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Transcranial color-coded duplex sonography allows to assess cerebral perfusion pressure noninvasively following severe traumatic brain injury

  • Clinical Article
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Abstract

Objective

Assess optimal equation to noninvasively estimate intracranial pressure (eICP) and cerebral perfusion pressure (eCPP) following severe traumatic brain injury (TBI) using transcranial color-coded duplex sonography (TCCDS).

Design and setting

This is an observational clinical study in a university hospital.

Patients

A total of 45 continuously sedated (BIS < 50), normoventilated (paCO2 > 35 mmHg), and non-febrile TBI patients.

Methods

eICP and eCPP based on TCCDS-derived flow velocities and arterial blood pressure values using three different equations were compared to actually measured ICP and CPP in severe TBI patients subjected to standard treatment. Optimal equation was assessed by Bland–Altman analysis.

Results

The equations: \( {\hbox{ICP}} = {1}0.{927} \times {\hbox{PI}}\left( {{\hbox{pulsatility}}\,{\hbox{index}}} \right) - {1}.{284} \) and \( {\hbox{CPP}} = {89}.{646} - {8}.{258} \times {\hbox{PI}} \) resulted in eICP and eCPP similar to actually measured ICP and CPP with eICP 10.6 ± 4.8 vs. ICP 10.3 ± 2.8 and eCPP 81.1 ± 7.9 vs. CPP 80.9 ± 2.1 mmHg, respectively. The other two equations, \( {\hbox{eCPP}} = \left( {{\hbox{MABP}} \times {\hbox{EDV}}} \right)/{\hbox{mFV}} + {14} \) and \( {\hbox{eCPP}} = \left[ {{\hbox{mFV}}/\left( {{\hbox{mFV}} - {\hbox{EDV}}} \right)} \right] \times \left( {{\hbox{MABP}} - {\hbox{RRdiast}}} \right) \), resulted in significantly decreased eCPP values: 72.9 ± 10.1 and 67 ± 19.5 mmHg, respectively. Superiority of the first equation was confirmed by Bland–Altman revealing a smallest standard deviations for eCPP and eICP.

Conclusions

TCCDS-based equation \( \left( {{\hbox{ICP}} = {1}0.{927} \times {\hbox{PI}} - {1}.{284}} \right) \) allows to screen patients at risk of increased ICP and decreased CPP. However, adequate therapeutic interventions need to be based on continuously determined ICP and CPP values.

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References

  1. BrainIT Standards—Hydrostatic Pressure Gradients and CPP. www.brainit.org/bit2web/faces/Standards_hpg.jsp

  2. Bellner J, Romner B, Reinstrup P, Kristiansson KA, Ryding E, Brandt L (2004) Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP). Surg Neurol 62:45–51

    Article  PubMed  Google Scholar 

  3. Edouard AR, Vanhille E, Le Moigno S, Benhamou D, Mazoit JX (2005) Non-invasive assessment of cerebral perfusion pressure in brain injured patients with moderate intracranial hypertension. Br J Anaesth 94:216–221

    Article  CAS  PubMed  Google Scholar 

  4. Kochanowicz J, Krejza J, Mariak Z, Bilello M, Lyson T, Lewko J (2006) Detection and monitoring of cerebral hemodynamic disturbances with transcranial color-coded duplex sonography in patients after head injury. Neuroradiology 48:31–36

    Article  CAS  PubMed  Google Scholar 

  5. Krejza J, Rudzinski W, Pawlak MA, Tomaszewski M, Ichord R, Kwiatkowski J, Gor D, Melhem ER (2007) Angle-corrected imaging transcranial doppler sonography versus imaging and nonimaging transcranial doppler sonography in children with sickle cell disease. AJNR Am J Neuroradiol 28:1613–1618

    Article  CAS  PubMed  Google Scholar 

  6. Lee JH, Kelly DF, Oertel M, McArthur DL, Glenn TC, Vespa P, Boscardin WJ, Martin NA (2001) Carbon dioxide reactivity, pressure autoregulation, and metabolic suppression reactivity after head injury: a transcranial Doppler study. J Neurosurg 95:222–232

    Article  CAS  PubMed  Google Scholar 

  7. McMahon CJ, McDermott P, Horsfall D, Selvarajah JR, King AT, Vail A (2007) The reproducibility of transcranial Doppler middle cerebral artery velocity measurements: implications for clinical practice. Br J Neurosurg 21:21–27

    Article  CAS  PubMed  Google Scholar 

  8. Moppett IK, Mahajan RP (2004) Transcranial Doppler ultrasonography in anaesthesia and intensive care. Br J Anaesth 93:710–724

    Article  CAS  PubMed  Google Scholar 

  9. Oertel M, Kelly DF, Lee JH, McArthur DL, Glenn TC, Vespa P, Boscardin WJ, Hovda DA, Martin NA (2002) Efficacy of hyperventilation, blood pressure elevation, and metabolic suppression therapy in controlling intracranial pressure after head injury. J Neurosurg 97:1045–1053

    Article  PubMed  Google Scholar 

  10. Ojha BK, Jha DK, Kale SS, Mehta VS (2005) Trans-cranial Doppler in severe head injury: evaluation of pattern of changes in cerebral blood flow velocity and its impact on outcome. Surg Neurol 64:174–179

    Article  PubMed  Google Scholar 

  11. Ract C, Le Moigno S, Bruder N, Vigué B (2007) Transcranial Doppler ultrasound goal-directed therapy for the early management of severe traumatic brain injury. Intensive Care Med 33:645–651

    Article  PubMed  Google Scholar 

  12. Rainov NG, Weise JB, Burkert W (2000) Transcranial Doppler sonography in adult hydrocephalic patients. Neurosurg Rev 23:34–38

    Article  CAS  PubMed  Google Scholar 

  13. Schmidt EA, Czosnyka M, Gooskens I, Piechnik SK, Matta BF, Whitfield PC, Pickard JD (2001) Preliminary experience of the estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography. J Neurol Neurosurg Psychiatry 70:198–204

    Article  CAS  PubMed  Google Scholar 

  14. Soehle M, Czosnyka M, Pickard JD, Kirkpatrick PJ (2004) Continuous assessment of cerebral autoregulation in subarachnoid hemorrhage. Anesth Analg 98:1133–1139

    Article  PubMed  Google Scholar 

  15. Soehle M, Chatfield DA, Czosnyka M, Kirkpatrick PJ (2007) Predictive value of initial clinical status, intracranial pressure and transcranial Doppler pulsatility after subarachnoid haemorrhage. Acta Neurochir (Wien) 149:575–583

    Article  CAS  Google Scholar 

  16. Swiat M, Weigele J, Hurst RW, Kasner SE, Pawlak M, Arkuszewski M, Al-Okaili RN, Swiercz M, Ustymowicz A, Opala G, Melhem ER, Krejza J (2009) Middle cerebral artery vasospasm: transcranial color-coded duplex sonography versus conventional nonimaging transcranial Doppler sonography. Crit Care Med 37:963–968

    Article  PubMed  Google Scholar 

  17. White H, Venkatesh B (2006) Applications of transcranial Doppler in the ICU: review. Intensive Care Med 32:981–994

    Article  PubMed  Google Scholar 

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Acknowledgements

The help of the ICU nursing staff in collecting clinical data is gratefully acknowledged.

Disclosure/Conflict of interest

None.

Funding

This study was supported in parts by grants from the Swiss National Research Foundation and the SUVA Fonds to JFS and RS.

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Correspondence to John F. Stover.

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Brandi, G., Béchir, M., Sailer, S. et al. Transcranial color-coded duplex sonography allows to assess cerebral perfusion pressure noninvasively following severe traumatic brain injury. Acta Neurochir 152, 965–972 (2010). https://doi.org/10.1007/s00701-010-0643-4

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  • DOI: https://doi.org/10.1007/s00701-010-0643-4

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