Transcranial Doppler Pulsatility Index

Behrens, Anders; Lenfeldt, Niklas; Ambarki, Khalid; Malm, Jan; Eklund, Anders; Koskinen, Lars-Owe D.

doi:10.1227/01.neu.0000369519.35932.f2

Cited by 112 publications

(83 citation statements)

References 31 publications

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“…However, findings from other studies in adults with neurological illness and injury are in direct contrast to these and suggest that TCD-derived parameters are clinically inadequate predictors of ICP. 6,9,31 To date, there have only been 2 studies evaluating the use of TCD-derived parameters to predict ICP in children with TBI. 13,21 Melo et al retrospectively reviewed the TCD evaluations on 117 head injured children with ICP monitors in place.…”

Section: < 00001)mentioning

confidence: 99%

“…5,6,17 There is a subset of patients who do not meet guideline recommendations for ICP monitoring but who are at risk for the development of intracranial hypertension, and in whom serial neurological exams to detect neurological abbreviatioNs GCS = Glasgow Coma Scale; ICP = intracranial pressure; MCA = middle cerebral artery; PI = pulsatility index; TBI = traumatic brain injury; TCD = transcranial Doppler; Vd = diastolic flow velocity; Vm = mean flow velocity; Vs = systolic flow velocity submitted October 4, 2014. obJect The aim of this study was to determine the relationship between transcranial Doppler (TCD) derived pulsatility index (PI), end diastolic flow velocity (Vd), and intracranial pressure (ICP). The subjects in this study were 36 children admitted after severe traumatic brain injury (TBI) (postresuscitation Glasgow Coma Scale ≤ 8) undergoing invasive ICP monitoring.…”

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confidence: 99%

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Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury

O’Brien

Maa

Reuter‐Rice

2015

PED

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OBJECT The aim of this study was to determine the relationship between transcranial Doppler (TCD) derived pulsatility index (PI), end diastolic flow velocity (Vd), and intracranial pressure (ICP). The subjects in this study were 36 children admitted after severe traumatic brain injury (TBI) (postresuscitation Glasgow Coma Scale ≤ 8) undergoing invasive ICP monitoring. METHODS Subjects underwent a total of 148 TCD studies. TCD measurements of systolic flow velocity (Vs), Vd, and mean flow velocity (Vm) were performed on the middle cerebral artery (MCA) ipsilateral to the ICP monitor. The PI was calculated by the TCD software (Vs-Vd/Vm). ICP registrations were made in parallel with TCD measurements. RESULTS Using a PI threshold of 1.3, postinjury Day 0–1 PI had 100% sensitivity and 82% specificity at predicting an ICP ≥ 20 mm Hg (n = 8). During this time frame, a moderately strong relationship was observed between the MCA PI and actual ICP (r = 0.611, p = 0.01). When using a threshold of < 25 cm/sec, postinjury Day 0-1 Vd had a 56% sensitivity to predict an ICP ≥ 20 mm Hg. Beyond the initial 24 hours from injury, the sensitivity of an MCA PI of 1.3 to detect an ICP ≥20 mm Hg was 47%, and a weak relationship between actual ICP values and MCA PI (r = 0.376, p = 0.01) and MCA Vd (r = -0.284, p = 0.01) was found. CONCLUSIONS Postinjury Day 0-1 MCA PI > 1.3 has good sensitivity and specificity at predicting an ICP ≥ 20 mm Hg. In those children with TBI who initially do not meet clear criteria for invasive ICP monitoring but who are at risk for development of intracranial hypertension, TCD may be used as a noninvasive tool to screen for the development of elevated ICP in the first 24 hours following injury.

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Section: < 00001)mentioning

confidence: 99%

mentioning

confidence: 99%

Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury

O’Brien

Maa

Reuter‐Rice

2015

PED

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“…Noninvasive ICP Monitoring A variety of methods to measure ICP noninvasively have been studied, including transcranial Doppler ultrasonography [17,18], optic nerve sheath diameter [19][20][21], fundoscopic papillary examination [22], and tympanic membrane displacement [23]. Unfortunately, all of these techniques are subject to artifact, have been studied in relatively small numbers of patients, require significant expertise to perform, and have only limited correlation with invasively obtained ICPs.…”

Section: Invasive Icp Monitoringmentioning

confidence: 99%

ICU Management of Traumatic Brain Injury

Hallman

Joffe

2013

Curr Anesthesiol Rep

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Traumatic brain injury (TBI) is a major cause of death and disability throughout the world. Injury can be divided into primary and secondary injuries. For patients with TBI admitted to the intensive care unit (ICU), the management and prevention of secondary injury is most important. The third edition of the Brain Trauma Foundation guidelines was published in 2007 and is widely used to guide treatment of patients with severe TBI. This article reviews ICU care of patients with severe TBI, with a particular focus on recent evidence that is not incorporated in the existing guidelines.

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“…Diğer taraftan tilt testinde presenkop durumunda da pulsatilite indeksi artar. Ayrıca distal vazospazm ortaya çıkmaktadır (7). Benzer sorun Pİ'ne dayanan SPB formülleri için de aynen geçerlidir.…”

Section: Pulsatilite Indeksinin Arttığı Diğer Durumlarunclassified

“…Bu dalga formuna "SİSTOLİK PİK" adı verilir ve aşırı derecede artmış KİB'yi işaret eder. KİB progresif artışı devam ederse sistolik pik süresi kısalır [6] ve daha sonra akım diastolde ve/veya geç sistolde geri dönmeye başlar [7][8]. Bu durumda KİB değeri diastolik kan basıncından büyüktür.…”

Section: Venöz Tcdunclassified

Neurosonology of intracranial pressure increase

Togcuoglu¹,

Arsava²

2011

Türk Beyin Damar Hast Derg

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Nörolojik yoğun bakımlarda kafa içi basıncı yükselmesi sadece sık görülmesinden dolayı değil aynı zamanda tedavi edilebilir olmasından dolayı da önemli bir problemdir. Birçok hastalığın seyrinde kafa içi basıncının doğrudan ölçümü ya da tahmin edilmesinin kritik önemi vardır. Non-invazif ve yatak başında kullanılabilen birçok nörosonolojik yöntem ile kafa içi basıncı monitörize edilebilir. Bu makalede bu yöntemler literatür bilgisi ışığında pratik uygulama temel alınarak gözden geçirilmektedir. Anahtar Sözcükler: Transkranial Doppler, B-mod, pulsatilite, orta hat şifti, orbital sonografi, otoregülasyon. NEUROSONOLOGY OF INTRACRANIAL PRESSURE INCREASE SUMMARYIncrease in intracranial pressure (ICP) is one of the most significant problems in the neurological intensive care units not only due to its high prevalence, but also due to its treatable nature. Direct measurement or indirect estimation of ICP during the course of many neurological diseases is of critical importance. A variety of neurosonogical methodologies, which are totally non invasive and applicable at the bed-side repeatedly, have extensively been used to evaluate and monitor ICP. These neurosonological techniques, including most recent developments, are herein reviewed primarily from the perspective of practical applications.

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Transcranial Doppler Pulsatility Index

Abstract: The in vivo results show that PI is not a reliable predictor of ICP. Mathematical simulations indicate that this is caused by variations in physiological parameters.

Cited by 112 publications

References 31 publications

Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury

Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury

ICU Management of Traumatic Brain Injury

Neurosonology of intracranial pressure increase

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