Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review

Robba, Chiara; Goffi, Alberto; Geeraerts, Thomas; Cardim, Danilo; Via, Gabriele; Czosnyka, Marek; Park, Soo‐Jin; Sarwal, Aarti; Padayachy, Llewellyn; Rasulo, Frank; Citerio, Giuseppe

doi:10.1007/s00134-019-05610-4

Cited by 155 publications

(114 citation statements)

References 95 publications

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“…However, the indications for invasive ICP monitoring remain controversial in some brain conditions [4]. Although non-invasive ICP methods are not accurate enough to substitute for invasive ICP, non-invasive ICP estimation may be helpful and could be used as a "triage" method (e.g., identifying patients at high risk of developing intracranial hypertension who require specific monitoring and/or surveillance) or as a diagnostic tool in patients with unexplained alteration of consciousness outside the ICU [25][26][27][28]. As such, the non-invasive estimation of ICP has been widely investigated in braininjured patients over the last few decades [29][30][31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Multimodal non-invasive assessment of intracranial hypertension: an observational study

et al. 2020

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Background: Although placement of an intra-cerebral catheter remains the gold standard method for measuring intracranial pressure (ICP), several non-invasive techniques can provide useful estimates. The aim of this study was to compare the accuracy of four non-invasive methods to assess intracranial hypertension. Methods: We reviewed prospectively collected data on adult intensive care unit (ICU) patients with traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), or intracerebral hemorrhage (ICH) in whom invasive ICP monitoring had been initiated and estimates had been simultaneously collected from the following non-invasive indices: optic nerve sheath diameter (ONSD), pulsatility index (PI), estimated ICP (eICP) using transcranial Doppler, and the neurological pupil index (NPI) measured using automated pupillometry. Intracranial hypertension was defined as an invasively measured ICP > 20 mmHg. Results: We studied 100 patients (TBI = 30; SAH = 47; ICH = 23) with a median age of 52 years. The median invasively measured ICP was 17 [12-25] mmHg and intracranial hypertension was present in 37 patients. Median values from the non-invasive techniques were ONSD 5.2 [4.8-5.8] mm, PI 1.1 [0.9-1.4], eICP 21 [14-29] mmHg, and NPI 4.2 [3.8-4.6]. There was a significant correlation between all the non-invasive techniques and invasive ICP (ONSD, r = 0.54; PI, r = 0.50; eICP, r = 0.61; NPI, r = − 0.41-p < 0.001 for all). The area under the curve (AUC) to estimate intracranial hypertension was 0.78 [CIs = 0.68-0.88] for ONSD, 0.85 [95% CIs 0.77-0.93] for PI, 0.86 [95% CIs 0.77-0.93] for eICP, and 0.71 [95% CIs 0.60-0.82] for NPI. When the various techniques were combined, the highest AUC (0.91 [0.84-0.97]) was obtained with the combination of ONSD with eICP. Conclusions: Non-invasive techniques are correlated with ICP and have an acceptable accuracy to estimate intracranial hypertension. The multimodal combination of ONSD and eICP may increase the accuracy to estimate the occurrence of intracranial hypertension.

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Section: Discussionmentioning

confidence: 99%

Multimodal non-invasive assessment of intracranial hypertension: an observational study

et al. 2020

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“…Transcranial Doppler (TCD) is a bedside, low-cost, and non-invasive technique able to evaluate cerebral hemodynamics [1]; the implementation of transcranial color-coded duplex sonography (TCCS) aids in evaluating the brain anatomy and intracranial lesions [2], real-time monitoring of “basic” (flow velocity (FV) and pulsatility index (PI)) as well as “advanced” TCD-derived parameters (Table 1; Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

“…In practice, we use a 2-MHz probe, and most information is obtained by insonating the middle cerebral artery through the temporal window; other windows include the transorbital, occipital, and submandibular windows. TCCD has the advantage to provide a direct visualization of the cerebral anatomy vessels and allow angle correction to assess FV [2]. TCD/TCCD practice is part of the standard training in our institution, and examinations are routinely performed by the medical staff.…”

Section: Introductionmentioning

confidence: 99%

How I use Transcranial Doppler

Robba

Taccone

2019

Crit Care

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“…PoCUS enables early diagnosis of neurological conditions by detecting indirect signs of intracranial hypertension such as brain midline shift and increase in the optic nerve sheath diameter. It also allows monitoring of changes in the vascular flow autoregulation during systemic diseases like sepsis, acute hepatic failure and brain trauma and can be used in neuro-and general ICUs, the trauma unit, the emergency department and the operating room [14].…”

Section: Brain Ultrasoundmentioning

confidence: 99%

Focus on ultrasound in intensive care

2020

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Over the past two decades, the amount of literature on point of care ultrasound (PoCUS) has been increasing rapidly. Nowadays, a growing body of evidence strongly supports its role in several fields with particular interest to the acute care settings. This article will review some recent literature that may be of interest to the critical care community. Our literature review mainly focuses on thoracic PoCUS, including eight articles on lung ultrasound (LUS), six articles on echocardiography and one article on diaphragm ultrasound. We also cite an important review on brain ultrasound, one article on multiorgan PoCUS and two articles on procedure guidance.

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Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review

Cited by 155 publications

References 95 publications

Multimodal non-invasive assessment of intracranial hypertension: an observational study

Multimodal non-invasive assessment of intracranial hypertension: an observational study

How I use Transcranial Doppler

Focus on ultrasound in intensive care

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