Transcranial Doppler as a non-invasive method to estimate cerebral perfusion pressure in children with severe traumatic brain injury

Abecasis, Francisco; Cardim, Danilo; Czosnyka, Marek; Robba, Chiara; Agrawal, Shruti

doi:10.1007/s00381-019-04273-2

Cited by 17 publications

(8 citation statements)

References 19 publications

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“…In a recently published paper using continuous TCD recordings to non-invasively estimate CPP in children who had suffered TBI, CPPe overestimated CPP by 19.61 mmHg with wide 95% CI of ± 40 mmHg on Bland-Altman analysis [36]. Our results are similar to this study in that we also identified wide limits of agreement for both the CPPe and CrCP/ CPPe methods (> − 15 to > + 25).…”

Section: Discussionsupporting

confidence: 87%

Non-invasive estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography in children with severe traumatic brain injury

et al. 2020

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Objective To identify if cerebral perfusion pressure (CPP) can be non-invasively estimated by either of two methods calculated using transcranial Doppler ultrasound (TCD) parameters. Design Retrospective review of previously prospectively gathered data. Setting Pediatric intensive care unit in a tertiary care referral hospital. Patients Twenty-three children with severe traumatic brain injury (TBI) and invasive intracranial pressure (ICP) monitoring in place. Interventions TCD evaluation of the middle cerebral arteries was performed daily. CPP at the time of the TCD examination was recorded. For method 1, estimated cerebral perfusion pressure (CPPe) was calculated as: CPPe = MAP × (diastolic flow (Vd)/ mean flow (Vm)) + 14. For method 2, critical closing pressure (CrCP) was identified as the intercept point on the x-axis of the linear regression line of blood pressure and flow velocity parameters. CrCP/CPPe was then calculated as MAP-CrCP. Measurements and main results One hundred eight paired measurements were available. Using patient averaged data, correlation between CPP and CPPe was significant (r = 0.78, p = < 0.001). However, on Bland-Altman plots, bias was 3.7 mmHg with 95% limits of agreement of − 17 to + 25 for CPPe. Using patient averaged data, correlation between CPP and CrCP/CPPe was significant (r = 0.59, p = < 0.001), but again bias was high at 11 mmHg with wide 95% limits of agreement of − 15 to + 38 mmHg. Conclusions CPPe and CrCP/CPPe do not have clinical value to estimate the absolute CPP in pediatric patients with TBI.

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Section: Discussionsupporting

confidence: 87%

Non-invasive estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography in children with severe traumatic brain injury

et al. 2020

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“…Conversely, in a recent study involving 100 TBI patients, nICP_FVd had essentially no agreement with invasive ICP (R = −0.17; 95% CI: −0.35, 0.03; p = 0.097) and a sensitivity of 0% for detecting ICP >20 mmHg, though notably few patients had elevations in ICP in this cohort (170). Similar findings have been reported in nCPP estimation in children with TBI using nICP_CrCP where the ability to identify CPP values below 70 mmHg was excellent (AUC = 0.91; 95% CI: 0.83-0.99) though overestimated true CPP by about 20 mmHg and was less precise for more clinically relevant thresholds of CPP < 60 mmHg and <50 mmHg (167). In another pediatric TBI study, both nICP_FVd and nICP_CrCP were compared against invasive monitoring and while there was a strong correlation between both models and CPP, each were also associated with wide limits of agreement and unable to discriminate CPP values <50-60 mmHg (171).…”

Section: Non-invasive Icp and Cppsupporting

confidence: 84%

“…Subsequent investigations using these non-invasive methods in different populations has produced mixed results with evidence of good correlation, though less accurate prediction, of absolute nICP and nCPP values ( 167 , 168 ). The multicenter IMPRESSIT-2 study found nICP estimation based on nICP_FVd resulted in a high NPV for ICP >20 mmHg and >25 mmHg, 91.3 and 98.6%, respectively, though a concordance correlation between nICP and invasive ICP of only 33.3% ( 169 ).…”

Section: Transcranial Dopplermentioning

confidence: 99%

Multimodal and autoregulation monitoring in the neurointensive care unit

2023

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Given the complexity of cerebral pathology in patients with acute brain injury, various neuromonitoring strategies have been developed to better appreciate physiologic relationships and potentially harmful derangements. There is ample evidence that bundling several neuromonitoring devices, termed “multimodal monitoring,” is more beneficial compared to monitoring individual parameters as each may capture different and complementary aspects of cerebral physiology to provide a comprehensive picture that can help guide management. Furthermore, each modality has specific strengths and limitations that depend largely on spatiotemporal characteristics and complexity of the signal acquired. In this review we focus on the common clinical neuromonitoring techniques including intracranial pressure, brain tissue oxygenation, transcranial doppler and near-infrared spectroscopy with a focus on how each modality can also provide useful information about cerebral autoregulation capacity. Finally, we discuss the current evidence in using these modalities to support clinical decision making as well as potential insights into the future of advanced cerebral homeostatic assessments including neurovascular coupling.

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“…At present, a large number of studies have confirmed the pathogenesis of VBI, mainly including the following points: ①cervical degenerative changes, cervical spondylosis, neck inflammation and neck muscle brain damage, etc., which will lead to compression of the vertebral artery. When the position of the head changes, it will stimulate the sympathetic nerve of the neck, and then induce the spasm of the vertebral artery, resulting in change of blood flow velocity of artery; ②due to the influence of their diseases, such as hyperlipidemia, hypertension, and diabetes, atherosclerosis will occur, involving all blood vessels and their branches, leading to stage vascular stenosis, resulting in corresponding changes in blood flow speed and spectrum morphology [8,9]. Previously, there was no simple and effective method for the detection of VBI, but in recent years, with the development and progress of medical technology and the emergence of TCD, it provides an accurate, noninvasive, and simple method for the diagnosis of VBI.…”

Section: Discussionmentioning

confidence: 99%

Evaluation on the application of transcranial Doppler (TCD) and electroencephalography (EEG) in patients with vertebrobasilar insufficiency

Zheng

Wang

et al. 2020

J Orthop Surg Res

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Background To evaluate the diagnostic value of transcranial Doppler (TCD) and electroencephalography (EEG) in patients with vertebrobasilar insufficiency (VBI) during clinical diagnosis and treatment Methods Eighty patients diagnosed with VBI in our hospital from June 2018 to December 2019 were randomly selected as the observation group, and 80 healthy people who received physical examination in the same period were selected as the control group. The abnormal rate, main performance and results, and the peak velocity of blood flow and vertebrobasilar artery blood flow of the two groups were compared. Results The abnormal rate of EEG and TCD in VBI patients was 38.75% (31/80) and the 93.75% (75/80), respectively. In TCD examination, ACA, PCA, MCA, and VA of both sides of the observation group were higher than those of the control group, while BA was lower than that of the control group (P < 0.05). The Vs, Vd, and Vm on both sides of BA and VA in the observation group were lower than those in the control group, while PI and RI were higher than those in the control group (P < 0.05). Conclusions TCD examination is highly sensitive to the degree and pattern of cerebral ischemia in VBI patients. EEG examination will define the changes of brain cell function after cerebral ischemia. Therefore, EEG and TCD have their own advantages. The application of TCD and EEG can be considered in the early diagnosis, curative effect, and prognosis evaluation of VBI patients, so as to improve the accuracy of diagnosis and prognosis.

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Transcranial Doppler as a non-invasive method to estimate cerebral perfusion pressure in children with severe traumatic brain injury

Cited by 17 publications

References 19 publications

Non-invasive estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography in children with severe traumatic brain injury

Non-invasive estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography in children with severe traumatic brain injury

Multimodal and autoregulation monitoring in the neurointensive care unit

Evaluation on the application of transcranial Doppler (TCD) and electroencephalography (EEG) in patients with vertebrobasilar insufficiency

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