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Reliability of cerebral blood flow measurements by transcerebral double-indicator dilution technique
F Mielck1, G Wietasch, A Weyland
1Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany. fmielck@gwdg.de
Background And Objective:
The recently developed transcerebral double-indicator dilution technique has proven to be a feasible monitoring alternative to measure global cerebral blood flow at the bedside. However, the short-term repeatability of transcerebral double-indicator dilution measurements has not yet been investigated. The present study was designed to investigate the accuracy in terms of reliability for repeated transcerebral double-indicator dilution measurements to assess global cerebral blood flow during a definite carbon dioxide challenge in a clinical trial.
Methods:
The investigation was performed in 10 patients scheduled for elective coronary artery bypass grafting. After induction of anaesthesia, repeated cerebral blood flow measurements using transcerebral double-indicator dilution were performed during target normocapnia, hypocapnia and hypercapnia. For transcerebral double-indicator dilution measurements, a bolus injection of ice-cold indocyanine green was administered into a central vein. The resulting thermal dye dilution curves were recorded simultaneously in the aorta and the jugular bulb using combined fibreoptic thermistor catheters. Cerebral blood flow was calculated from the mean transit times of the indicators through the brain. Additionally, transcranial Doppler sonography was simultaneously performed to measure transient changes in the cerebral blood flow velocity.
Results:
Transcerebral double-indicator dilution measurements revealed a reasonable coefficient of repeatability with 9.1, 9.7 and 20.2 mL min-1 100 g-1 during normo-, hypo- and hypercapnic conditions, respectively. However, a total of 20% of the administered measurements had to be rejected for methodological reasons.
Conclusions:
Repeated measurements with the transcerebral double-indicator dilution method show a reasonable repeatability. With consideration to the limitations of the transcerebral double-indicator dilution technique, this new method proves to be a reliable monitoring tool to measure global cerebral blood flow at the bedside.