Noninvasive estimation of cerebral perfusion pressure with transcranial Doppler ultrasonography in traumatic brain injury

Güra, Melek; Sılav, Gökalp; Isik, Nejat; Elmacı, İlhan

doi:10.5137/1019-5149.jtn.4201-11.1

Cited by 17 publications

(11 citation statements)

References 10 publications

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“…Third, we used non-invasive measurements to estimate ICP. While several studies have shown correlation between CBFV as measured by TCD and ICP it is possible that invasive monitoring would reveal more significant changes [21,27,28]. Fourth, a single provider performed all palpations.…”

Section: Discussionmentioning

confidence: 99%

Cerebral blood flow changes during palpation of external airway structures in healthy volunteers

Basel¹,

April²,

Araña³

et al. 2020

PLoS ONE

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Introduction Previous studies demonstrate increased intracranial pressure (ICP) during direct laryngoscopy in patients with traumatic brain injury (TBI). Worse outcomes in TBI have been associated with increased ICP. It remains unclear if the same effect occurs during cricothyrotomy. We evaluated changes in cerebral blood flow and hemodynamic changes that occurred during preparation for cricothyrotomy in healthy volunteers. Methods An emergency medicine trainee performed routine anatomical procedural palpation with simultaneous transcranial doppler (TCD) measurements of cerebral blood flow velocities (CBFV) from bilateral middle cerebral arteries (MCAs). Mean arterial pressure (MAP) and heart rate (HR) were recorded throughout event. Our primary outcome was changes in pulsatility index (PI) and CBFV by TCD during palpation. TCD measurements were used as a surrogate for ICP. Results We enrolled 20 healthy volunteers for this study. No significant differences were found in pulsatility index [Right MCA-0.02 (95% confidence interval,-0.09 to 0.06), left MCA-0.02 (95% confidence interval,-0.011 to 0.07)] or mean CBFV [right MCA-0.70 mm/s (95% confidence interval,-10.15 to 8.75) left MCA-1.20 mm/s (95% confidence interval,-10.68 to 8.28)] during palpation. No significant change in HR was found [-1.1 bpm ((95% confidence interval,-2.4 to 0.1)]. A change in MAP was observed [1.3 mmHg (95% confidence interval,-0.1 to 2.4)].

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Section: Discussionmentioning

confidence: 99%

Cerebral blood flow changes during palpation of external airway structures in healthy volunteers

Basel¹,

April²,

Araña³

et al. 2020

PLoS ONE

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show abstract

“…Gura et al used this formula to estimate CPP with a correlation coefficient of 0.92 (p < 0.0001). 7 An estimation difference of 10 mm Hg for CPP is an accept able tradeoff between the risk of an indwelling catheter and the benefit of a noninvasive method to estimate CPP.…”

Section: Discussionmentioning

confidence: 99%

Utility of Transcranial Doppler in Estimating Cerebral Perfusion Pressure in Traumatic Brain Injury: A Prospective Observational Trial

Rajagopal

Joseph

2017

IJNT

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Title Utility of transcranial Doppler (TCD) in estimating cerebral perfusion pressure (eCPP) in traumatic brain injury—a prospective observational trial. Aim To validate the utility of a noninvasive technique of eCPP estimation using transcranial Doppler (TCD). Materials and Methods Eighteen patients with severe traumatic brain injury (TBI) requiring intracranial pressure (ICP) monitoring as per the Brain Trauma Foundation guidelines were prospectively recruited for the study. ICP was measured in all patients using an intraventricular catheter. Mean arterial pressure (MAP) was recorded from an intra-arterial catheter. Cerebral perfusion pressure (CPP) was calculated as the difference between MAP and ICP. Middle cerebral blood flow velocities were recorded using TCD, and CPP was estimated from the middle cerebral artery (MCA) flow velocities (eCPP) using the formula eCPP = (MAP × end diastolic velocity [EDV]/mean velocity [MV]) + 14. Total 185 simultaneous readings of CPP and eCPP were available for analysis. Reliability statistics between CPP and eCPP were computed to calculate the intraclass correlation (ICC). Results The average CPP measured using intraventricular catheter was 73.2 (+/−12.4), and the mean estimated eCPP was 76.7 (+/−10.9). We found a very good Pearson's correlation between CPP and eCPP (r = 0.743) with a Cronbach's α of 0.843. In 86.2% of examinations, the estimation error of measuring CPP was within 10 mm Hg, and in 93.1% examinations, it was within 15 mm Hg. Conclusion eCPP estimated using TCD can serve as reliable noninvasive alternative in situations in which ICP monitoring is not available, even in moderate or mild head injury.

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“…concluded that Independent of the type of intracranial pathology, there is a strong correlation between PI intranscranial Doppler ultrasonography (TCD) and invasive ICP measurements. [ 35 ] Also Ragauskas et al . showed that Doppler ultrasound of OA is precise and accurate compared with gold standard CSF pressure measured via lumbar puncture.…”

Section: Discussionmentioning

confidence: 99%

Transocular Doppler and optic nerve sheath diameter monitoring to detect intracranial hypertension

et al. 2015

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Noninvasive estimation of cerebral perfusion pressure with transcranial Doppler ultrasonography in traumatic brain injury

Cited by 17 publications

References 10 publications

Cerebral blood flow changes during palpation of external airway structures in healthy volunteers

Cerebral blood flow changes during palpation of external airway structures in healthy volunteers

Utility of Transcranial Doppler in Estimating Cerebral Perfusion Pressure in Traumatic Brain Injury: A Prospective Observational Trial

Transocular Doppler and optic nerve sheath diameter monitoring to detect intracranial hypertension

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