Poor agreement between transcranial Doppler and near-infrared spectroscopy-based estimates of cerebral blood flow changes in sepsis
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Poor agreement between transcranial Doppler and near-infrared spectroscopy-based estimates of cerebral blood flow changes in sepsis. / Toksvang, Linea N; Plovsing, Ronni R; Petersen, Marie W.; Møller, Kirsten; Berg, Ronan M G.
In: Clinical Physiology and Functional Imaging, Vol. 34, No. 5, 2014, p. 405-409.Research output: Contribution to journal › Journal article › Research › peer-review
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T1 - Poor agreement between transcranial Doppler and near-infrared spectroscopy-based estimates of cerebral blood flow changes in sepsis
AU - Toksvang, Linea N
AU - Plovsing, Ronni R
AU - Petersen, Marie W.
AU - Møller, Kirsten
AU - Berg, Ronan M G
N1 - © 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.
PY - 2014
Y1 - 2014
N2 - BACKGROUND: Continuous monitoring of cerebral blood flow (CBF) may be valuable in critically ill patients with sepsis. In this study, we compared spatially resolved near-infrared spectroscopy (NIRS) to transcranial Doppler ultrasound (TCD)-derived estimates of noradrenaline-associated changes in CBF in such patients.METHODS: Mean arterial blood pressure (MAP) was elevated by increasing the noradrenaline infusion rate in eight mechanically ventilated, critically ill patients diagnosed with severe sepsis or septic shock. The associated changes in CBF were assessed by simultaneous ipsilateral NIRS (ScO(2)) and TCD (middle cerebral artery blood flow velocity, MCAv) measurements.RESULTS: A total of fifteen simultaneous NIRS- and TCD-derived assessments of noradrenaline-associated changes in CBF were obtained. MAP was increased from 74 (median; interquartile range (IQR), 71-90) to 100 (median; IQR, 93-115) mmHg (P<0·05), which was associated with an increase in MCAv of 14% (median; IQR, 2-22; P<0·05), whereas no changes were observed in ScO(2) ; 1% (median; IQR, [-4]-3; P = 0·96). A Bland-Altman plot was used to compare the two methods and showed a poor agreement between NIRS- and TCD-derived estimates with a relative bias of 14% and limits of agreement of -18% to 45% change in CBF.CONCLUSION: Our findings stress that TCD and NIRS cannot be used interchangeably for monitoring changes in cerebral haemodynamics in critically ill patients with sepsis receiving vasopressor treatment with noradrenaline.
AB - BACKGROUND: Continuous monitoring of cerebral blood flow (CBF) may be valuable in critically ill patients with sepsis. In this study, we compared spatially resolved near-infrared spectroscopy (NIRS) to transcranial Doppler ultrasound (TCD)-derived estimates of noradrenaline-associated changes in CBF in such patients.METHODS: Mean arterial blood pressure (MAP) was elevated by increasing the noradrenaline infusion rate in eight mechanically ventilated, critically ill patients diagnosed with severe sepsis or septic shock. The associated changes in CBF were assessed by simultaneous ipsilateral NIRS (ScO(2)) and TCD (middle cerebral artery blood flow velocity, MCAv) measurements.RESULTS: A total of fifteen simultaneous NIRS- and TCD-derived assessments of noradrenaline-associated changes in CBF were obtained. MAP was increased from 74 (median; interquartile range (IQR), 71-90) to 100 (median; IQR, 93-115) mmHg (P<0·05), which was associated with an increase in MCAv of 14% (median; IQR, 2-22; P<0·05), whereas no changes were observed in ScO(2) ; 1% (median; IQR, [-4]-3; P = 0·96). A Bland-Altman plot was used to compare the two methods and showed a poor agreement between NIRS- and TCD-derived estimates with a relative bias of 14% and limits of agreement of -18% to 45% change in CBF.CONCLUSION: Our findings stress that TCD and NIRS cannot be used interchangeably for monitoring changes in cerebral haemodynamics in critically ill patients with sepsis receiving vasopressor treatment with noradrenaline.
KW - Adrenergic alpha-Agonists/administration & dosage
KW - Aged
KW - Arterial Pressure
KW - Biomarkers/blood
KW - Blood Flow Velocity
KW - Cerebrovascular Circulation/drug effects
KW - Critical Illness
KW - Female
KW - Humans
KW - Infusions, Parenteral
KW - Male
KW - Middle Aged
KW - Middle Cerebral Artery/diagnostic imaging
KW - Norepinephrine/administration & dosage
KW - Oximetry/methods
KW - Oxygen/blood
KW - Predictive Value of Tests
KW - Regional Blood Flow
KW - Reproducibility of Results
KW - Respiration, Artificial
KW - Sepsis/blood
KW - Spectroscopy, Near-Infrared
KW - Time Factors
KW - Ultrasonography, Doppler, Pulsed
KW - Ultrasonography, Doppler, Transcranial
U2 - 10.1111/cpf.12120
DO - 10.1111/cpf.12120
M3 - Journal article
C2 - 24750661
VL - 34
SP - 405
EP - 409
JO - Clinical Physiology and Functional Imaging
JF - Clinical Physiology and Functional Imaging
SN - 1475-0961
IS - 5
ER -
ID: 236993014