title: Gradient adjustment method for better discriminating correlating and non-correlating regions of physiological signals: application to the partitioning of impaired and intact zones of cerebral autoregulation.
abstract: Cerebral blood flow (CBF) is regulated over a range of systemic blood pressures by the cerebral autoregulation (CA) control mechanism. This range lies within the lower and upper limits of autoregulation (LLA, ULA), beyond which blood pressure drives CBF, and CA function is considered impaired. A standard method to determine autoregulation limits noninvasively using NIRS technology is via the COx measure: a moving correlation index between mean arterial pressure and regional oxygen saturation. In the intact region, there should be no correlation between these variables whereas in the impaired region, the correlation index should approximate unity. In practice, however, the data may be noisy and/or the intact region may often exhibit a slightly positive relationship. This positive relationship may render traditional autoregulation limit calculations difficult to perform, resulting in the need for manual interpretation of the data using arbitrary thresholds. Further, the underlying mathematics of the technique are asymmetric in terms of the results produced for impaired and intact regions and are, in fact, not computable for the ideal case within the intact region. In this work, we propose a novel gradient adjustment method (GACOx) to enhance the differences in COx values observed in the intact and impaired regions. Results from a porcine model (N = 8) are used to demonstrate that GACOx is successful in determining LLA values where traditional methods fail. It is shown that the derived GACOx indices exhibit a mean difference between the intact/impaired regions of 1.54 ± 0.26 (mean ± SD), compared to 0.14 ± 0.10 for the traditional COx method. The GACOx effectively polarizes the COx data in order to better differentiate the intact and impaired zones and, in doing so, makes the determination of the LLA and ULA points a simpler and more consistent task. The method lends itself to the automation of the robust determination of autoregulation zone limits.
authors: Medtronic Respiratory and Monitoring Solutions, Edinburgh, Scotland, UK. paul.addison@medtronic.com.
authors: Paul S
authors: http://orcid.org/0000-0002-6925-0935
authors: PS
authors: Addison
authors: Medtronic Respiratory and Monitoring Solutions, Edinburgh, Scotland, UK.
authors: André
authors: http://orcid.org/0000-0002-9428-8759
authors: A
authors: Antunes
authors: Medtronic Respiratory and Monitoring Solutions, Edinburgh, Scotland, UK.
authors: Dean
authors: http://orcid.org/0000-0001-5200-3439
authors: D
authors: Montgomery
authors: Medtronic Respiratory and Monitoring Solutions, Boulder, CO, USA.
authors: Ulf R
authors: UR
authors: Borg
mesh_terms: D000465:Algorithms; D000818:Animals; D062186:Arterial Pressure; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001921:Brain / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D001330:Electronic Data Processing; D005260:Female; D006706:Homeostasis; D008962:Models, Theoretical; D010100:Oxygen / Q000737:chemistry; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012815:Signal Processing, Computer-Assisted; D019265:Spectroscopy, Near-Infrared; D013552:Swine
chemical_list: D010100:Oxygen
keywords: Blood pressure; Cerebral autoregulation; Regional oxygen saturation