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This concept is not reliable as blood flow cannot be reliably inferred from heart rate and blood pressure measurements until extreme hypotension occurs [2].
Directionality of blood flow cannot be determined with LSI, but because pMCAO included a complete transection of the base of MCA (between the two tightened suture knots), blood flow observed in the cortical branches of MCA (distal to the occlusion) at 24 hours post occlusion, must be flowing (in the reverse direction) from another arterial source via collateral vessels.
The drawback is that deeper blood flow cannot be retrieved due to the limited penetration depth of RCM.
This inference is necessary because vital organ blood flow cannot be accurately measured in acutely septic patients.
Although small doses of dobutamine appear to restore gut mucosal perfusion and improve hepatic arterial blood flow in this setting, total hepato-splanchnic blood flow cannot be maintained with either dobutamine or dopamine [ 62].
Moreover, no human data show that substantial (>20 mL/kg) fluid resuscitation reliably improves blood pressure or end-organ perfusion (an elusive outcome given that organ blood flow cannot be accurately measured in septic humans).
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In addition, flow cannot be calculated automatically and simultaneously in multiple vessels, so that blood flow distribution histograms can not readily be obtained.
Designing vascular imaging protocols can be challenging owing to the non-uniform velocity of blood in the aorta, differences in cardiac output between patients and the effect of different disease states on blood flow that cannot be predicted pre-scan.
Importantly, low blood flow rates cannot be entirely compensated for by an increase in the surface area of the membrane oxygenator.
With respect to pulseless electrical activity states, the question of adequate cerebral blood flow (CBF) cannot be answered by echocardiography alone.
This is especially true because renal perfusion (renal blood flow (RBF)) cannot be reliably measured in man.
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Justyna Jupowicz-Kozak
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