/s12028-013-9898-y
- PMID
- 24233812
- PMCID
- PMC4049542
- NLM abbreviation
- Neurocrit Care
- ISSN
- 1541-6933
- eISSN
- 1556-0961
- Language
- English
- Date published
- 02/2014
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984017488702771
Metrics
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