Role of transcranial Doppler in neurocritical care

Saqqur, Maher; Zygun, David; Demchuk, Andrew M.

doi:10.1097/01.ccm.0000260633.66384.fb

Cited by 89 publications

(67 citation statements)

References 55 publications

(58 reference statements)

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“…The fact that TCD is a noninvasive and sensitive method to assess the intracranial dynamics in TBI makes it an ideal tool in neurointensive care units (NICU) (2,17,30). The use of TCD as a predictor of ICP was first described by Klingerhofer et al They have shown that Middle cerebral artery (MCA) flow velocities and PI may help to assess the progression of the injury, correlate well with ICP and guide the treatment protocols if invasive ICP measurements are not available at the NICU (2,11,12,19,30). Several studies have focused on the changes in MCA flow velocity measurements after head injuries and they reinforce the use of TCD together with multimodality monitoring to understand the patterns of perfusion, oxygenation and autoregulation (8,15,22,26).…”

Section: Introductionmentioning

confidence: 99%

Correlation of pulsatility index with intracranial pressure in traumatic brain injury

Güra¹,

Elmacı²,

Sarı³

et al. 2010

Turkish Neurosurgery

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AIm:In traumatic brain injury (TBI) patients, it is desired to monitor the intracranial pressure (ICP) to assess the cerebral haemodynamics and guide the therapy. The study was designed to see if the pulsatility index (PI) measured by transcranial Doppler ultrasonography (TCD) predicts information about ICP values. mAterIAl and methOds:In 52 TBI patients with Glasgow Coma Scale (GCS) score < 9, invasive intracranial monitoring and TCD ultrasonography for PI were performed through five days. ICP, cerebral perfusion pressure (CPP), PI values were recorded and calculated. The correlation and regression analysis between ICP, PI and CPP were investigated in the whole group and in patients with a Glasgow Outcome Score (GOS) of 3-5. results:The decline in ICP and PI values was significant through five days. The correlation between ICP and PI was strongly significant (p < 0.0001) on days 1, 3 and 5. In patients with a GOS of 3-5, correlation of ICP and PI was also observed. The only significant correlation observed between CPP and PI was on day 5. COnClusIOn:The strong correlation observed between ICP and PI through the management period of TBI patients can lead us to use TCD ultrasonography-derived PI as a guide if invasive monitoring is not available. BulGulAr: ICP ve PI değerlerindeki 5 gün boyunca olan azalma anlamlıdır. ICP ve PI arasındaki korelasyon 1, 3 ve 5. günlerde kuvvetli bir şekilde anlamlı bulunmuştur (p < 0,0001). Glasgow Outcome Skoru (GOS) 3-5 olan hastalarda da ICP ve PI değerlendirilmiştir. CPP ve PI arasındaki tek önemli korelasyon 5. günde tespit edilmiştir. sOnuÇ: ICP ve PI arasında bulunan güçlü korelasyon, tedavinin yönetilmesi için invaziv monitörizasyon yapmanın mümkün olmadığı hastalarda PI değerlerinin kullanılmasına yönlendirebilir.

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Section: Introductionmentioning

confidence: 99%

Correlation of pulsatility index with intracranial pressure in traumatic brain injury

Güra¹,

Elmacı²,

Sarı³

et al. 2010

Turkish Neurosurgery

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“…18 TCD has the advantage of being a bedside examination, repeatable, and less expensive that CTA. 19 A new TCD technology, power motion mode Doppler (PMD-TCD), is thought to increase the speed by which acoustic windows are found and arteries. 20,21 However, the rate of successful identification of obstructed intracranial vessels with PMD-TCD only, when compared with CTA, is not known.…”

mentioning

confidence: 99%

Accuracy of Transcranial Doppler Compared With CT Angiography in Diagnosing Arterial Obstructions in Acute Ischemic Strokes

Brunser

Lavados

Hoppe

et al. 2009

Stroke

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Background and Purpose-Patients with acute ischemic stroke and intracranial arterial obstructions have a poor prognosis and a high probability of deteriorating at 24 hours. We aimed to evaluate the diagnostic accuracy of power motion mode Doppler (PMD-TCD) compared with CT angiography as standard in diagnosing intracranial arterial obstructions in patients presenting with ischemic stroke of Ͻ24 hours. Methods-Consecutive patients presenting with acute ischemic stroke to the emergency department underwent highresolution brain CT angiography and PMD-TCD within a 6-hour difference. Results-A total of 100 patients were included. PMD-TCD demonstrated 34 intracranial occlusions and CTA 33. There were 6 false-positives and 4 false-negative diagnoses with PMD-TCD. PMD-TCD had a positive likelihood ratio of 13.7, a negative likelihood ratio of 0.19, sensitivity of 81.8%, and specificity of 94% for detecting an arterial occlusion in any specific artery.Results for the middle cerebral artery were: positive likelihood ratio 24.6, negative likelihood ratio 0.045, sensitivity 95.6%, and specificity 96.2%. For the anterior circulation, the results were: positive likelihood ratio 18.5, negative likelihood ratio 0, sensitivity 100%, and specificity 94.5%. For the posterior circulation, the results were: positive likelihood ratio Ͼ1000, negative likelihood ratio 0.42, sensitivity 57.1%, and specificity 100%. The post-test probability for any occluded artery when PMD-TCD was positive increased for any admission National Institutes of Health Stroke Scale score but was especially remarkable for National Institutes of Health Stroke Scale scores between 7 and 15 points. Conclusions-PMD-TCD is valid compared with CT angiography for the diagnosis of arterial occlusions in patients with acute ischemic stroke, especially in middle cerebral artery obstructions.

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“…Despite the widespread use of triple H therapy to prevent vasospasm after SAH, only a few studies have questioned its efficacy and there is insufficient data of evidence based medicine to make recommendations for the preventive use of triple H therapy in SAH patients (26,36).…”

Section: The Study Findingsmentioning

confidence: 99%

Haemodynamic augmentation in the treatment of vasospasm in aneurysmal subarachnoid hemorrhage

Güra

Elmacı²,

Çerçi³

et al. 2011

Turkish Neurosurgery

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AIM: Hypertension, hypervolemia and hemodilution therapy is a common approach to cerebral vasospasm after subarachnoid haemorrhage. This study is designed to see the difference of moderate or aggressive hypervolemia supported with induced hypertension in symptomatic vasospasm detected with transcranial Doppler ultrasonography (TCD) measurements. MATeRIAL and MeTHods:Fifty eight patients who had aneurysm clipping and were admitted to the neurointensive care unit were treated with normovolemia and induced hypertension (n=35) or hypervolemia supported with induced hypertension (n=23) targeting a mean arterial pressure of 110-130 mm Hg and central venous pressure of 8-12 mm Hg. Daily TCD, fluid intake, fluid balance and haemodynamic values were recorded for 14 days.ResULTs: There were no differences detected in mean arterial pressure, central venous pressure, hematocrit values, fluid balance and middle cerebral artery flow velocities between the two groups through 14 days (p>0.05). Hyponatremia, pulmonary edema and cerebral ischemia were observed as complications. CoNCLUsIoN:Hypervolemia adds no benefit compared to normovolemia in the treatment of vasospasm occurred as a result of subarachnoid hemorrhage. Induced hypertension establishes the haemodynamic augmentation to prevent and treat vasospasm. BULGULAR:On dört gün boyunca takip edilen ortalama arter basıncı, santral venöz basınç, hematokrit değerleri, sıvı dengesi ve orta serebral arter akım hızlarında iki grup arasında fark yoktu. Komplikasyon olarak hiponatremi, pulmoner ödem ve serebral iskemi kaydedildi. soNUÇ: Subaraknoid kanama sonucu ortaya çıkan vasospasmın tedavisinde normovolemi ile karşılaştırıldığında hipervolemi ek bir yarar sunmamaktadır. Hipertansiyon vasospasmı önlemek ve tedavi etmek için gereken hemodinamik desteği sağlamaktadır.

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Role of transcranial Doppler in neurocritical care

Cited by 89 publications

References 55 publications

Correlation of pulsatility index with intracranial pressure in traumatic brain injury

Correlation of pulsatility index with intracranial pressure in traumatic brain injury

Accuracy of Transcranial Doppler Compared With CT Angiography in Diagnosing Arterial Obstructions in Acute Ischemic Strokes

Haemodynamic augmentation in the treatment of vasospasm in aneurysmal subarachnoid hemorrhage

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