Optical assessment of cerebral autoregulation

S. Fantini
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Abstract

Cerebral autoregulation (CA) is a homeostatic mechanism that maintains a relatively constant cerebral blood flow (CBF) in the presence of changes in the cerebral perfusion pressure (CCP), defined as the difference between mean arterial pressure (MAP) and intracranial pressure (ICP). Given the importance of adequate and consistent brain perfusion, CA is critical for brain viability and is known to be impaired in a number of neurological disorders. Global brain measurements of dynamic CA have been performed with transcranial Doppler ultrasound (to sense the blood flow velocity in the middle cerebral artery) and finger plethysmography (to measure systemic MAP as a surrogate for CCP). Optical methods offer the advantage of providing local measurements of cerebral blood flow and CA, thus allowing for local assessment and spatial mapping of CA. Optical techniques for the non-invasive assessment of CA include near-infrared spectroscopy (NIRS) and diffuse correlation spectroscopy (DCS). I will describe our approach to CA assessment with NIRS, complemented by the novel technique of coherent hemodynamics spectroscopy (CHS), and our findings of the expected enhancement in CA during hyperventilation-induced hypocapnia. I will also report dynamic traces of local CBF measured with NIRS-CHS and DCS during transient changes in MAP. Optical techniques offer the potential to address the challenge of continuous monitoring of local cerebral autoregulation at the bedside and in a critical care environment.
脑自动调节的光学评价
脑自调节(CA)是一种在脑灌注压(CCP)发生变化时维持相对恒定的脑血流量(CBF)的稳态机制,CCP的定义是平均动脉压(MAP)和颅内压(ICP)之间的差值。鉴于充足和一致的脑灌注的重要性,CA对脑活力至关重要,并且已知在许多神经系统疾病中受损。动态CA的全脑测量采用经颅多普勒超声(感知大脑中动脉的血流速度)和手指体积图(测量全身MAP作为CCP的替代品)进行。光学方法的优势在于提供脑血流和CA的局部测量,从而允许CA的局部评估和空间映射。用于CA非侵入性评估的光学技术包括近红外光谱(NIRS)和漫射相关光谱(DCS)。我将描述我们用近红外光谱(NIRS)评估CA的方法,辅以相干血流动力学光谱(CHS)的新技术,以及我们在过度通气引起的低碳酸血症期间CA预期增强的发现。我还将报告在MAP瞬态变化期间用NIRS-CHS和DCS测量的局部CBF的动态轨迹。光学技术为解决在床边和重症监护环境中持续监测局部大脑自动调节的挑战提供了潜力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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