Validation of a Stand-Alone Near-Infrared Spectroscopy System for Monitoring Cerebral Autoregulation During Cardiac Surgery
Validation of a Stand-Alone Near-Infrared Spectroscopy System for Monitoring Cerebral Autoregulation During Cardiac Surgery
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DOI：
10.1213/ane.0b013e318271fb10
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发表时间：
2013-01-01
影响因子：
5.7
通讯作者：
Hogue, Charles W.
中科院分区：
文献类型：
--
作者：
Ono, Masahiro;Zheng, Yueying;Hogue, Charles W.
背景技术：基于脑血流量（CBF）自动调节监测的体外循环（CPB）期间个体化动脉血压（ABP）目标可能提供比当前标准治疗更有效的预防脑灌注不足的方法。经颅多普勒（TCD）可以对自动调节进行真实的实时监测。我们以前已经证明，近红外光谱（NIRS）衍生的局部脑氧饱和度（rS（c）O（2））提供了一个临床上合适的替代CBF的自动调节监测。本研究的目的是确定一个独立的“即插即用”的自动调节监测，使用市售的NIRS监测TCD methods.METHODS的调查系统的准确性：TCD监测大脑中动脉CBF速度和NIRS监测进行了70例CPB期间。自动调节指数计算的个人计算机为基础的系统和一个研究原型的近红外光谱为基础的监测。计算ABP慢波与CBF流速（平均流速指数[Mx]）和rS（c）O（2）（脑氧饱和指数[考克斯]）之间的线性相关系数。当CBF自动调节时，CBF和ABP之间没有相关性;当CBF失调时，Mx和考克斯接近1（即，CBF和ABP相关）。线性回归和偏差分析之间的时间平均值的Mx和考克斯来自个人计算机为基础的系统和考克斯测量的原型监测。将每例患者的Mx和考克斯值分类为ABP的5 mm Hg箱。当Mx递增至>= 0.4时，CBF自动调节的下限为ABP。结果：考克斯与Mx之间有良好的相关性（r = 0.510; 95%可信区间，0.414-0.595; P < 0.001;偏倚，-0.07 ± 0.19）。基于个人计算机的考克斯与来自原型NIRS监测器的考克斯之间的相关性和偏差为r = 0.957（95%置信区间，0.945-0.966; P分别< 0.001和0.06 +/-0.06）。自动调节下限的平均ABP为63 +/- 11 mmHg（95%预测区间，52-74 mmHg）。尽管在COx确定的自动调节下限时，原型监测仪测定的平均ABP与Mx测定的ABP存在统计学差异，（59 9 mm Hg; 95%预测区间，50-68 mm Hg; P = 0.026），差异不太可能有临床意义。用独立NIRS监测仪监测CBF自动调节与基于TCD的方法相关且一致性良好。这种装置的可用性将允许广泛的自动调节监测作为CPB期间个体化ABP目标的手段。（Anesth Analg 2013;116：198-204）
BACKGROUND: Individualizing arterial blood pressure (ABP) targets during cardiopulmonary bypass (CPB) based on cerebral blood flow (CBF) autoregulation monitoring may provide a more effective means for preventing cerebral hypoperfusion than the current standard of care. Autoregulation can be monitored in real time with transcranial Doppler (TCD). We have previously demonstrated that near-infrared spectroscopy (NIRS)-derived regional cerebral oxygen saturation (rS(c)O(2)) provides a clinically suitable surrogate of CBF for autoregulation monitoring. The purpose of this study was to determine the accuracy of a stand-alone "plug-and-play" investigational system for autoregulation monitoring that uses a commercially available NIRS monitor with TCD methods.METHODS: TCD monitoring of middle cerebral artery CBF velocity and NIRS monitoring were performed in 70 patients during CPB. Indices of autoregulation were computed by both a personal computer-based system and an investigational prototype NIRS-based monitor. A moving linear correlation coefficient between slow waves of ABP and CBF velocity (mean velocity index [Mx]) and between ABP and rS(c)O(2), (cerebral oximetry index [COx]) were calculated. When CBF is autoregulated, there is no correlation between CBF and ABP; when CBF is dysregulated, Mx and COx approach 1 (i.e., CBF and ABP are correlated). Linear regression and bias analysis were performed between time-averaged values of Mx and COx derived from the personal computer-based system and from COx measured with the prototype monitor. Values for Mx and COx were categorized in 5 mm Hg bins of ABP for each patient. The lower limit of CBF autoregulation was defined as the ABP where Mx incrementally increased to >= 0.4.RESULTS: There was correlation and good agreement between COx derived from the prototype monitor and Mx (r = 0.510; 95% confidence interval, 0.414-0.595; P < 0.001; bias, -0.07 +/- 0.19). The correlation and bias between the personal computer based COx and the COx from the prototype NIRS monitor were r = 0.957 (95% confidence interval, 0.945-0.966; P < 0.001 and 0.06 +/- 0.06, respectively). The average ABP at the lower limit of autoregulation was 63 +/- 11 mm Hg (95% prediction interval, 52-74 mm Hg). Although the mean ABP at the COx-determined lower limit of autoregulation determined with the prototype monitor was statistically different from that determined by Mx (59 9 mm Hg; 95% prediction interval, 50-68 mm Hg; P = 0.026), the difference was not likely clinically meaningful.CONCLUSIONS: Monitoring CBF autoregulation with an investigational stand-alone NIRS monitor is correlated and in good agreement with TCD-based methods. The availability of such a device would allow widespread autoregulation monitoring as a means of individualizing ABP targets during CPB. (Anesth Analg 2013;116:198-204)