Quick Assessment of the Lower Limit of Autoregulation by Use of Transcranial Doppler Ultrasound During Cardiac Surgery.

Introduction: Assessment of the individual safest minimal mean arterial pressure (MAP) during cardiac surgery remains empirical. The objective of this study was to evaluate the lower limit of autoregulation (LLA) within a short period (15 min).

Methods: After developing autoregulation software (OptiMAP) incorporated into transcranial Doppler ultrasound (Waki-Atys, Lyon, France), we monitored the mean blood flow velocity (MV) and MAP. Thirty successive values of MV and MAP were automatically analysed to calculate the correlation (Mx) between the two parameters. We compared two methods of Mx sampling during a period of 15 min: Mx = long averaging windows (one MAP/MV pair recorded every 10 s), and Mx = short averaging windows (one MAP/MV pair recorded every 2 s). The LLA value calculated from the whole recording (Mx) was used as the reference. Autoregulation was considered impaired at an Mx value >0.35.

Results: Five patients were included in the study. The surgery lasted for 138 ± 32 min and cardiopulmonary bypass lasted for 72 ± 33 min. MAP and MV were recorded for 117 ± 24 min. MAP varied from 33 ± 10 to 92 ± 10 mmHg. LLA calculated from the whole recording (Mx) was similar to LLA calculated from the 15-min recording (Mx): 70 ± 2.5 versus 73 ± 3.5 mmHg. MAP remained below LLA during 48 ± 12% of the recording. During the 15-min recording, Mx was not able to calculate the LLA value.

Conclusion: In cases of haemodynamic instability, decreasing the Mx sampling window seems to accurately detect LLA.