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Intracranial Physiology and Cerebrovascular Autoregulation
The catheter is placed in areas at risk for hypoperfusion and can further help detect intracerebral vasospasm and assess cerebrovas- cular autoregulation.57 However, there are still concerns about the validity of using thermal diffusion flowmetry long-term, as monitor dysfunctions secondary to placement errors and missing data during recalibration occur.58
Flow velocity has a linear rela- tionship to CBF as long as the vessel's cross-sectional area and the angle of insonation remain constant.59 This tech- nique can continuously monitor flow velocity within the main components of the circle of Willis through the oph- thalmic, temporal, and foramen magnum acoustic win- dows.60 It has excellent temporal resolution and can detect inadequate CBF, assess pressure autoregulation and carbon dioxide reactivity, and can help predict outcome in patients with head trauma.60,61 Changes in velocity can be used to assess alterations of vascular caliber (e.g.
CEREBROVASCULAR AUTOREGULATION AND VASOMOTOR REACTIVITY
, cerebrovascular autoregulation).62 Static cerebro- vascular autoregulation can be determined with sustained blood pressure manipulation by using either a tilt test or a direct vasopressor, whereas dynamic cerebrovascular
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