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Updated: Jan 16, 2026
Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
Published on: March 14, 2013
Clinical research study: cerebral autoregulation in neonates and infants undergoing open heart surgery: global
Pierre Bourgoin1,2,3, Erta Beqiri4, Peter Smielewski4
1IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, University of Bordeaux, Pessac, France. Pierre.bourgoin@chu-nantes.fr.
Insights
Cardiopulmonary bypass often disrupts cerebral autoregulation (CAR) in children. Monitoring CAR allows for individualized optimal mean arterial pressure (MAP) targets, improving perfusion and outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Neuroprotection
- Perfusion Management
Background:
- Optimal perfusion pressure during pediatric cardiopulmonary bypass (CPB) remains debated.
- Cerebral autoregulation (CAR) monitoring can guide perfusion pressures, but its feasibility in children needs study.
Purpose of the Study:
- To investigate the feasibility and clinical significance of CAR monitoring in children undergoing CPB.
- To explore associations between CAR-derived metrics and postoperative outcomes.
Main Methods:
- Prospective observational study calculating Cerebral Oxygenation Index (COx) from mean arterial pressure (MAP) and cerebral oxygenation.
- Assessing CAR disruption during CPB and its restoration post-CPB.
- Correlating CAR metrics with patient factors and postoperative outcomes.
Main Results:
- CPB significantly disrupted CAR (COx increased from 0.17±0.17 to 0.36±0.13).
- CAR partially restored post-CPB (mean COx 0.32±0.16).
- Lower MAP below the lower limit of autoregulation during CPB correlated with adverse outcomes (creatinine ratio, lactate levels).
Conclusions:
- CPB commonly disrupts CAR, necessitating careful perfusion management.
- Individualized optimal MAP targets using CAR monitoring are feasible in pediatric CPB.
- Maintaining optimal perfusion pressure improves systemic and cerebral perfusion.
Background:
Optimal perfusion pressure targets during cardiopulmonary bypass in children are debated. Monitoring of CAR allow determination of optimal perfusion pressures, but its feasibility within a large cohort of children warrants further investigations.
Methods:
Prospective, single center, observational study. Cerebral Oxygenation Index (COx) was calculated as a moving linear correlation coefficient between slow waves of mean arterial pressure (MAP) and cerebral oxygenation saturation. Postoperative outcomes were recorded and associations with CAR derived metrics were explored.
Results:
Mean COx values demonstrated CAR disruption during CPB (0.17 ± 0.17 before vs. 0.36 ± 0.13 during, p < 0.001). Post-CPB, CAR restored partially (mean Cox 0.32 ± 0.16, p < 0.05). Factors associated with CAR Disruption were age at surgery and average hematocrit during CPB. MAPopt determination was feasible in 83.3%, 75.4%, and 67.5% of patients before, during, and after surgery, respectively. LLA was determined in 78.1%, 53.5%, and 56.1%, and ULA in 71%, 50%, and 57% during the same time frames. Dose of MAP below LLA during CPB was independently associated with pre-postoperative serum creatinine ratio and 24 h postoperative serum lactate levels.
Conclusions:
The findings highlight the clinical significance of CAR monitoring, with implications for optimizing cerebral and systemic perfusion in this vulnerable population.
Impact:
In most cases, cardiopulmonary bypass is associated with CAR disruption, highlighting the need for rigorous perfusion pressure management. Individualized determination of optimal MAP target is feasible in neonates and infants undergoing cardiopulmonary bypass using CAR-derived metrics. The time spent within a range of optimal pressure is associated with better body perfusion. Live determination of optimal MAP may be used to develop individualized PAM management interventions, and ultimately improve body perfusion including the brain.
