The sit-to-stand technique for the measurement of dynamic cerebral autoregulation

Ultrasound Med Biol. 2009 Jan;35(1):21-9. doi: 10.1016/j.ultrasmedbio.2008.08.001. Epub 2008 Oct 2.

Abstract

Measurement of cerebral autoregulation is important for the evaluation and management of a number of clinical disorders that affect cerebral blood flow. We currently lack simple bedside measures that mimic common physiologic stresses. Therefore, we evaluated a new sit-to-stand technique as an alternative method to the frequently-used thigh-cuff technique in healthy volunteers. Continuous middle cerebral artery (MCA) blood flow velocities (BFV) and arterial blood pressure (ABP) were measured in response to standing from a sitting position, or rapid thigh-cuff deflation in 24 healthy subjects (50 +/- 22 y). Autoregulatory index (ARI) was calculated as the BFV response for step changes in ABP using a second-order differential equation with a set of parameters that can be used to grade the performance of autoregulation. Of these 24 subjects, 30% could tolerate only two thigh-cuffs and refused to proceed with the third cuff, whereas none of our subjects had any difficulty with performing the three sit-to-stand trials. The two techniques produced similar changes in mean ABP, but the times to nadir of the blood pressure and BFV were significantly faster for the thigh-cuff. The mean group ARIs were similar between the two techniques. Although between-subjects variability was higher for sit-to-stand ARIs, the within-subject sit-to-stand ARI variability was small. Thus, for the assessment of cerebral autoregulation, the sit-to-stand procedure is well tolerated and produces ARI values that have low within-subject variability. The sit-to-stand technique appears to be a suitable measure of individual ARI values for inferring dynamic cerebral autoregulation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aging / physiology
  • Analysis of Variance
  • Blood Flow Velocity / physiology
  • Blood Pressure / physiology
  • Cerebrovascular Circulation / physiology*
  • Female
  • Homeostasis
  • Humans
  • Ligation
  • Male
  • Middle Aged
  • Middle Cerebral Artery / diagnostic imaging*
  • Movement / physiology
  • Thigh
  • Ultrasonography, Doppler, Transcranial*