Background and Aims TCD is a non invasive cerebral circulation monitoring tool by evaluation of cerebral blood flow velocities in the circle of Willis.
The Aim is to show what extent the TCD allows to detect the intracranial hypertension and test the hypothesis that in children with severe TBI, there is a correlation between intracranial pressure (ICP) and TCD values.
Methods Data were prospectively collected from consecutive TCD studies in children with severe TBI undergoing ICP monitoring. For each examination of the TCD we measured the systolic, diastolic and mean velocities respectively, and we calculated the pulsatility index (PI). Middle cerebral artery through the temporal window was used for examinations of the TCD. For each patient 2–4 Doppler examinations have been recorded systematically and at ICP peaks.
Results 58 children underwent 232 TCD. There was a weak relationship between mean values of ICP and PI. Any increase in ICP above 20 mmHg was accompanied by a PI > 1.4 with a diastolic velocity < 30 cm/s. The CPP is comparable to the figures estimated by CPP with TCD.
Conclusion TCD has become an essential tool in the management of children for diagnosis of intracranial hypertension. Its use as in particular following traumatic brain injury, and confirmation of a clinical diagnosis of brain death by documentation of cerebral circulatory arrest. Pulsativity index (PI) and diastolic velocity (Vd) give sufficient information to evaluate the resistance status of small downstream arteries and an indicator cerebral hypoperfusion.
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