Journal
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM
Volume 33, Issue 4, Pages 519-523Publisher
SAGE PUBLICATIONS INC
DOI: 10.1038/jcbfm.2012.191
Keywords
arterial blood pressure; cerebral autoregulation; cerebral blood flow; pseudo-random binary sequences
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Funding
- UK EPSRC [EP/G008787/1, EP/G010420/1]
- Engineering and Physical Sciences Research Council [EP/G008787/1, EP/G010420/1] Funding Source: researchfish
- EPSRC [EP/G008787/1, EP/G010420/1] Funding Source: UKRI
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Although the assessment of dynamic cerebral autoregulation (CA) based on measurements of spontaneous fluctuations in arterial blood pressure (ABP) and cerebral blood flow (CBF) is a convenient and much used method, there remains uncertainty about its reliability. We tested the effects of increasing ABP variability, provoked by a modification of the thigh cuff method, on the ability of the autoregulation index to discriminate between normal and impaired CA, using hypercapnia as a surrogate for dynamic CA impairment. In 30 healthy volunteers, ABP (Finapres) and CBF velocity (CBFV, transcranial Doppler) were recorded at rest and during 5% CO2 breathing, with and without pseudo-random sequence inflation and deflation of bilateral thigh cuffs. The application of thigh cuffs increased ABP and CBFV variabilities and was not associated with a distortion of the CBFV step response estimates for both normocapnic and hypercapnic conditions (P = 0.59 and P = 0.96, respectively). Sensitivity and specificity of CA impairment detection were improved with the thigh cuff method, with the area under the receiver-operator curve increasing from 0.746 to 0.859 (P = 0.031). We conclude that the new method is a safe, efficient, and appealing alternative to currently existing assessment methods for the investigation of the status of CA. Journal of Cerebral Blood Flow & Metabolism (2013) 33, 519-523; doi:10.1038/jcbfm.2012.191; published online 12 December 2012
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