Reproducibility of the blood flow index as noninvasive, bedside estimation of cerebral blood flow

ObjectiveTo investigate the feasibility and reproducibility of the blood flow index (BFI) method for measuring cerebral blood flow.Design and settingProspective functional study in pediatric intensive care.Patients and participants14 consecutive patients with median age of 2 months (range 1 days–11 years) requiring artificial ventilation, invasive arterial blood pressure monitoring, and central venous access.InterventionsThe first passage of an intravenous indocyanine green (ICG) bolus through the cerebral vasculature was monitored by noninvasive near-infrared spectroscopy. BFI was calculated by dividing maximal ICG absorption change by rise time. Reproducibility was evaluated by six ICG injections at 5-min intervals.ResultsOf all ICG injections 6% were canceled, and 4% were eliminated due to injection failures. Median BFI of 17 reproducibility determinations was 71 (range 12–213) and median coefficient of variation (CV) of BFI was 10% (4.9–18.5). The quantity of ICG bolus did not affect the CV (0.1 vs. 0.3 mg ICG/kg). Eight reproducibility tests in patients after cardiac surgery had smaller CV than the others, and the eight in newborns had higher CV than in older children. Patient parameters such as arterial blood pressure, endtidal CO2, and percutaneous oxygen saturation were stable and showed CV below 2% during reproducibility determination.ConclusionsThe BFI method allows rapid and repeated measurements of CBF with good feasibility and reproducibility. As a relative but not absolute measure of CBF, BFI seems to be suited for clinical evaluation of intraindividual CBF changes during determination of cerebrovascular reactivities or during therapeutic interventions.