Cerebral autoregulatory performance and the cerebrovascular response to head‐of‐bed positioning in acute ischaemic stroke

Background and purpose Cerebrovascular responses to head‐of‐bed positioning in patients with acute ischaemic stroke are heterogeneous, questioning the applicability of general recommendations on head positioning. Cerebral autoregulation is impaired to various extents after acute stroke, although it...

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Bibliographic Details
Published in:European journal of neurology 2018-11, Vol.25 (11), p.1365-e117
Main Authors: Truijen, J., Rasmussen, L. S., Kim, Y. S., Stam, J., Stok, W. J., Pott, F. C., Lieshout, J. J.
Format: Article
Language:English
Subjects:
Blood flow
Blood pressure
Blood volume
Cerebral blood flow
cerebral infarction
Cerebrovascular system
Doppler effect
Flow velocity
Hemispheres
Hemodynamics
Hemoglobin
Infrared spectroscopy
near‐infrared spectroscopy
Original
patient positioning
Patients
Perfusion
Posture
Stroke
transcranial Doppler ultrasonography
Transfer functions
Ultrasound
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Summary:Background and purpose Cerebrovascular responses to head‐of‐bed positioning in patients with acute ischaemic stroke are heterogeneous, questioning the applicability of general recommendations on head positioning. Cerebral autoregulation is impaired to various extents after acute stroke, although it is unknown whether this affects cerebral perfusion during posture change. We aimed to elucidate whether the cerebrovascular response to head position manipulation depends on autoregulatory performance in patients with ischaemic stroke. Methods The responses of bilateral transcranial Doppler ultrasound‐determined cerebral blood flow velocity (CBFV) and local cerebral blood volume (CBV), assessed by near‐infrared spectroscopy of total hemoglobin tissue concentration ([total Hb]), to head‐of‐bed lowering from 30° to 0° were determined in 39 patients with acute ischaemic stroke and 17 reference subjects from two centers. Cerebrovascular autoregulatory performance was expressed as the phase difference of the arterial pressure‐to‐CBFV transfer function. Results Following head‐of‐bed lowering, CBV increased in the reference subjects only ([total Hb]: + 2.1 ± 2.0 vs. + 0.4 ± 2.6 μM; P < 0.05), whereas CBFV did not change in either group. CBV increased upon head‐of‐bed lowering in the hemispheres of patients with autoregulatory performance
ISSN:1351-5101
1468-1331
DOI:10.1111/ene.13737