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(Stroke. 1995;26:2285-2292.)
© 1995 American Heart Association, Inc.

Articles

Can Cerebrovascular Reactivity Be Measured With Near-Infrared Spectroscopy?

Peter Smielewski, MSc; Peter Kirkpatrick, FRCS(SN); Paven Minhas, MB, BS; John D. Pickard, FRCS Marek Czosnyka, PhD

From the Medical Research Council Cambridge Centre for Brain Repair and Academic Neurosurgical Unit, Addenbrooke's Hospital, University of Cambridge (UK).

Correspondence to Peter Smielewski, Neurosurgery Unit, Level 4, A Block, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 2QQ, UK.

Background and Purpose We used near-infrared spectroscopy (NIRS) to monitor the cerebral oxygenation changes during CO₂ reactivity tests.

Methods Fifty healthy volunteers were examined (age range, 19 to 68 years). The monitored parameters were as follows: transcranial Doppler (TCD) time-averaged middle cerebral artery flow velocity end-tidal CO₂ (EtCO₂); change in concentration of cerebral oxyhemoglobin (HbO₂), deoxyhemoglobin (Hb), and total hemoglobin; mean arterial blood pressure; peripheral arterial oxygen saturation (SaO₂); and extracranial tissue perfusion with the use of cutaneous laser-Doppler flowmetry. The examination protocol included both hypercapnia and hypocapnia. The cerebrovascular reactivity indexes were calculated as follows: TCD, relative change in flow velocity per 1 kPa increase in EtCO₂; NIRS, absolute change in HbO₂, Hb, and total hemoglobin concentration (micromoles per liter) per 1 kPa increase in EtCO₂.

Results Mean middle cerebral artery flow velocity was found to be 58 cm/s at a mean baseline EtCO₂ of 4.7 kPa. Mean cerebrovascular reactivities were as follows: TCD, 24%/kPa (SEM, 1.1); HbO₂, 2.06 µmol/L per kilopascal (SEM, 0.08); Hb, -0.63 µmol/L per kilopascal (SEM, 0.09); and total hemoglobin concentration, 1.44 µmol/L per kilopascal (SEM, 0.1). Statistical analysis revealed significant correlation between reactivities calculated with the use of NIRS and TCD (P<.001). Although some fluctuations were observed in SaO₂ and laser-Doppler flux, they were not correlated with either EtCO₂ or NIRS.

Conclusions NIRS signal changes in HbO₂, Hb, and total hemoglobin concentration are very sensitive to alterations in EtCO₂, which are largely independent of extracranial tissue perfusion. NIRS may be developed as an alternative method for testing cerebrovascular reactivity and may be of particular clinical importance when the ultrasound window is poor.

Key Words: carbon dioxide • laser Doppler flowmetry • spectroscopy, near-infrared • ultrasonics

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