Monitoring cerebral blood flow pressure autoregulation in pediatric patients during cardiac surgery.
OBJECTIVE
The limits of cerebral blood flow-pressure autoregulation have not been adequately defined for pediatric patients. Mean arterial blood pressure below these limits might contribute to brain injury during cardiac surgery. The purpose of this pilot study was to assess a novel method of determining the lower limits of pressure autoregulation in pediatric patients supported with cardiopulmonary bypass.


METHODS
A prospective, observational pilot study was conducted in children (n=54) undergoing cardiac surgery with cardiopulmonary bypass for correction of congenital heart defects. Cerebral oximetry index (COx) was calculated as a moving, linear correlation coefficient between slow waves of arterial blood pressure and cerebral oximetry measured with near-infrared spectroscopy. An autoregulation curve was constructed for each patient with averaged COx values sorted by arterial blood pressure.


RESULTS
Hypotension was associated with increased values of COx (P<0.0001). For 77% of patients, an individual estimate of lower limits of pressure autoregulation could be determined using a threshold COx value of 0.4. The mean lower limits of pressure autoregulation for the cohort using this method was 42+/-7 mm Hg.


CONCLUSIONS
This pilot study of COx monitoring in pediatric patients demonstrates an association between hypotension during cardiopulmonary bypass and impairment of autoregulation. The COx may be useful to identify arterial blood pressure-dependent limits of cerebral autoregulation during cardiopulmonary bypass. Larger trials with neurological outcomes are indicated.
Brady
Ken M
KM
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA. Kbrady5@jhmi.edu
Mytar
Jennifer O
JO
Lee
Jennifer K
JK
Cameron
Duke E
DE
Vricella
Luca A
LA
Thompson
W Reid
WR
Hogue
Charles W
CW
Easley
R Blaine
RB
D000293:Adolescent; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D010092:Oximetry; D010865:Pilot Projects; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared / Q000379:methods*