Comparison between two static autoregulation evaluation methods

Cerebral static autoregulation (AR) was evaluated at bedside in 14 severely head injured patients. 16 investigations were performed. Cerebral perfusion pressure (CPP) was increased by infusing vasopressors during one hour, and registered every 2-5 minutes. CBF was simultaneously estimated by: 1) middle cerebral artery mean flow velocity (FV) monitoring with Transcranial Doppler (TDC), and 2) the reciprocal of arteriovenous oxygen content difference, calculated from basal and hypertensive arterial and jugular bulb blood samples. AR assessment: For TCD results, linear regression method was used, studying two pairs of variables: a) %FV-CPP (the regression slope was the main AR value adopted) and b) % cerebrovascular resistance (CVR)-%CPP. For the AVDO2 method, autoregulation was considered preserved if estimated % delta CBF/delta PPE < 1%/mm Hg. TCD method clearly defined three groups. Group 1 and 2 (8 and 5 investigations) were considered as two grades of preserved AR, and the third one (3 cases) as impaired AR. AVDO2 method: 12 studies were evaluated. 10 showed preserved AR, and 2 impaired AR. There was coincidence of results from both methods in 10 out of 12 studies. (0.83).