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British Journal of Anaesthesia
BJA

Intraoperative utilisation of high-resolution data for cerebral autoregulation: a feasibility study

Published:December 03, 2021DOI:https://doi.org/10.1016/j.bja.2021.10.035
      Editor—In this feasibility study we show the feasibility of automatic intraoperative near-infrared spectroscopy (NIRS) and arterial BP (ABP) monitoring for calculation of cerebral autoregulation lower and upper limits and optimal ABP (the ABP with the most robust autoregulation) for a given number of patients. This retrospective feasibility study included 55 patients who underwent off-pump coronary artery bypass graft in January and February 2021 at our institution (IRB# 300005436, University of Alabama at Birmingham). It is known that time spent outside lower and upper limits of autoregulation is associated with post-procedure morbidity, and increases the risk of organ injury and dysfunction in cardiac surgery.
      • Montgomery D.
      • Brown C.
      • Hogue C.W.
      • et al.
      Real-time intraoperative determination and reporting of cerebral autoregulation state using near-infrared spectroscopy.
      ,
      • Ono M.
      • Arnaoutakis G.J.
      • Fine D.M.
      • et al.
      Blood pressure excursions below the cerebral autoregulation threshold during cardiac surgery are associated with acute kidney injury.
      Automated calculation and quality checks of these parameters in real time at multiple sites may improve clinical practice, and impact intraoperative goal-directed haemodynamic management. A first step is demonstrating the feasibility of an automated workflow. Therefore, we considered the fraction of quality (i.e. meeting the specifications defined by Aries and colleagues
      • Aries M.J.H.
      • Czosnyka M.
      • Budohoski K.P.
      • et al.
      Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury.
      ) cerebral autoregulation curves across all patients as our main outcome measure, and secondarily calculated mean and standard deviation for lower and upper limits of autoregulation and optimal ABP.

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