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Determining Optimal Mean Arterial Blood Pressure Based on Cerebral Autoregulation in Children after Cardiac Surgery
Laurence Tabone1,2, Jihad El-Tannoury3, Michael Levy4
1Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
Insights
Continuous determination of optimal mean arterial blood pressure (opt-MAP) is feasible in children post-cardiac surgery. This method helps monitor cerebral autoregulation and identify time spent outside safe blood pressure limits.
Area of Science:
- Pediatric critical care medicine
- Neurocritical care
- Cerebrovascular physiology
Background:
- Cerebral autoregulation is crucial for maintaining stable cerebral blood flow.
- Optimal mean arterial blood pressure (opt-MAP) targets are vital in pediatric cardiac surgery patients.
- Assessing cerebral autoregulation continuously can guide hemodynamic management.
Purpose of the Study:
- To assess the feasibility of continuous opt-MAP determination post-cardiac surgery in children.
- To describe opt-MAP, autoregulation limits, and time outside these limits.
- To evaluate the burden of deviation from autoregulation limits.
Main Methods:
- Cerebral autoregulation assessed via correlation coefficient (COx) between cerebral oxygenation and MAP.
- opt-MAP determined using weighted multiple time windows on COx-MAP plots.
- Time spent outside autoregulation limits and deviation burden calculated for each patient.
Main Results:
- Continuous opt-MAP calculation was feasible for 94% of monitored time.
- opt-MAP was significantly lower in neonates (<1 month old).
- Patients spent 24% of monitored time outside autoregulation limits, irrespective of age group.
Conclusions:
- Continuous opt-MAP determination is feasible in children within 48 hours of cardiac surgery.
- This approach allows for dynamic assessment of cerebral autoregulation.
- Understanding time outside autoregulation limits can inform clinical management strategies.
Abstract:
To evaluate the feasibility of continuous determination of the optimal mean arterial blood pressure (opt-MAP) according to cerebral autoregulation and to describe the opt-MAP, the autoregulation limits, and the time spent outside these limits in children within 48 h of cardiac surgery. Cerebral autoregulation was assessed using the correlation coefficient (COx) between cerebral oxygenation and MAP in children following cardiac surgery. Plots depicting the COx according to the MAP were used to determine the opt-MAP using weighted multiple time windows. For each patient, we estimated (1) the time spent with MAP outside the autoregulation limits and (2) the burden of deviation, defined as the area between the MAP curve and the autoregulation limits when the MAP was outside these limits. Fifty-one patients with a median age of 7.1 (IQR 0.7-52.0) months old were included. The opt-MAP was calculated for 94% (IQR 90-96) of the monitored time. The opt-MAP was significantly lower in neonates < 1 month old. The patients spent 24% (18-31) of the time outside of the autoregulation limits, with no significant differences between age groups. Continuous determination of the opt-MAP is feasible in children within the first 48 h following cardiac surgery.
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