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(Stroke. 2009;40:1820.)
© 2009 American Heart Association, Inc.

Original Contributions

Cerebrovascular Reactivity Measured by Near-Infrared Spectroscopy

Jennifer K. Lee, MD; Kathleen K. Kibler, BS; Paul B. Benni, PhD; R. Blaine Easley, MD; Marek Czosnyka, PhD; Peter Smielewski, PhD; Raymond C. Koehler, PhD; Donald H. Shaffner, MD Ken M. Brady, MD

From the Department of Anesthesiology and Critical Care Medicine (J.K.L., K.K.K., R.B.E., R.C.K., D.H.S., K.M.B.), Johns Hopkins University School of Medicine, Baltimore, Md; CAS Medical Systems, Inc (CASMED; P.B.B.), Branford, Conn; and the Department of Academic Neurosurgery (M.C., P.S.), Addenbrooke’s Hospital, Cambridge, UK.

Correspondence to Ken M. Brady, MD, Johns Hopkins University School of Medicine, Department of Anesthesiology, Division of Pediatric Anesthesiology and Critical Care Medicine, 600 North Wolfe Street, Blalock 904, Baltimore, MD 21287. E-mail kbrady5{at}jhmi.edu

Background and Purpose— The pressure reactivity index (PRx) describes cerebral vessel reactivity by correlation of slow waves of intracranial pressure (ICP) and arterial blood pressure. In theory, slow changes in the relative total hemoglobin (rTHb) measured by near-infrared spectroscopy are caused by the same blood volume changes that cause slow waves of ICP. Our objective was to develop a new index of vascular reactivity, the hemoglobin volume index (HVx), which is a low-frequency correlation of arterial blood pressure and rTHb measured with near-infrared spectroscopy.

Methods— Gradual hypotension was induced in piglets while cortical laser-Doppler flux was monitored. ICP was monitored, and rTHb was measured continuously using reflectance near-infrared spectroscopy. The HVx was recorded as a moving linear correlation between slow waves (20 to 300 seconds) of arterial blood pressure and rTHb. Autoregulation curves were constructed by averaging values of the PRx or HVx in 5-mm Hg bins of cerebral perfusion pressure.

Results— The laser-Doppler flux-determined lower limit of autoregulation was 29.4±6.7 mm Hg (±SD). Coherence between rTHb and ICP was high at low frequencies. HVx was linearly correlated with PRx. The PRx and HVx both showed higher values below the lower limit of autoregulation and lower values above the lower limit of autoregulation. Areas under the receiver operator characteristic curves were 0.88 and 0.85 for the PRx and HVx, respectively.

Conclusions— Coherence between the rTHb and ICP waveforms at the frequency of slow waves suggests that slow waves of ICP are related to blood volume changes. The HVx has potential for further development as a noninvasive alternative to the PRx.

Key Words: autoregulation • cerebral blood flow • hemoglobin • hypotension • near-infrared spectroscopy • neonate • piglet