Applications of Transcranial Color-Coded Sonography in the Emergency Department

Blanco, Pablo; Blaivas, Michael

doi:10.7863/ultra.16.04050

Cited by 29 publications

(37 citation statements)

References 44 publications

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“…In contrast to intracranial arteries, the OA has a high-resistance velocity profile [11]. Precautions should be taken into account when using the transorbital window; it is recommended to decrease the power output to 20% in order to avoid potential risks of ocular damage [15]. In transforaminal windows, the patient is placed in lateral decubitus, with the neck flexed so the chin touches the chest [15].…”

Section: Conventional Transcranial Dopplermentioning

confidence: 99%

“…Precautions should be taken into account when using the transorbital window; it is recommended to decrease the power output to 20% in order to avoid potential risks of ocular damage [15]. In transforaminal windows, the patient is placed in lateral decubitus, with the neck flexed so the chin touches the chest [15]. The transducer is placed along the midline below the occipital prominence and directed toward the nose.…”

Section: Conventional Transcranial Dopplermentioning

confidence: 99%

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Transcranial Doppler ultrasound in neurocritical care

Blanco

Abdo-Cuza

2018

J Ultrasound

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Multimodality monitoring is a common practice in caring for neurocritically ill patients, and consists mainly in clinical assessment, intracranial pressure monitoring and using several imaging methods. Of these imaging methods, transcranial Doppler (TCD) is an interesting tool that provides a non-invasive, portable and radiation-free way to assess cerebral circulation and diagnose and follow-up (duplex method) intracranial mass-occupying lesions, such as hematomas and midline shift. This article reviews the basics of TCD applied to neurocritical care patients, offering a rationale for its use as well as tips for practitioners.

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Section: Conventional Transcranial Dopplermentioning

confidence: 99%

Section: Conventional Transcranial Dopplermentioning

confidence: 99%

Transcranial Doppler ultrasound in neurocritical care

Blanco

Abdo-Cuza

2018

J Ultrasound

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“…Three main parameters can be obtained from the Doppler spectrum: flow direction, velocities, and indices for arterial resistance. The latter includes the pulsatility index (PI) and the resistive index (RI) (12). PI was reported to increase during adult sepsis (7,(13)(14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Transcranial Doppler Can Predict Development and Outcome of Sepsis-Associated Encephalopathy in Pediatrics With Severe Sepsis or Septic Shock

et al. 2020

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Background and Aim: Sepsis is a common cause of pediatric intensive care unit (ICU) admission. Sepsis-associated encephalopathy (SAE) may occur owing to brain dysfunction in those patients and may be related to impaired cerebral microcirculation. Transcranial Doppler (TCD) can be used to detect this impairment. In this study, we aimed to assess the role of TCD in prediction of SAE and mortality in patients with severe sepsis or septic shock admitted to PICU. Patients and Methods: This prospective study included 75 children admitted to PICU owing to severe sepsis or septic shock. Upon admission, all patients were subjected to careful history taking, thorough clinical examination, and standard laboratory workup. Severity of clinical illness was assessed using the Pediatric Risk of Mortality (PRISM) III score. TCD was performed on the first day of admission after the normalization of systolic blood pressure with or without vasopressors. The primary study outcome was differences in the measurement of TCD in SAE, and the secondary outcome was discharge from ICU or mortality. Results: The study comprised 45 children with SAE and 30 age- and sex-matched children without SAE. In this study, SAE patients had significantly higher pulsatility index [PI; median interquartile range (IQR): 1.15 (0.98–1.48) vs. 1.0 (0.95–1.06), p = 0.002] and resistive index [RI; median (IQR): 0.68 (0.61–0.77) vs. 0.62 (0.59–0.64), p = 0.001] than had non-SAE patients. PI and RI showed good performance as predictors of subsequent SAE development [area under the curve (AUC): 0.72 and 0.73, respectively]. Non-survivors in SAE patients had significantly higher PRISM III. Receiver operating characteristic (ROC) curve analysis showed good performance of PI and RI as predictors of mortality at the end of follow-up. Conclusions: In children with SAE, cerebrovascular resistance is high and is associated with increased mortality.

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“…As a noninvasive monitoring measure, transcranial Doppler ultrasound (TCD) monitoring may help identify cerebral hypoperfusion in patients with TBI, who lack invasive ICP monitoring in community hospitals, emergency departments, or intensive care units. Targetdirected therapy of cerebral blood ow measured by TCD can restore normal cerebral tissue perfusion within a short time, which is conducive to controlling secondary brain insults [4,5].…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Evaluation of Intracranial Pressure by Transcranial Doppler Ultrasound in Patients With Traumatic Brain Injury

Chang

Yang

Qian

et al. 2020

Preprint

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Background As a noninvasive monitoring measure, transcranial Doppler ultrasound (TCD) has been widely used to monitor the secondary brain injury in patients with traumatic brain injury (TBI). There are different physiological theories on the noninvasive assessment of intracranial pressure by TCD parameters, including ONSD and PI, which may cause that the change of ONSD and PI is not always synchronous with that of ICP. Therefore, the objective of this study was to investigate the relationship between PI or ONSD and ICP at different levels or in different periods after the operation, and the ability of prediction intracranial hypertension with these parameters in patients with TBI. Methods The clinical data of 68 patients with TBI were retrospectively analyzed. The statistical correlation analysis was performed to investigate the relationship between the PI or ONSD and ICP one week after the operation. Besides, the area under the curve (AUC) of ONSD or PI alone or a combination of them was calculated to determine the ability of intracranial hypertension. Results 1. There was a correlation between ONSD and ICP ≥ 20 mmHg (r = 0.665, p < 0.001), ICP < 20 mmHg (r = 0.358, p = 0.006). The correlation still remained at ONSD ≥ 5 mm (r = 0.644, p < 0.001), but no correlation at ONSD < 5 mm (p = 0.137). 2. There was a strong correlation between PI and ICP at ICP of 15–20 mmHg (r = 0.705, p < 0.001), and ICP ≥ 20 mmHg (r = 0.716, p < 0.001). Nevertheless, it revealed a weak correlation at PI < 1.2 (r = 0.271, p = 0.021), PI ≥ 1.2 (r = 0.350, p = 0.020). In different period after the operation, there was a moderate correlation between ICP and PI on days 3, 4, and 5 (r = 0.508, p < 0.001), a strong correlation on days 6 and 7 after the operation (r = 0.645, p < 0.001). 3. For prediction intracranial hypertension with PI ≥ 1.2 or ONSD ≥ 5 mm alone or a combination of ONSD ≥ 5 mm and PI ≥ 1.2, the AUC value was 0.729 (p < 0.001), 0.900 (p < 0.001), and 0.943 (p < 0.001), respectively. Conclusion The correlation between the parameters of TCD, including ONSD and PI, and invasive ICP vary at different levels of ICP and in different periods in patients with TBI post-operation. It could also allow for a more accurate prediction of elevated intracranial pressure with a combination of ONSD ≥ 5 mm and PI ≥ 1.2.

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Applications of Transcranial Color-Coded Sonography in the Emergency Department

Cited by 29 publications

References 44 publications

Transcranial Doppler ultrasound in neurocritical care

Transcranial Doppler ultrasound in neurocritical care

Transcranial Doppler Can Predict Development and Outcome of Sepsis-Associated Encephalopathy in Pediatrics With Severe Sepsis or Septic Shock

Noninvasive Evaluation of Intracranial Pressure by Transcranial Doppler Ultrasound in Patients With Traumatic Brain Injury

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