Utility of Transcranial Doppler in Moderate and Severe Traumatic Brain Injury: A Narrative Review of Cerebral Physiologic Metrics

Gomez, Alwyn; Batson, Carleen; Froese, Logan; Sainbhi, Amanjyot Singh; Zeiler, Frederick A.

doi:10.1089/neu.2020.7523

Cited by 13 publications

(20 citation statements)

References 81 publications

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“…The echo will be of a higher frequency if the object is moving toward the source of the soundwaves, and the echo will be of a lower frequency if the object is moving away from the source. The Doppler shift is known as the difference of the emitted frequency vs. the reflected soundwave and it is directly proportional to the relative speed of the moving object to the source ( 18 ).…”

Section: Transcranial Dopplermentioning

confidence: 99%

Non-Invasive and Minimally-Invasive Cerebral Autoregulation Assessment: A Narrative Review of Techniques and Implications for Clinical Research

et al. 2022

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The process of cerebral vessels regulating constant cerebral blood flow over a wide range of systemic arterial pressures is termed cerebral autoregulation (CA). Static and dynamic autoregulation are two types of CA measurement techniques, with the main difference between these measures relating to the time scale used. Static autoregulation looks at the long-term change in blood pressures, while dynamic autoregulation looks at the immediate change. Techniques that provide regularly updating measures are referred to as continuous, whereas intermittent techniques take a single at point in time. However, a technique being continuous or intermittent is not implied by if the technique measures autoregulation statically or dynamically. This narrative review outlines technical aspects of non-invasive and minimally-invasive modalities along with providing details on the non-invasive and minimally-invasive measurement techniques used for CA assessment. These non-invasive techniques include neuroimaging methods, transcranial Doppler, and near-infrared spectroscopy while the minimally-invasive techniques include positron emission tomography along with magnetic resonance imaging and radiography methods. Further, the advantages and limitations are discussed along with how these methods are used to assess CA. At the end, the clinical considerations regarding these various techniques are highlighted.

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Section: Transcranial Dopplermentioning

confidence: 99%

Non-Invasive and Minimally-Invasive Cerebral Autoregulation Assessment: A Narrative Review of Techniques and Implications for Clinical Research

et al. 2022

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“…Over recent decades there has been a dramatic expansion of continuous bedside multi-modal cerebral physiologic monitoring, beyond the classic intra-cranial pressure (ICP) and cerebral perfusion pressure (CPP) ( 4 , 6 ). Such devices include continuous multi-channel near infrared spectroscopy (NIRS) based cerebral oximetry, ( 36 ) invasive parenchymal extracellular oxygen partial pressure monitoring (PbtO 2 ) ( 6 , 37 , 38 ), invasive parenchymal thermal diffusion based cerebral blood flow (CBF) monitoring ( 39 ), transcranial Doppler (TCD) based cerebral blood flow velocity (CBFV) monitoring ( 40 – 42 ), and continuous electroencephalogram (EEG) ( 4 , 43 – 45 ). Many of these devices output full-waveform level data, in high-frequency, with varying levels of literature supporting their association with patient's long-term outcomes ( 3 , 4 , 6 , 46 – 49 ) and variable support from multi-disciplinary groups ( 4 , 5 , 50 , 51 ).…”

Section: Current Status Of Omics Data In Moderate/severe Tbimentioning

confidence: 99%

Integrative Neuroinformatics for Precision Prognostication and Personalized Therapeutics in Moderate and Severe Traumatic Brain Injury

et al. 2021

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Despite changes in guideline-based management of moderate/severe traumatic brain injury (TBI) over the preceding decades, little impact on mortality and morbidity have been seen. This argues against the “one-treatment fits all” approach to such management strategies. With this, some preliminary advances in the area of personalized medicine in TBI care have displayed promising results. However, to continue transitioning toward individually-tailored care, we require integration of complex “-omics” data sets. The past few decades have seen dramatic increases in the volume of complex multi-modal data in moderate and severe TBI care. Such data includes serial high-fidelity multi-modal characterization of the cerebral physiome, serum/cerebrospinal fluid proteomics, admission genetic profiles, and serial advanced neuroimaging modalities. Integrating these complex and serially obtained data sets, with patient baseline demographics, treatment information and clinical outcomes over time, can be a daunting task for the treating clinician. Within this review, we highlight the current status of such multi-modal omics data sets in moderate/severe TBI, current limitations to the utilization of such data, and a potential path forward through employing integrative neuroinformatic approaches, which are applied in other neuropathologies. Such advances are positioned to facilitate the transition to precision prognostication and inform a top-down approach to the development of personalized therapeutics in moderate/severe TBI.

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“…However, these measurements of imaging equipment have poor time resolution, large size, and high cost and are not suitable for bedside real-time monitoring 12 . Successives measurements, such as ICP, transcranial doppler(TCD) 13 and near-infrared spectroscopy (NIRS) monitor 14 , use some physical quantities as a surrogate for CBF or CBV and can be applied to bedside, continuous, real-time CVAR monitoring. Various indexes for monitoring and evaluation of CVAR are obtained with these methods.…”

Section: Introductionmentioning

confidence: 99%

An experimental study of conductivity reactivity index for assessment of cerebrovascular autoregulation in cerebral ischemic rabbits

Jin

Zhuang

et al. 2022

Preprint

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Cerebrovascular autoregulation function is the mechanism ensuring the maintenance of constant cerebral blood flow by adjusting the caliber of cerebral vessels. It is important to have an effective noncontact tool for assessment and monitoring of the function in patients with acute ischemic stroke. The adjustment of intracranial arteriole caliber leads to changes in the conductivity of entire brain by relative changes in cerebral blood volume. Here, the electrical properties measurement of entire brain by magnetic induction phase shift with two contactless coils placed across the head is a valuable alternative to assess the function. Then, we proposed the correlation coefficient between spontaneous slow oscillations in arterial blood pressure and corresponding slow spontaneous oscillations in magnetic induction phase shift as a new index called conductivity reactivity index. The novel index is preliminarily confirmed the feasibility to monitor cerebrovascular autoregulation function after ischemic stroke on the animal experience. It has the potential to be used for noncontact, global, deep, bedside and real-time assessment of cerebrovascular autoregulation function of patients with cerebral ischemic stroke.

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Utility of Transcranial Doppler in Moderate and Severe Traumatic Brain Injury: A Narrative Review of Cerebral Physiologic Metrics

Cited by 13 publications

References 81 publications

Non-Invasive and Minimally-Invasive Cerebral Autoregulation Assessment: A Narrative Review of Techniques and Implications for Clinical Research

Non-Invasive and Minimally-Invasive Cerebral Autoregulation Assessment: A Narrative Review of Techniques and Implications for Clinical Research

Integrative Neuroinformatics for Precision Prognostication and Personalized Therapeutics in Moderate and Severe Traumatic Brain Injury

An experimental study of conductivity reactivity index for assessment of cerebrovascular autoregulation in cerebral ischemic rabbits

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