Clinical applications of transcranial Doppler in non-trauma critically ill children: a scoping review

Millet, Anne; Evain, Jean-Noël; Desrumaux, Amélie; Francony, Gilles; Bouzat, Pierre; Mortamet, Guillaume

doi:10.1007/s00381-021-05282-w

Cited by 5 publications

(7 citation statements)

References 95 publications

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“…Cerebral perfusion reflected by cerebral blood flow (CBF) might be easily assessed in children using TCD. In this population, CBF is estimated by means of MCA velocities ( 15 , 16 ), but the normal ranges for MCA velocities differ depending on age, sex and sedation ( 14 ). Baseline flows should be interpreted as standard deviations from normative values.…”

Section: Discussionmentioning

confidence: 99%

“…TCD reflects cerebral blood flow velocities which may be considered a surrogate for cerebral perfusion in stable conditions ( 14 ). Cerebral perfusion monitoring using TCD has already shown its efficacy to detect ischemic injury in several populations of critically ill children ( 14 – 16 ). NIRS offers a continuous and non-invasive cerebral saturation monitoring ( 17 ) that might reflect cerebral oxygenation ( 18 ), and is routinely used during pediatric cardiac surgery ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

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Low Dosing Norepinephrine Effects on Cerebral Oxygenation and Perfusion During Pediatric Shock

et al. 2022

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BackgroundCerebral hypoperfusion and impaired oxygen delivery during pediatric critical illness may result in acute neurologic injury with subsequent long-term effects on neurodevelopmental outcome. Yet, the impact of norepinephrine on cerebral hemodynamics is unknown in children with shock. We aimed to describe the norepinephrine effects on cerebral perfusion and oxygenation during pediatric shock.Patients and MethodsWe conducted an observational multicentre prospective study in 3 French pediatric intensive care units. Children <18 years of age excluding traumatic brain injury were included in the study if they need norepinephrine for shock. Systemic and cerebral hemodynamics were compared between the time of initiation of norepinephrine (T0), and the steady-state (Tss). Cardiac output (CO) was measured using ultrasound. Cerebral perfusion was assessed on middle cerebral arteries (MCA) using transcranial doppler ultrasound. Cerebral tissue oxygen saturation (rScO2) was recorded using near infrared spectroscopy, and we calculated cerebral fractional tissue oxygen extraction (cFTOE = SpO2-rScO2/SpO2).Main ResultsFourteen children (median [IQR] age of 3.5[1; 13.5] years) were included. Norepinephrine at 0.2[0.1; 0.32] μg/kg/min significantly increased mean arterial blood pressure (61[56; 73] mmHg at Tss vs. 49[42;54] mmHg at T0, p=10−3) without change of CO. MCA velocities, pulsatility index, rScO2, and cFTOE did not significantly change between T0 and Tss. Some individuals observed variations in estimated CBF, which slightly improved in 7 patients, remained unchanged in 5, and was impaired in 2. No patient experienced significant variations of rScO2.ConclusionsLow-dosing norepinephrine, despite a homogeneous and significant increase in arterial blood pressure, had little effects on cerebral perfusion and oxygenation during pediatric shock. This reinforces the need for personalized tailored therapies in this population.Trial RegistrationClinicaltrials.gov, NCT 03731104. Registered 6 November, 2018. https://clinicaltrials.gov/ct2/show/NCT03731104.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low Dosing Norepinephrine Effects on Cerebral Oxygenation and Perfusion During Pediatric Shock

et al. 2022

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“…9,23 In addition, TCCD's ability to monitor alterations in ventricular size, estimate intracranial pressure, and diagnose/monitor cerebrovascular hemodynamics in pediatric cases of central nervous system infections makes it a promising neurocritical care tool in LMICs. 25 Intracranial imaging is rapidly advancing. Transcranial ultrasound has the potential to provide high-quality images, which might have implications for operative planning, intraoperative decision-making, and postoperative management of patients.…”

Section: Implementation and Ways Forward In Global Neurosurgerymentioning

confidence: 99%

Section: Implementation and Ways Forward In Global Neurosurgerymentioning

confidence: 99%

Letter: The Role of Sonolucent Implants in Global Neurosurgery

Williams,

Abu-Bonsrah,

Lee

et al. 2023

Neurosurgery

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“…TCD reflects cerebral blood flow velocities which may be considered a surrogate for cerebral perfusion in stable conditions (14). Cerebral perfusion monitoring using TCD has already shown its efficacy to detect ischemic injury in several populations of critically ill children (14)(15)(16). NIRS offers a continuous and non-invasive cerebral saturation monitoring (17) that might reflect cerebral oxygenation (18), and is routinely used during pediatric cardiac surgery (19).…”

Section: Introductionmentioning

confidence: 99%

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Clinical applications of transcranial Doppler in non-trauma critically ill children: a scoping review

Cited by 5 publications

References 95 publications

Low Dosing Norepinephrine Effects on Cerebral Oxygenation and Perfusion During Pediatric Shock

Low Dosing Norepinephrine Effects on Cerebral Oxygenation and Perfusion During Pediatric Shock

Letter: The Role of Sonolucent Implants in Global Neurosurgery

Data_Sheet_1.DOCX

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