Analysis of dynamic autoregulation assessed by the cuff deflation method.
BACKGROUND
Dynamic testing of cerebral pressure autoregulation is more practical than static testing for critically ill patients. The process of cuff deflation is innocuous in the normal subject, but the systemic and cerebral effects of cuff deflation in severely head-injured patients have not been studied. The purposes of this study were to examine the physiological effects of cuff deflation and to study their impact on the calculation of autoregulatory index (ARI).


METHODS
In 24 severely head-injured patients, 388 thigh cuff deflations were analyzed. The physiological parameters were recorded before, during, and after a transient decrease in blood pressure. Autoregulation was graded by generating an ARI value from 0 to 9.


RESULTS
Mean arterial blood pressure (MAP) dropped rapidly during the first 2-3 seconds, but the nadir MAP was not reached until 8 +/- 7 seconds after the cuff deflation. MAP decreased by an average value of 19 +/- 5 mmHg. Initially the tracings for MAP and cerebral perfusion pressure (CPP) were nearly identical, but after 30 seconds, variable increases in intracranial pressure caused some differences between the MAP and CPP curves. The difference between the ARI values calculated twice using MAP as well as CPP was zero for 70% of left-sided studies and 73% for right-sided studies and less than or equal to 1 for 93% of left- and 95% of right-sided cuff deflations.


CONCLUSIONS
Transient and relatively minor perturbations were detected in systemic physiology induced by dynamic testing of cerebral pressure autoregulation. Furthermore, this study confirms that the early changes in MAP and CPP after cuff deflation are nearly identical. MAP can substitute for CPP in the calculation of ARI even in the severely brain-injured patient.
Hlatky
Roman
R
Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA. hlatky@uthscsa.edu
Valadka
Alex B
AB
Robertson
Claudia S
CS
D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D001921:Brain / Q000098:blood supply / Q000378:metabolism; D002552:Cerebral Ventricles / Q000473:pathology / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D016638:Critical Illness; D005260:Female; D006706:Homeostasis; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D010100:Oxygen / Q000378:metabolism; D014696:Ventriculostomy / Q000295:instrumentation* / Q000379:methods*
D010100:Oxygen