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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

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Non-invasive monitoring of cerebrovascular reactivity with near infrared spectroscopy allows determination of optimal arterial blood and cerebral perfusion pressure

Meeting Abstract

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  • Christian Zweifel - Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom
  • Gianluca Castellani - Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom
  • Adel Helmy - Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom
  • John D Pickard - Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom
  • Marek Czosnyka - Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom
  • Peter Smielewski - Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1591

doi: 10.3205/10dgnc066, urn:nbn:de:0183-10dgnc0669

Published: September 16, 2010

© 2010 Zweifel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Monitoring of cerebrovascular pressure reactivity (PRx) has diagnostic and prognostic value in head injured patients but needs invasive monitoring of intracranial pressure (ICP). Near infrared spectroscopy (NIRS) is a non-invasive modality, suitable for the continuous detection of cerebral blood volume changes that are reflected by the Total Hemoglobin Index. To compare a NIRS-based index, total hemoglobin reactivity (THx), against standard measurements of PRx.

Methods: Forty patients with closed head injury were prospectively included in the study from June 2008 to June 2009. Patients were monitored daily with arterial blood pressure (ABP), ICP and Total Hemoglobin Index. PRx and THx were calculated as the moving correlation coefficients, using 5 minute time-windows, between 10-second averaged values of ICP and ABP, and Total Hemoglobin Index and ABP, respectively. By evaluation of the distribution of PRx and THx versus cerebral perfusion pressure (CPP) and ABP, so called ‘optimal' CPP and ‘optimal' ABP was calculated, indicating pressures levels where both indices demonstrated strongest reactivity (I.e. PRx and THx reached minimal values).

Results: 120 recordings on individual days were performed, with a median time of the first day after head injury (IQR 0.75–2), and stopped at day 4 (IQR 2–6), with a total duration of 1,760 hours. PRx and THx demonstrated significant association in averaged individual recordings (r=0.49 p<0.0001) and averaged for patients (r=0.56, p=0.0002). Assessment of optimal CPP and ABP using THx was possible in about 50% of recordings and showed a good agreement with the optimal CPP and ABP assessed with PRx.

Conclusions: THx, noninvasively assessed with NIRS, significantly correlated with PRx. THx may be of diagnostic value to optimize a cerebrovascular reactivity- oriented therapy, especially in patients for whom direct ICP monitoring is not feasible.