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Reproducibility of the blood flow index as noninvasive, bedside estimation of cerebral blood flow

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Abstract

Objective

To investigate the feasibility and reproducibility of the blood flow index (BFI) method for measuring cerebral blood flow.

Design and setting

Prospective functional study in pediatric intensive care.

Patients and participants

14 consecutive patients with median age of 2 months (range 1 days–11 years) requiring artificial ventilation, invasive arterial blood pressure monitoring, and central venous access.

Interventions

The first passage of an intravenous indocyanine green (ICG) bolus through the cerebral vasculature was monitored by noninvasive near-infrared spectroscopy. BFI was calculated by dividing maximal ICG absorption change by rise time. Reproducibility was evaluated by six ICG injections at 5-min intervals.

Results

Of all ICG injections 6% were canceled, and 4% were eliminated due to injection failures. Median BFI of 17 reproducibility determinations was 71 (range 12–213) and median coefficient of variation (CV) of BFI was 10% (4.9–18.5). The quantity of ICG bolus did not affect the CV (0.1 vs. 0.3 mg ICG/kg). Eight reproducibility tests in patients after cardiac surgery had smaller CV than the others, and the eight in newborns had higher CV than in older children. Patient parameters such as arterial blood pressure, endtidal CO2, and percutaneous oxygen saturation were stable and showed CV below 2% during reproducibility determination.

Conclusions

The BFI method allows rapid and repeated measurements of CBF with good feasibility and reproducibility. As a relative but not absolute measure of CBF, BFI seems to be suited for clinical evaluation of intraindividual CBF changes during determination of cerebrovascular reactivities or during therapeutic interventions.

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References

  1. Paulson OB, Strandgaard S, Edvinsson L (1990) Cerebral autoregulation. Cerebrovasc Brain Metab Rev 2:161–192

    CAS  PubMed  Google Scholar 

  2. Wittlich F, Kohno K, Mies G, Norris DG, Hoehn-Berlage M (1995) Quantitative measurement of regional blood flow with gadolinium diethylenetriamine pentaacetate bolus track NMR imaging in cerebral infarcts in rats: validation with the iodo [14C]antipyrine technique. Proc Natl Acad Sci U S A 92:1846–1850

    CAS  PubMed  Google Scholar 

  3. Ye FQ, Berman KF, Ellmore T, Esposito G, van Horn JD, Yang Y, Duyn J, Smith AM, Frank JA, Weinberger DR, McLaughlin AC (2000) H (2)(15) O PET validation of steady-state arterial spin tagging cerebral blood flow measurements in humans. Magn Reson Med 44:450–456

    Article  CAS  PubMed  Google Scholar 

  4. Vajkoczy P, Roth H, Horn P, Lucke T, Thome C, Hubner U, Martin GT, Zappletal C, Klar E, Schilling L, Schmiedek P (2000) Continuous monitoring of regional cerebral blood flow: experimental and clinical validation of a novel thermal diffusion microprobe. J Neurosurg 93:265–274

    CAS  PubMed  Google Scholar 

  5. Raichle ME, Martin WR, Herscovitch P, Mintun MA, Markham J (1983) Brain blood flow measured with intravenous H2 (15) O. II. Implementation and validation. J Nucl Med 24:790–798

    CAS  PubMed  Google Scholar 

  6. Schutt S, Horn P, Roth H, Quintel M, Schilling L, Schmiedek P, Schure L (2001) Bedside monitoring of cerebral blood flow by transcranial thermo-dye-dilution technique in patients suffering from severe traumatic brain injury or subarachnoid hemorrhage. J Neurotrauma 18:595–605

    Article  CAS  PubMed  Google Scholar 

  7. Kuebler WM, Sckell A, Habler O, Kleen M, Kuhnle GE, Welte M, Messmer K, Goetz AE (1998) Noninvasive measurement of regional cerebral blood flow by near-infrared spectroscopy and indocyanine green. J Cereb Blood Flow Metab 18:445–456

    CAS  PubMed  Google Scholar 

  8. Wyatt JS, Cope M, Delpy DT, Wray S, Reynolds EO (1986) Quantification of cerebral oxygenation and haemodynamics in sick newborn infants by near infrared spectrophotometry. Lancet II:1063–1066

    Google Scholar 

  9. Tateishi A, Maekawa T, Soejima Y, Sadamitsu D, Yamamoto M, Matsushita M, Nakashima K (1995) Qualitative comparison of carbon dioxide-induced change in cerebral near-infrared spectroscopy versus jugular venous oxygen saturation in adults with acute brain disease. Crit Care Med 23:1734–1738

    CAS  PubMed  Google Scholar 

  10. Smielewski P, Kirkpatrick P, Minhas P, Pickard JD, Czosnyka M (1995) Can cerebrovascular reactivity be measured with near-infrared spectroscopy? Stroke 26:2285–2292

    CAS  PubMed  Google Scholar 

  11. Soul JS, Taylor GA, Wypij D, Duplessis AJ, Volpe J (2000) Noninvasive detection of changes in cerebral blood flow by near-infrared spectroscopy in a piglet model of hydrocephalus. Pediatr Res 48:445–449

    CAS  PubMed  Google Scholar 

  12. Perbeck L, Lund F, Svensson L, Thulin L (1985) Fluorescein flowmetry: a method for measuring relative capillary blood flow in the intestine. Clin Physiol 5:281–292

    CAS  PubMed  Google Scholar 

  13. Perbeck L, Lewis DH, Thulin L, Tyden G (1985) Correlation between fluorescein flowmetry, 133Xenon clearance and electromagnetic flow measurement: a study in the intestine of the pig. Clin Physiol 5:293–299

    CAS  PubMed  Google Scholar 

  14. Schoning M, Scheel P (1996) Color duplex measurement of cerebral blood flow volume: intra- and interobserver reproducibility and habituation to serial measurements in normal subjects. J Cereb Blood Flow Metab 16:523–531

    CAS  PubMed  Google Scholar 

  15. Madsen PL, Schmidt JF, Wildschiodtz G, Friberg L, Holm S, Vorstrup S, Lassen NA (1991) Cerebral O2 metabolism and cerebral blood flow in humans during deep and rapid-eye-movement sleep. J Appl Physiol 70:2597–2601

    CAS  PubMed  Google Scholar 

  16. Morita-Tsuzuki Y, Bouskela E, Hardebo JE (1992) Vasomotion in the rat cerebral microcirculation recorded by laser-Doppler flowmetry. Acta Physiol Scand 146:431–439

    CAS  PubMed  Google Scholar 

  17. Urlesberger B, Trip K, Ruchti JJ, Kerbl R, Reiterer F, Muller W (1998) Quantification of cyclical fluctuations in cerebral blood volume in healthy infants. Neuropediatrics 29:208–211

    CAS  PubMed  Google Scholar 

  18. Taga G, Konishi Y, Maki A, Tachibana T, Fujiwara M, Koizumi H (2000) Spontaneous oscillation of oxy- and deoxy-hemoglobin changes with a phase difference throughout the occipital cortex of newborn infants observed using non-invasive optical topography. Neurosci Lett 282:101–104

    Article  CAS  PubMed  Google Scholar 

  19. Kety SS, Schmidt CF (1945) The determination of cerebral blood flow in man by the use of nitrous oxide in low concentrations. Am J Physiol 143:53–66

    CAS  Google Scholar 

  20. Dorfler P, Puls I, Schliesser M, Maurer M, Becker G (2000) Measurement of cerebral blood flow volume by extracranial sonography. J Cereb Blood Flow Metab 20:269–271

    CAS  PubMed  Google Scholar 

  21. Garski TR, Staller BJ, Hepner G, Banka vs, Finney RA (1978) Adverse reactions after administration of indocyanine green. JAMA 240:635

    CAS  Google Scholar 

  22. Abels C, Karrer S, Baumler W, Goetz AE, Landthaler M, Szeimies RM (1998) Indocyanine green and laser light for the treatment of AIDS-associated cutaneous Kaposi's sarcoma. Br J Cancer 77:1021–1024

    CAS  PubMed  Google Scholar 

  23. Newton CR, Wilson DA, Gunnoe E, Wagner B, Cope M, Traystman RJ (1997) Measurement of cerebral blood flow in dogs with near infrared spectroscopy in the reflectance mode is invalid. J Cereb Blood Flow Metab 17:695–703

    CAS  PubMed  Google Scholar 

  24. Bucher HU, Edwards AD, Lipp AE, Duc G (1993) Comparison between near infrared spectroscopy and 133Xenon clearance for estimation of cerebral blood flow in critically ill preterm infants. Pediatr Res 33:56–60

    CAS  PubMed  Google Scholar 

  25. Roberts IG, Fallon P, Kirkham FJ, Kirshbom PM, Cooper CE, Elliott MJ, Edwards AD (1998) Measurement of cerebral blood flow during cardiopulmonary bypass with near-infrared spectroscopy. J Thorac Cardiovasc Surg 115:94–102

    CAS  PubMed  Google Scholar 

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Acknowledgements

This research was funded by the Swiss National Science Foundation no. 32-51078.97. We thank Mark Cope, Department of Medical Physics and Bioengineering, University College of London, London, UK, for contributing the specific extinction coefficients of ICG. These findings were presented in part at the Meeting of the European Society of Pediatric Research, June 1999 Copenhagen.

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Authors and Affiliations

  1. Pediatric Intensive Care, Department of Pediatrics, Inselspital, University of Berne, 3010, Berne, Switzerland

    Bendicht P. Wagner

  2. Pediatric Intensive Care, Department of Pediatrics, University of Berne, Berne, Switzerland

    Susanne Gertsch

  3. Department of Pediatrics, University of Berne, Berne, Switzerland

    Roland A. Ammann

  4. Pediatric Intensive Care, Department of Pediatrics, University of Berne, Berne, Switzerland

    Juerg Pfenninger

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  1. Bendicht P. Wagner
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  2. Susanne Gertsch
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  3. Roland A. Ammann
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  4. Juerg Pfenninger
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Correspondence to Bendicht P. Wagner.

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Wagner, B.P., Gertsch, S., Ammann, R.A. et al. Reproducibility of the blood flow index as noninvasive, bedside estimation of cerebral blood flow. Intensive Care Med 29, 196–200 (2003). https://doi.org/10.1007/s00134-002-1592-z

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  • DOI: https://doi.org/10.1007/s00134-002-1592-z

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