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|Title:||Cerebral hemodynamic with intra-aortic balloon pump: business as usual?|
Panerai, Ronney B.
|Citation:||Physiological Measurement, 2017, in press|
|Abstract:||Intra-aortic balloon pump (IABP) is commonly used as mechanical support after cardiac surgery or cardiac shock. Although its benefits for cardiac function have been well documented, its effects on cerebral circulation are still controversial. We hypothesized that transfer function analysis (TFA) and continuous estimates of dynamic cerebral autoregulation (CA) provide consistent results in the assessment of cerebral autoregulation in patients with IABP. Continuous recordings of blood pressure (BP, intra-arterial line), end-tidal CO2, heart rate and cerebral blood flow velocity (CBFV, transcranial Doppler) were obtained i) 5 minutes with IABP ratio 1:3, ii) 5 minutes, starting 1 minute with the IABP-ON, and continuing for another 4 minutes without pump assistance (IABP-OFF). Autoregulation index (ARI) was estimated from the CBFV response to a step change in BP derived by TFA and as a function of time using an autoregressive moving-average model during removal of the device (ARIt). Critical closing pressure and resistance area-product were also obtained. ARI with IABP-ON (4.3 ± 1.2) were not different from corresponding values at IABP-OFF (4.7 ± 1.4, p=0.42). Removal of the balloon had no effect on ARIt, CBFV, BP, cerebral critical closing pressure or resistance area-product. IABP does not disturb cerebral hemodynamics. TFA and continuous estimates of dynamic CA can be used to assess cerebral hemodynamics in patients with IABP. These findings have important implications for the design of studies of critically ill patients requiring the use of different invasive support devices.|
|Embargo on file until:||23-Mar-2018|
|Rights:||Copyright © the authors, 2017. After an embargo period this version will be an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.|
|Description:||The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.|
|Appears in Collections:||Published Articles, Dept. of Cardiovascular Sciences|
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|Caldas+et+al_2017_Physiol._Meas._10.1088_1361-6579_aa68c4.pdf||Post-review (final submitted author manuscript)||1.03 MB||Adobe PDF||View/Open|
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