Validation of transcranial near-infrared spectroscopy for evaluation of cerebral blood flow autoregulation

The aim of the study was to evaluate a new noninvasive transcranial near-infrared spectroscopy (TNIRS) technique for determination of the lower limit of cerebral blood flow (CBF) autoregulation by comparing this technique with the standard cerebral arteriovenous oxygen saturation difference (AVDo(2)) method. In eight healthy volunteers, mean arterial blood pressure was increased by infusion of angiotensin and decreased by the combination of lower-body negative pressure and labetalol. For each 5-mm Hg change in mean arterial pressure, blood was sampled from the bulb of the internal jugular vein and a radial artery, and simultaneously, the oxygen saturation of hemoglobin in the brain was measured with an INVOS 3100 Cerebral Oximeter (Somanetics). The lower limit of autoregulation was then calculated by a computer using (a) AVDo(2) and (b) the difference between arterial oxygen saturation and the saturation determined with the cerebral oximeter (ACDo(2)). The median lower limit of autoregulation determined by the two methods was 73 and 78.5 mm Hg, respectively (p > 0.05). A statistically significant correlation between relative CBF (percentage of baseline) determined with the two methods was found below the lower limit of autoregulation (1/AVDo(2) = 12 + 0.8 x 1/ACDo(2); r = 0.55; p < 0.001). For all the 98 pairs of saturations registered, the correlation was 0.37 (p < 0.001), the mean difference was 16%, and the limits of agreement were -2.2 and 33.8%. We conclude that the cerebral oximeter might be useful in evaluation of the lower limit of cerebral autoregulation. This method, however, is of no value for estimation of levels of global cerebral oxygen saturation.