A Survey of Neuromonitoring Practices in North American Pediatric Intensive Care Units

Transcranial Doppler Ultrasound, a Review for the Pediatric Intensivist

“…While the majority of the reported TCD literature in critically ill children focuses on non-imaging TCD, the use of imaging TCD is becoming more frequent as it is accessible on most commercially available ultrasound machines used in the PICU. In a recent neuromonitoring practices survey, of respondents who reported using TCD, 18 (86%) used imaging TCD whereas 5 (24%) used non-imaging TCD [ 7 ]. Given the focus of the current literature base, most studies reported in this manuscript use non-imaging TCD.…”

“…The use of TCD in the PICU has been gaining popularity with a recent study reporting that 93% of surveyed institutions ( n = 27/29) providing pediatric neurocritical care use TCD [ 10 ]. In contrast, another survey of 52 institutions noted that 40% ( n = 21/52) now use TCD (responding institutions likely overlapped) [ 7 ]. The increasing popularity of TCD has prompted additional work to provide recommendations to standardize the approach to performing, interpreting, and reporting TCD [ 5 ].…”

“…Its use has been described in a variety of clinical scenarios including traumatic brain injury, hypoxic-ischemic brain injury, stroke, sepsis, diabetic ketoacidosis, central nervous system infections, hepatic encephalopathy, and monitoring while on extra-corporeal membrane oxygenation. Use is institution-dependent but is more frequently driven by physician recommendation as opposed to institutional protocols [ 7 ]. A recent multi-center study of pediatric intensivists in France noted that TCD was used for diagnosis, to guide management, and as a prompt to obtain additional imaging [ 11 ].…”

Exploring Trends in Neuromonitoring Use in a General Pediatric ICU: The Need for Standardized Guidance

“…Similarly, neuromonitoring has noted benefits in anesthesia for certain intraoperative settings [14]. In most pediatric centers, though, the availability and utilization of different neuromonitoring technologies lack equivalent consensus, and the impacts of neuromonitoring on outcome are likewise unknown [9,15]. Forms of neuromonitoring in children are vast, spanning from noninvasive technologies, such as NIRS, sensory evoked potentials, and TCD, to invasive monitoring, such as ICP monitors or cerebral microdialysis.…”

“…Diseases such as traumatic brain injury, status epilepticus, hypoxic ischemic injury, stroke, and meningitis/encephalitis are associated with higher rates of death and disability when compared to the general PICU population [ 3 , 4 , 5 , 6 ]. In this setting, pediatric neurocritical care (PNCC) services and neuromonitoring technologies are emerging as resources with vast ranging potential benefits to children in the PICU [ 7 , 8 , 9 ].…”