Transcranial color-coded duplex sonography allows to assess cerebral perfusion pressure noninvasively following severe traumatic brain injury
| Autor: | Susanne Sailer, Reto Stocker, Giovanna Brandi, Christoph Haberthür, John F. Stover, Markus Béchir |
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| Přispěvatelé: | University of Zurich |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Middle Cerebral Artery Adolescent Critical Care Intracranial Pressure Ultrasonography Doppler Transcranial 610 Medicine & health Blood Pressure Pulsatility index Sensitivity and Specificity Clinical study Young Adult Nuclear magnetic resonance Brain Injury Chronic medicine Humans Prospective Studies Cerebral perfusion pressure Ultrasonography Doppler Color Aged business.industry Brain Middle Aged University hospital Prognosis 2746 Surgery Survival Rate 10022 Division of Surgical Research 2728 Neurology (clinical) Regional Blood Flow Brain Injuries Pulsatile Flow Duplex sonography Surgery Female Neurology (clinical) Radiology Ultrasonography business Blood Flow Velocity Craniotomy |
| Popis: | 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). This is an observational clinical study in a university hospital. A total of 45 continuously sedated (BIS 35 mmHg), and non-febrile TBI patients. 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. 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. 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. |
| Databáze: | OpenAIRE |
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