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Background <p>Patient differences from optimal mean arterial pressure (MAP<sub>OPT</sub>) derived by a cerebral oximetry index (COx_a) are associated with outcome, but the validity of COx_a-derived MAP<sub>OPT</sub> remains in question due to the lack of agreement with pressure reactivity index (PRx)–derived MAP<sub>OPT</sub>. The study aimed to elucidate the relationship between PRx and COx_a to justify the use of COx_a and COx_a-derived MAP<sub>OPT</sub> in patients with aneurysmal subarachnoid hemorrhage (aSAH).</p> Methods <p>This was a retrospective single-center study of six patients with aSAH with simultaneous near-infrared spectroscopy, intracranial pressure, and MAP monitoring. Repeated-measures Pearson correlation and Bland–Altman plot analysis were performed to compare PRx and COx_a and to compare PRx-derived MAP<sub>OPT</sub> and COx_a-derived MAP<sub>OPT</sub>. Coinciding changes in PRx and COx_a were compared, and the ability of COx_a to detect PRx-based autoregulation impairment was assessed over different time windows.</p> Results <p>Repeated-measures Pearson correlation analysis showed no correlation between PRx and COx_a (<i>r</i> = 0.06, <i>p</i> &lt; 0.01). The correlation between PRx- and COx_a-derived MAP<sub>OPT</sub> over 388&#xa0;h was <i>r</i> = 0.50 (<i>p</i> &lt; 0.01). The bias and upper and lower limits of agreement were − 1.60, + 20.24, and − 23.43&#xa0;mm&#xa0;Hg, respectively. The shift in the overall distribution of moving correlation to higher values as the time-window length increased was more pronounced for COx_a than PRx (COx_a: 0.09–0.41, PRx: 0.00–0.15). When using a typical PRx threshold of 0.3, COx_a was found to be ineffective in identifying impaired autoregulation across all time windows (area under the receiver operating characteristic curve: 0.494–0.527).</p> Conclusions <p>The threshold applied to PRx should not be applied to COx_a. It is suggested to consider higher thresholds for COx_a than PRx in deriving the range for MAP<sub>OPT</sub> calculations for continuous cerebral autoregulation assessment in aSAH. Further research is needed to optimize the MAP<sub>OPT</sub> derived from PRx and COx_a based on specific monitoring targets.</p>

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The Relationship Between Pressure Reactivity and Cerebral Oximetry Indexes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Single-Center Pilot Study

  • 期刊论文

  • 发表日期：

    2025年8月8日

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  • Yunseo Ku,
  • Murad Megjhani,
  • Tammam Alalqum,
  • Soon Bin Kwon,
  • Daniel Nametz,
  • Bennett Weinerman,
  • Angela Velazquez,
  • Shivani Ghoshal,
  • Sachin Agarwal,
  • David J. Roh,
  • E. Sander Connolly Jr.,
  • Jan Claassen,
  • Soojin Park

摘要

Background

Patient differences from optimal mean arterial pressure (MAPOPT) derived by a cerebral oximetry index (COx_a) are associated with outcome, but the validity of COx_a-derived MAPOPT remains in question due to the lack of agreement with pressure reactivity index (PRx)–derived MAPOPT. The study aimed to elucidate the relationship between PRx and COx_a to justify the use of COx_a and COx_a-derived MAPOPT in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods

This was a retrospective single-center study of six patients with aSAH with simultaneous near-infrared spectroscopy, intracranial pressure, and MAP monitoring. Repeated-measures Pearson correlation and Bland–Altman plot analysis were performed to compare PRx and COx_a and to compare PRx-derived MAPOPT and COx_a-derived MAPOPT. Coinciding changes in PRx and COx_a were compared, and the ability of COx_a to detect PRx-based autoregulation impairment was assessed over different time windows.

Results

Repeated-measures Pearson correlation analysis showed no correlation between PRx and COx_a (r = 0.06, p < 0.01). The correlation between PRx- and COx_a-derived MAPOPT over 388 h was r = 0.50 (p < 0.01). The bias and upper and lower limits of agreement were − 1.60, + 20.24, and − 23.43 mm Hg, respectively. The shift in the overall distribution of moving correlation to higher values as the time-window length increased was more pronounced for COx_a than PRx (COx_a: 0.09–0.41, PRx: 0.00–0.15). When using a typical PRx threshold of 0.3, COx_a was found to be ineffective in identifying impaired autoregulation across all time windows (area under the receiver operating characteristic curve: 0.494–0.527).

Conclusions

The threshold applied to PRx should not be applied to COx_a. It is suggested to consider higher thresholds for COx_a than PRx in deriving the range for MAPOPT calculations for continuous cerebral autoregulation assessment in aSAH. Further research is needed to optimize the MAPOPT derived from PRx and COx_a based on specific monitoring targets.