Transcranial Doppler to detect on admission patients at risk for neurological deterioration following mild and moderate brain trauma

Jaffres, P.; Brun, Julien; Declety, P; Bosson, Jean Luc; Fauvage, B.; Schleiermacher, Almuth; Kaddour, Affif; Anglade, Daniel; Jacquot, C.; Payen, Jean François

doi:10.1007/s00134-005-2630-4

Cited by 61 publications

(32 citation statements)

References 36 publications

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“…Recientes estudios han demostrado el papel pronóstico de la sonografía intracerebral en los enfermos traumáticos basándose en la velocidad e índice de pulsatilidad en las primeras horas tras el TCE 11,15 . Un reciente estudio preliminar 12 mediante DTCC mostró que determinados parámetros hemodinámicos se correlacionaban con un peor pronóstico en los enfermos con TCE.…”

Section: Discussionunclassified

Hemodinámica cerebral en pacientes con traumatismo craneoencefálico evaluada por doppler transcraneal y duplex transcraneal con codificación en color: Estudio comparativo

Homar

et al. 2007

Neurocirugía

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Recibido:221 Neurocirugía 2007; 18: 221-226 Resumen Objetivos. Comparar el número de vasos identificados y las velocidades e índices de pulsatilidad de los mismos mediante doppler transcraneal (DTC) y dúplex transcraneal codificado en color (DTCC) en una población de enfermos con traumatismo craneoencefálico (TCE).Material y métodos. Se estudiaron 30 enfermos ingresados por TCE en una Unidad de Cuidados Intensivos (UCI) neurocríticos. Consecutivamente se realizaron estudios mediante DTC y DTCC. Se compararon la tasa de insonación de las arterias del polígono de Willis y los parámetros hemodinámicos obtenidos.Resultados. La edad media fue de 50 años. El 67% fueron varones. En el estudio mediante DTCC se insonó la arteria carótida interna en un 95% de los casos, la arteria cerebral media (ACM) en el 95% de las ocasiones, la arteria cerebral anterior (ACA) en un 91% y la arteria cerebral posterior (ACP) en un 92% de los estudios. Mediante DTC convencional se hallaron en un 29%, 93%, 67% y 35% respectivamente. La velocidad media mediante DTCC y DTC en la ACM fue de 79 cm/ seg vs 59 cm/seg respectivamente (p<0.0001), en la ACA de 61 cm/seg vs 42 cm/seg (p<0.0001) y en la ACP de 43 cm/seg y 33 cm/seg (p<0.0001).Conclusiones. El DTCC permite un estudio hemodinámico más completo en los enfermos con TCE ingresados en la UCI. Su impacto en el pronóstico del TCE deberá determinarse en próximos estudios.PALABRAS CLAVE: Dúplex transcraneal codificado en color. Doppler transcraneal. Traumatismo craneoencefálico. Hemodinámica cerebral. Cerebral hemodynamics in patients with traumatic brain injury evaluated by transcranial doppler and transcranial color coded sonography. A comparison study Summary Objective. To compare the number of vessels identified and mean velocity and pulsatility index values obtained by transcranial doppler (TCD) and transcranial color coded sonography (TCCS) in patients with traumatic brain injury (TBI).Methods. Thirty patients suffering from TBI admitted in our neurocritical Intensive Care Unit (ICU) were studied. We performed consecutive studies by TCD and TCCS. The number of Circle of Willis vessels insonated and the hemodynamic parameters were compared.Results. Mean age was 50 years. Twenty patients were male. By using TCCS, internal carotid artery was insonated in 95%, middle cerebral artery (MCA) in 95%, anterior cerebral artery (ACA) in 91% and posterior cerebral artery (PCA) in 92% of the studies. Using conventional TCD they were insonated in 29%, 93% 67% and 35% of the studies respectively. Mean velocity values measured by CCS and TCD in MCA were 79 cm/sec vs 59 cm/sec respectively (p<0.0001), in ACA were 61 cm/sec vs 42 cm/sec (p<0.0001) and in PCA were 43 cm/sec vs 33 cm/sec (p<0.0001).Conclusion. TCCS allows a high quality hemodynamic study of TBI patients admitted to the ICU. Further studies must define its impact on outcome of TBI patients.

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Section: Discussionunclassified

Hemodinámica cerebral en pacientes con traumatismo craneoencefálico evaluada por doppler transcraneal y duplex transcraneal con codificación en color: Estudio comparativo

Homar

et al. 2007

Neurocirugía

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“…Brain oedema increases cerebral circulation resistance. First, the diastolic blood flow velocity decreases [8] and the pulsatility index then starts to increase [9][10][11]. The diastolic blood flow velocity decreases more than the systolic flow, which directly leads to an increase in the PI value [7,12,13].…”

Section: Introductionmentioning

confidence: 99%

Low-dose mannitol (0.3 g kg⁻¹) improves the pulsatility index and minimum diastolic blood flow velocity in traumatic brain injury

Nincevic¹,

Meštrović

Nincevic

et al. 2015

Brain Injury

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Low-dose mannitol administration appears to be efficacious for improving the indicators of disturbed circulation in a TBI (FV-min increase, PI decrease). The maximum decrease in the PI was recorded 1 hour after the administration of mannitol and was 10.9% of the initial value. The maximum increase in the FV-min was recorded 1 hour after administration and was 29.7% of the initial value. These changes were significant ∼ 2 hours later.

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“…This is likely to have a deleterious effect on outcome. A study by Jaffres and coworkers [8] may represent a glimmer of light in this otherwise dark tunnel.…”

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confidence: 99%

“…In a prospective cohort study ( n = 78) set in the emergency room of a French district hospital, consecutive patients admitted with mild or moderate TBI underwent both CT and transcranial Doppler (TCD) studies within 12 hours of admission [8]. Patients were then assessed, based on objective predefined criteria, for neurological deterioration 7 days after admission.…”

mentioning

confidence: 99%

“…Jaffres and coworkers [8] go on to discuss the mechanisms by which PI is inversely related to cerebral perfusion pressure, and suggest that an appropriate combination of CT classification of TBI and measurement of PI on admission may be used to identify those at risk for subsequent deterioration. However, they point out that the feasibility and practicalities of early TCD are not inconsequential and that no threshold value for PI was identified in this small study.…”

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confidence: 99%

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Sadler

Williams

2005

Crit Care

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Tracheostomies have been around for close to 3000 years, so one would hope that the controversies might have been thrashed out by now, but apparently not. Judging by some recent publications it would appear that we still do not know when or how to insert them. Monitoring is fundamental to critical care; two papers describe novel/modified techniques for assessing traumatic brain injury and cardiac output. The intensive care unit imposes a heavy treatment burden, particularly on the elderly. What impact does this have on the lives of the survivors?

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Transcranial Doppler to detect on admission patients at risk for neurological deterioration following mild and moderate brain trauma

Cited by 61 publications

References 36 publications

Hemodinámica cerebral en pacientes con traumatismo craneoencefálico evaluada por doppler transcraneal y duplex transcraneal con codificación en color: Estudio comparativo

Hemodinámica cerebral en pacientes con traumatismo craneoencefálico evaluada por doppler transcraneal y duplex transcraneal con codificación en color: Estudio comparativo

Low-dose mannitol (0.3 g kg⁻¹) improves the pulsatility index and minimum diastolic blood flow velocity in traumatic brain injury

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Transcranial Doppler to detect on admission patients at risk for neurological deterioration following mild and moderate brain trauma

Cited by 61 publications

References 36 publications

Hemodinámica cerebral en pacientes con traumatismo craneoencefálico evaluada por doppler transcraneal y duplex transcraneal con codificación en color: Estudio comparativo

Hemodinámica cerebral en pacientes con traumatismo craneoencefálico evaluada por doppler transcraneal y duplex transcraneal con codificación en color: Estudio comparativo

Low-dose mannitol (0.3 g kg−1) improves the pulsatility index and minimum diastolic blood flow velocity in traumatic brain injury

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Low-dose mannitol (0.3 g kg⁻¹) improves the pulsatility index and minimum diastolic blood flow velocity in traumatic brain injury