Abstract
Cerebral autoregulation is a mechanism which maintains constant cerebral blood flow (CBF) despite changes in mean arterial pressure (MAP). Assessing whether this mechanism is intact or impaired and determining its boundaries is important in many clinical settings, where primary or secondary injuries to the brain may occur. Herein we describe the development of a new ultrasound tagged near infra red light monitor which tracks CBF trends, in parallel, it continuously measures blood pressure and correlates them to produce a real time autoregulation index. Its performance is validated in both in-vitro experiment and a pre-clinical case study. Results suggest that using such a tool, autoregulation boundaries as well as its impairment or functioning can be identified and assessed. It may therefore assist in individualized MAP management to ensure adequate organ perfusion and reduce the risk of postoperative complications, and might play an important role in patient care.
Highlights
Cerebral autoregulation (AR) refers to the intrinsic ability of the brain’s vasculature to react to changes in arterial blood pressure (BP), in order to maintain stable cerebral blood flow (CBF) [1,2,3]
Flow measured by sensor number 1 experienced corresponding concurrent changes (CFI = 44.93±18.18, coefficient of variance (CV) = 0.4), while flow measured by sensor 2 (Panel D) was kept constant throughout the experiment (CFI = 22.89±4.6, CV = 0.2)
To further validate the difference between cerebral flow index (CFI) values measured by the two different sensors during the experiment, measurements were divided to periods before and after mean arterial pressure (MAP) increase, and the difference between groups was evaluated using t-test
Summary
Cerebral autoregulation (AR) refers to the intrinsic ability of the brain’s vasculature to react to changes in arterial blood pressure (BP), in order to maintain stable cerebral blood flow (CBF) [1,2,3]. AR may be further compromised by certain disease states of the brain, ranging from impairment to non-function, leaving the brain unprotected against potentially harmful effects of BP changes. In severe head injury or acute ischemic stroke, autoregulation may be impaired or even lost[7, 8]. Assessing whether this mechanism is intact or impaired, and determining the boundaries of the aforementioned plateau, is important in many clinical settings, where primary or secondary injuries to the brain may occur due to hypo or hyperperfusion. Until today, no real time monitor for AR functioning exists
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