• Wesley B Baker, Ashwin B Parthasarathy, Kimberly P Gannon, Venkaiah C Kavuri, David R Busch, Kenneth Abramson, Lian He, Rickson C Mesquita, Michael T Mullen, John A Detre, Joel H Greenberg, Daniel J Licht, Ramani Balu, W Andrew Kofke, and Arjun G Yodh.
• 1 Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, USA.
• J. Cereb. Blood Flow Metab. 2017 Aug 1; 37 (8): 2691-2705.

AbstractThe critical closing pressure ( CrCP) of the cerebral circulation depends on both tissue intracranial pressure and vasomotor tone. CrCP defines the arterial blood pressure ( ABP) at which cerebral blood flow approaches zero, and their difference ( ABP -  CrCP) is an accurate estimate of cerebral perfusion pressure. Here we demonstrate a novel non-invasive technique for continuous monitoring of CrCP at the bedside. The methodology combines optical diffuse correlation spectroscopy (DCS) measurements of pulsatile cerebral blood flow in arterioles with concurrent ABP data during the cardiac cycle. Together, the two waveforms permit calculation of CrCP via the two-compartment Windkessel model for flow in the cerebral arterioles. Measurements of CrCP by optics (DCS) and transcranial Doppler ultrasound (TCD) were carried out in 18 healthy adults; they demonstrated good agreement (R = 0.66, slope = 1.14 ± 0.23) with means of 11.1 ± 5.0 and 13.0 ± 7.5 mmHg, respectively. Additionally, a potentially useful and rarely measured arteriole compliance parameter was derived from the phase difference between ABP and DCS arteriole blood flow waveforms. The measurements provide evidence that DCS signals originate predominantly from arteriole blood flow and are well suited for long-term continuous monitoring of CrCP and assessment of arteriole compliance in the clinic.

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