Transcranial Doppler Sonography in Pediatric Neurocritical Care

LaRovere, Kerri L.; O’Brien, Nicole

doi:10.7863/ultra.15.02016

Cited by 36 publications

(15 citation statements)

References 90 publications

(81 reference statements)

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“…Although the use of TCD in pediatric TBI is still considered experimental and it is not part of the standard of care, there is a growing body of literature. Most recent studies conducted using TCD in pediatric TBI have primarily focused on its use in the diagnosis of increased intracranial pressure, cerebral vasospasm, or hyperemia and trending of cerebral flow velocities (LaRovere & O’Brien, 2015; LaRovere, O’Brien & Tasker, 2015; O’Brien, Maa, Reuter-Rice, 2015; O’Brien, Maa, Yeates, 2015; O’Brien, Reuter-Rice, Khanna, Peterson & Quinto, 2010). …”

Section: Transcranial Doppler Ultrasoundmentioning

confidence: 99%

“…Flow velocities have also been normed for sex and ages 4 to 16 (Table 7). Flow velocities are increasingly higher in the children from birth to 8 years of age, and to decline to adult values at age 18 (Bode & Eden, 1989; Bode & Wais, 1988; LaRovere & O’Brien, 2015; O’Brien, 2015). Other studies have found that girls have higher MCA and BA flow velocities than boys (Tontisirin et al, 2006; Vavilala, Kincaid, Mauangman, Suz, Rozet & Lam, 2005) and in children who are critically ill, ventilated and sedated have lower BA flow than healthy children (O’Brien, 2015).…”

Section: Transcranial Doppler Ultrasoundmentioning

confidence: 99%

“…It has the capability to assess cerebrovascular dynamics and function while also providing intraoperative monitoring in interventional neurodiagnostic procedures, cardiopulmonary bypass, and carotid endarterectomy (Markus, 2000; Newell, 1995). However, in children, TCD has been used most often in evaluations of sickle cell disease and cerebrovascular anomalies, and only recently in traumatic brain injury (TBI) (LaRovere & O’Brien, 2015; Verlhac, 2011). As the indications for its clinical use expand, it behooves clinicians and researchers to familiarize themselves with TCD practice standards and guidelines, diagnostic interpretation, and common data reporting.…”

Section: Introductionmentioning

confidence: 99%

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Transcranial Doppler Ultrasound Use in Pediatric Traumatic Brain Injury

Reuter‐Rice

2017

Journal of Radiology Nursing

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Transcranial Doppler ultrasound (TCD) is an inexpensive portable diagnostic tool commonly available within most healthcare systems. A team of trained individuals perform and interpret the test to inform patient care management. The benefit of TCD is well established in adult patients with traumatic brain injury. However, in children with TBI, it is still considered exploratory and its use is not a part of the standard of care. This article describes what TCD is, its use in children, and how TCD measurements apply to children and adolescents in an effort to establish criteria for the use of TCD for children with TBI. The benefit of TCD in pediatric TBI is illustrated by 2 cases of children who participated in a TBI research study. Early indications are that the use of TCD in pediatric cases of TBI may produce unexpected real-time data about the cerebral vasculature and circulation characteristics in children with TBI. Transcranial Doppler ultrasound has the potential for playing an informative diagnostic role in future pediatric TBI management. Ultimately the goal to promote best outcomes after a TBI requires insights into the multi-dynamic nature of the injury and TCD has the ability to support these efforts.

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Section: Transcranial Doppler Ultrasoundmentioning

confidence: 99%

Section: Transcranial Doppler Ultrasoundmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transcranial Doppler Ultrasound Use in Pediatric Traumatic Brain Injury

Reuter‐Rice

2017

Journal of Radiology Nursing

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“…Thus, PI can be used in non-invasive ICP assessment in the ICU [18] , for example, when placing an invasive-ICP monitor is contraindicated (e.g. in severe coagulopathy), where ICP monitoring is not accessible as in equipment's-poor ICU, or in patients with mild to moderate TBI who are without ICP monitor but may be at risk of impending worsening [19] .…”

Section: Introductionmentioning

confidence: 99%

Is The Combination of Glasgow Coma Scale and Transcranial Doppler Pulsatility Index Improving The Prediction of Outcome in Traumatic Brain Injury Patients?

Abdelhaleem¹,

Othman²,

Razek³

et al. 2019

Zagazig University Medical Journal

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Background: Glasgow coma scale (GCS) is a familiar scoring system with a standard statistical association with neurological outcome, it has many limitations that minimize its ability in prediction of Traumatic brain injury (TBI) patients' outcome. Transcranial Doppler (TCD) is a noninvasive aid in this field that can improve outcome prediction. Objective: This study aims to explore the effect of combination of GCS and Pulsatility Index (PI) in the prediction of outcome of TBI patients. Patients and Method: This study was performed in Zagazig University Hospital (ZUH). 103 traumatic brain injured patients were engaged in the investigations with hospital days of 1, 2, 3, and 7 or until patient discharge. The study was performed by TCD along with GCS recordings. Prognosis was also assessed by the Glasgow outcome scale (GOS). Results: The sensitivity and negative predictive value of PI was more than GCS in TBI patients (GCS 3-15), as they were (67.5% versus 50%) and (81.1% versus 74.3%), respectively. The combination of both PI and GCS increased the sensitivity and the negative predictive value up to 70% and 83.3%, respectively. PI had higher sensitivity, positive and negative predictive values than GCS in the identification of secondary neurologic deterioration (SND) in mild and moderate TBI patients (73.3% versus 40.0%, 61.1% versus 50.0%, and 92.0% versus 83.9%, respectively), while the combined value of both PI and GCS increased both sensitivity and positive predictive value up to 76.7% and 66.7%, respectively. Conclusion: The combination of GCS and PI would improve the prediction of outcome.

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“…Similar data were obtained by other authors who also show that in children with traumatic brain injury, an increase in RI greater than 1.3 is a highly sensitive and specific sign of an increase in ICP of more than 20 mm Hg. (LaRovere et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Non-invasive evaluation of cerebral hemodynamic and intracranial pressure in pediatric neuroinfections

Georgiynts

Корсунов

Ольховська

et al. 2018

Regul. Mech. Biosyst.

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The study of intracranial pressure (eICP), cerebral perfusion pressure (eCPP), cerebral blood flow index (CFI), zero flow pressure (ZFP) in 49 children hospitalized in the intensive care unit with severe course of neuroinfections was carried out. The level of consciousness was determined by the Glasgow pediatric scale. Monitoring of central and peripheral hemodynamics (ECG, heart rate, systolic, diastolic and mean blood pressure, and cardiac output), pulse oximetry, capnography, hemoglobin, hematocrit, total protein, urea, creatinine, lactate, glucose and serum electrolytes was done. An ultrasound scanner was used to perform ultrasound duplex scanning of blood flow in the left and middle cerebral artery (MCA), measuring maximum, minimum and average blood flow velocities, pulsation index (PI), and resistance index (RI). Based on the formulae of Edouard et al. indicators of eCPP, ZFP, CFI, eICP were calculated. The eSCP was also determined by the formulae of Kligenchöfer et al. and Bellner et al. All patients were divided into group I with RI > 1.3 and group II with RI < 1.3. It was found that eCPP in the group I was significantly less (29.5 ± 1.3 mm Hg) than in the II group (41.6 ± 1.7 mm Hg). Despite the lack of a reliable difference in blood pressure between groups I and II, the difference in eCPP was found due to a significant difference in eICP 34.6 ± 1.4 and 27.6 ± 0.89 mm Hg in I and II groups respectively. ZFP in group I was significantly higher than in group II. The indexes of the Glasgow coma scale was significantly lower in group I and 7.8 ± 0.6 points. There were observed direct moderate correlations between systolic blood pressure, cardiac output and eSRP and CFI, presumably associated with a loss of autoregulation. CFI in the group I was lower than in the group II. Thus, non-invasive examination of cerebral flow in MCA by duplex sonography revealed that PI > 1.3 is an informative marker of intracranial hypertension and reduction of cerebral perfusion, which is common in children with neuroinfections. To determine the eSRP and CFI it is advisable to use the formula of Edouard et al. and to determine the eICP the formula of Kligenchöfer et al. The obtained data can be useful for objectifying the severity of the condition, predicting the outcomes of neuroinfections, choosing the directions of intensive care and evaluating its effectiveness.

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Transcranial Doppler Sonography in Pediatric Neurocritical Care

Cited by 36 publications

References 90 publications

Transcranial Doppler Ultrasound Use in Pediatric Traumatic Brain Injury

Transcranial Doppler Ultrasound Use in Pediatric Traumatic Brain Injury

Is The Combination of Glasgow Coma Scale and Transcranial Doppler Pulsatility Index Improving The Prediction of Outcome in Traumatic Brain Injury Patients?

Non-invasive evaluation of cerebral hemodynamic and intracranial pressure in pediatric neuroinfections

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