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Jijeh AMZ, Fatima A, Faraji MA, Hamadah HK, Shaath GA. Intracranial Pressure and Cerebral Hemodynamics in Infants Before and After Glenn Procedure. Crit Care Explor 2024; 6:e1083. [PMID: 38694846 PMCID: PMC11057806 DOI: 10.1097/cce.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVES This prospective cohort study aimed to investigate changes in intracranial pressure (ICP) and cerebral hemodynamics in infants with congenital heart disease undergoing the Glenn procedure, focusing on the relationship between superior vena cava pressure and estimated ICP. DESIGN A single-center prospective cohort study. SETTING The study was conducted in a cardiac center over 4 years (2019-2022). PATIENTS Twenty-seven infants with congenital heart disease scheduled for the Glenn procedure were included in the study, and detailed patient demographics and primary diagnoses were recorded. INTERVENTIONS Transcranial Doppler (TCD) ultrasound examinations were performed at three time points: baseline (preoperatively), postoperative while ventilated (within 24-48 hr), and at discharge. TCD parameters, blood pressure, and pulmonary artery pressure were measured. MEASUREMENTS AND MAIN RESULTS TCD parameters included systolic flow velocity, diastolic flow velocity (dFV), mean flow velocity (mFV), pulsatility index (PI), and resistance index. Estimated ICP and cerebral perfusion pressure (CPP) were calculated using established formulas. There was a significant postoperative increase in estimated ICP from 11 mm Hg (interquartile range [IQR], 10-16 mm Hg) to 15 mm Hg (IQR, 12-21 mm Hg) postoperatively (p = 0.002) with a trend toward higher CPP from 22 mm Hg (IQR, 14-30 mm Hg) to 28 mm Hg (IQR, 22-38 mm Hg) postoperatively (p = 0.1). TCD indices reflected alterations in cerebral hemodynamics, including decreased dFV and mFV and increased PI. Intracranial hemodynamics while on positive airway pressure and after extubation were similar. CONCLUSIONS Glenn procedure substantially increases estimated ICP while showing a trend toward higher CPP. These findings underscore the intricate interaction between venous pressure and cerebral hemodynamics in infants undergoing the Glenn procedure. They also highlight the remarkable complexity of cerebrovascular autoregulation in maintaining stable brain perfusion under these circumstances.
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Affiliation(s)
- Abdulraouf M Z Jijeh
- Department of Cardiology, Division of Pediatric Cardiac Intensive Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Anis Fatima
- Department of Cardiology, Division of Pediatric Cardiac Intensive Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Mohammad A Faraji
- Department of Radiology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hussam K Hamadah
- Department of Cardiology, Division of Pediatric Cardiac Intensive Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ghassan A Shaath
- Department of Cardiology, Division of Pediatric Cardiac Intensive Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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2
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Connor-Schuler R, Phillips S, Kuo E, Kandiah P, Sadan O. Feasibility and Reliability of Transcranial POCUS Color-Coded Duplex Sonography Performed by Physicians of Varied Ultrasound Experience in Diagnosing Vasospasm in Aneurysmal Subarachnoid Hemorrhage. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:315-322. [PMID: 37902179 DOI: 10.1002/jum.16364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality, which is largely attributable to secondary complications such as vasospasm and subsequent delayed cerebral ischemia. Transcranial Doppler (TCD) is recommended for the screening of vasospasm; however, technicians are not always available. We aimed to see how feasible and reliable bedside transcranial point-of-care ultrasound (POCUS) color-coded duplex sonography was compared with formal non-imaging TCD in measuring velocities and in diagnosing vasospasm. METHODS This was a prospective observational study that took place in the neuroscience intensive care unit at a single academic medical center. Patients with aSAH who were undergoing formal TCDs were scanned on days 2-10 of their admission by physicians of ranging ultrasound experience. Absolute velocities were compared as well as the diagnosis of vasospasm via POCUS and formal TCDs. RESULTS A total of 226 bedside ultrasound exams were performed and compared with 126 formal TCD studies. Sonographic windows were obtained in 89.4% of patients. Scans took 6.6 minutes to complete on average by the advanced group versus 14.5 minutes in the beginner. Correlation ranged from .52 in the beginner group to .65 in the advanced. When good quality of images obtained at a depth of 4-5 cm were reviewed, correlation of mean velocities increased to .96. Overall sensitivity for diagnosing vasospasm was 75%, with a specificity of 99% and negative predictive value of 99%. CONCLUSION Overall, POCUS TCD cannot replace a formal study performed by expert sonographers. An abbreviated POCUS scan can be performed quickly, however, particularly with more experienced operators. POCUS TCD can also feasibly detect vasospasm, and accurate velocities can be obtained by those with all levels of ultrasound experience. Care must be taken on image interpretation that velocities are obtained at an appropriate depth to ensure appropriate insonation of the MCA as well as in optimal alignment with the vessel to obtain the most accurate velocities.
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Affiliation(s)
- Randi Connor-Schuler
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Steven Phillips
- Division of Neurocritical Care, Department of Neurology and Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Emory Kuo
- Division of Neurocritical Care, Department of Neurology and Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Prem Kandiah
- Division of Neurocritical Care, Department of Neurology and Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Ofer Sadan
- Division of Neurocritical Care, Department of Neurology and Neurosurgery, Emory University, Atlanta, Georgia, USA
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3
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Dinsmore M, Venkatraghavan L. Clinical applications of point‐of‐care ultrasound in brain injury: a narrative review. Anaesthesia 2022; 77 Suppl 1:69-77. [DOI: 10.1111/anae.15604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/01/2021] [Indexed: 12/24/2022]
Affiliation(s)
- M. Dinsmore
- Department of Anaesthesia and Pain Management Toronto Western Hospital University Health Network University of Toronto Toronto ON Canada
| | - L. Venkatraghavan
- Department of Anaesthesia and Pain Management Toronto Western Hospital University Health Network University of Toronto Toronto ON Canada
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4
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Millet A, Evain JN, Desrumaux A, Francony G, Bouzat P, Mortamet G. Clinical applications of transcranial Doppler in non-trauma critically ill children: a scoping review. Childs Nerv Syst 2021; 37:2759-2768. [PMID: 34244843 DOI: 10.1007/s00381-021-05282-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/29/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Many applications of transcranial Doppler (TCD) as a diagnosis or monitoring tool have raised interest in the last decades. It is important that clinicians know when and how to perform TCD in this population, what parameter to assess and monitor and how to interpret it. OBJECTIVE This review aims to describe the emerging clinical applications of TCD in critically ill children excluding those suffering from trauma. METHODS Databases Web of Science, Cochrane and PubMed were searched in May 2020. We considered all publications since the year 2000 addressing the use of TCD as a prognostic, diagnostic or follow-up tool in children aged 0 to 15 years admitted to intensive care or emergency units, excluding neonatology and traumatic brain injury. Two independent reviewers selected 82 abstracts and full-text articles from the 2011 unique citations identified at the outset. RESULTS TCD provides crucial additional information at bedside about cerebrovascular hemodynamics. Many clinical applications include the diagnosis and management of various medical and surgical neurologic conditions (central nervous system infections, arterial ischemic stroke, subarachnoid hemorrhage and vasospasm, brain death, seizures, metabolic disease, hydrocephalus) as well as monitoring the impact systemic conditions on brain perfusion (hemodynamic instability, circulatory assistance). CONCLUSION To conclude, TCD has become an invaluable asset for non-invasive neuromonitoring in critically ill children excluding those suffering from trauma. However, the scope of TCD remains unclearly defined yet and reference values in critically ill children are still lacking.
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Affiliation(s)
- Anne Millet
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, Grenoble, France
| | - Jean-Noël Evain
- Department of Anesthesia and Intensive Care, Grenoble-Alpes University Hospital, Grenoble, France
| | - Amélie Desrumaux
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, Grenoble, France
| | - Gilles Francony
- Department of Anesthesia and Intensive Care, Grenoble-Alpes University Hospital, Grenoble, France
| | - Pierre Bouzat
- Department of Anesthesia and Intensive Care, Grenoble-Alpes University Hospital, Grenoble, France
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, Grenoble, France.
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O'Brien NF, Reuter-Rice K, Wainwright MS, Kaplan SL, Appavu B, Erklauer JC, Ghosh S, Kirschen M, Kozak B, Lidsky K, Lovett ME, Mehollin-Ray AR, Miles DK, Press CA, Simon DW, Tasker RC, LaRovere KL. Practice Recommendations for Transcranial Doppler Ultrasonography in Critically Ill Children in the Pediatric Intensive Care Unit: A Multidisciplinary Expert Consensus Statement. J Pediatr Intensive Care 2021; 10:133-142. [PMID: 33884214 PMCID: PMC8052112 DOI: 10.1055/s-0040-1715128] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 12/16/2022] Open
Abstract
Transcranial Doppler ultrasonography (TCD) is being used in many pediatric intensive care units (PICUs) to aid in the diagnosis and monitoring of children with known or suspected pathophysiological changes to cerebral hemodynamics. Standardized approaches to scanning protocols, interpretation, and documentation of TCD examinations in this setting are lacking. A panel of multidisciplinary clinicians with expertise in the use of TCD in the PICU undertook a three-round modified Delphi process to reach unanimous agreement on 34 statements and then create practice recommendations for TCD use in the PICU. Use of these recommendations will help to ensure that high quality TCD images are captured, interpreted, and reported using standard nomenclature. Furthermore, use will aid in ensuring reproducible and meaningful study results between TCD practitioners and across PICUs.
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Affiliation(s)
- Nicole Fortier O'Brien
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University, Ohio, United States
| | - Karin Reuter-Rice
- Department of Pediatrics, Division of Pediatric Critical Care, School of Medicine, School of Nursing, Duke University, Duke Institute for Brain Sciences, North Carolina, United States
| | - Mark S. Wainwright
- Department of Neurology, University of Washington, Seattle Children's Hospital, Washington, United States
| | - Summer L. Kaplan
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Brian Appavu
- Department of Pediatrics, Division of Critical Care Medicine, Barrow Neurological Institute at Phoenix Children's Hospital, University of Arizona College of Medicine—Phoenix, Arizona, United States
| | - Jennifer C. Erklauer
- Department of Pediatrics, Division of Critical Care Medicine and Neurology, Baylor College of Medicine, Texas Children's Hospital, Texas, United States
| | - Suman Ghosh
- Department of Pediatrics, Division of Pediatric Neurology, University of Florida, College of Medicine, Florida, United States
| | - Matthew Kirschen
- Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Neurology, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Brandi Kozak
- Department of Radiology, Ultrasound Division, Center for Pediatric Contrast Ultrasound, The Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Karen Lidsky
- Department of Pediatrics, Division of Pediatric Critical Care, Wolfson Children's Hospital, University of Florida, Florida, United States
| | - Marlina Elizabeth Lovett
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University, Ohio, United States
| | - Amy R. Mehollin-Ray
- Department of Radiology, Baylor College of Medicine, E.B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Texas, United States
| | - Darryl K. Miles
- Department of Pediatrics/Division of Critical Care, UT Southwestern Medical Center, Texas, United States
| | - Craig A. Press
- Department of Pediatrics, Section of Child Neurology, University of Colorado, Children's Hospital Colorado, Colorado, United States
| | - Dennis W. Simon
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pennsylvania, United States
| | - Robert C. Tasker
- Departments of Neurology & Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Massachusetts, United States
| | - Kerri Lynn LaRovere
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Massachusetts, United States
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6
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Kreft B, Bergs J, Shahryari M, Danyel LA, Hetzer S, Braun J, Sack I, Tzschätzsch H. Cerebral Ultrasound Time-Harmonic Elastography Reveals Softening of the Human Brain Due to Dehydration. Front Physiol 2021; 11:616984. [PMID: 33505319 PMCID: PMC7830390 DOI: 10.3389/fphys.2020.616984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/09/2020] [Indexed: 01/12/2023] Open
Abstract
Hydration influences blood volume, blood viscosity, and water content in soft tissues - variables that determine the biophysical properties of biological tissues including their stiffness. In the brain, the relationship between hydration and stiffness is largely unknown despite the increasing importance of stiffness as a quantitative imaging marker. In this study, we investigated cerebral stiffness (CS) in 12 healthy volunteers using ultrasound time-harmonic elastography (THE) in different hydration states: (i) during normal hydration, (ii) after overnight fasting, and (iii) within 1 h of drinking 12 ml of water per kg body weight. In addition, we correlated shear wave speed (SWS) with urine osmolality and hematocrit. SWS at normal hydration was 1.64 ± 0.02 m/s and decreased to 1.57 ± 0.04 m/s (p < 0.001) after overnight fasting. SWS increased again to 1.63 ± 0.01 m/s within 30 min of water drinking, returning to values measured during normal hydration (p = 0.85). Urine osmolality at normal hydration (324 ± 148 mOsm/kg) increased to 784 ± 107 mOsm/kg (p < 0.001) after fasting and returned to normal (288 ± 128 mOsm/kg, p = 0.83) after water drinking. SWS and urine osmolality correlated linearly (r = -0.68, p < 0.001), while SWS and hematocrit did not correlate (p = 0.31). Our results suggest that mild dehydration in the range of diurnal fluctuations is associated with significant softening of brain tissue, possibly due to reduced cerebral perfusion. To ensure consistency of results, it is important that cerebral elastography with a standardized protocol is performed during normal hydration.
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Affiliation(s)
- Bernhard Kreft
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bergs
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mehrgan Shahryari
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Stefan Hetzer
- Bernstein Center of Advanced Neuroimaging, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heiko Tzschätzsch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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7
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Marenghi A, Ceriani E, Fiorelli EM, Bonzi M, Montano N, Annoni F. Diagnostic Accuracy of Carotid Doppler Ultrasound for the Detection of Right-to-Left Cardiac Shunt. J Cardiovasc Echogr 2021; 30:201-205. [PMID: 33828941 PMCID: PMC8021086 DOI: 10.4103/jcecho.jcecho_70_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/14/2020] [Accepted: 09/19/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Right-to-left cardiac shunt is a condition anatomically related to patent foramen ovale (PFO) and potentially related to cryptogenic cerebrovascular events. As recent studies demonstrated a reduction of recurrent stroke in patients undergoing percutaneous PFO closure after a cryptogenic cerebrovascular event, it is now of pivotal importance to screen these patients for Right-to-left shunt(RLS) presence. At this regard, transcranial color Doppler (TCCD) with contrast has a good sensitivity (97%) and specificity (93%) compared to transesophageal echocardiography and became the test of choice to assess RLS presence, thanks to its noninvasive nature. However, temporal bone window is not accessible in 6%–20% patients. Several approaches have been explored to overcome this limitation with encouraging but not definitive results for extracranial internal carotid artery (ICA) approach, proposed in previous pivotal studies. Aims of this study were to further assess the diagnostic accuracy of ICA Doppler ultrasound with contrast for RLS detection compared to TCCD, with the two tests performed simultaneously. Materials and Methods: Sixty-four patients underwent simultaneously to TCCD and ICA Doppler ultrasound, both performed at rest and after Valsalva maneuver. Diagnosis of RLS was made, both for TCCD and ICA ultrasound, if=1 microembolic signals (MES) were detected during the examination (either at rest or after Valsalva maneuver). Results: ICA Doppler ultrasound sensitivity and specificity resulted respectively of 97% (confidence interval [CI] 95%) and 100% ([CI] 95%), while negative likelihood ratio was 0.03 (CI 95%). Conclusions: ICA Doppler ultrasound represents a valid alternative to TCCD for RLS screening in patients without adequate transcranial acoustic window.
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Affiliation(s)
- Anna Marenghi
- Department of Internal Medicine, Allergology and Immunology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Ceriani
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Elisa Maria Fiorelli
- Department of Internal Medicine, Allergology and Immunology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mattia Bonzi
- Emergency Department and Emergency Medicine Unit, Foundation Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Montano
- Department of Internal Medicine, Allergology and Immunology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Annoni
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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8
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Cardio-respiratory, oxidative stress and acute mountain sickness responses to normobaric and hypobaric hypoxia in prematurely born adults. Eur J Appl Physiol 2020; 120:1341-1355. [PMID: 32270264 DOI: 10.1007/s00421-020-04366-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE We compared the effects of hypobaric and normobaric hypoxia on select cardio-respiratory responses, oxidative stress and acute mountain sickness (AMS) severity in prematurely born individuals, known to exhibit blunted hypoxic ventilatory response. METHODS Sixteen prematurely born but otherwise healthy males underwent two 8-h hypoxic exposures under: (1) hypobaric hypoxic [HH; terrestrial altitude 3840 m; PiO2:90.2 (0.5) mmHg; BP: 478 (2) mmHg] and (2) normobaric hypoxic [NH; PiO2:90.6 (0.9) mmHg; FiO2:0.142 (0.001)] condition. Resting values of capillary oxyhemoglobin saturation (SpO2), heart rate (HR) and blood pressure were measured before and every 2 h during the exposures. Ventilatory responses and middle cerebral artery blood flow velocity (MCAv) were assessed at rest and during submaximal cycling before and at 4 and 8 h. Plasmatic levels of selected oxidative stress and antioxidant markers and AMS symptoms were also determined at these time points. RESULTS HH resulted in significantly lower resting (P = 0.010) and exercise (P = 0.004) SpO2 as compared to NH with no significant differences in the ventilatory parameters, HR or blood pressure. No significant differences between conditions were found in resting or exercising MCAv and measured oxidative stress markers. Significantly lower values of ferric-reducing antioxidant power (P = 0.037) were observed during HH as opposed to NH. AMS severity was higher at 8 h compared to baseline (P = 0.002) with no significant differences between conditions. CONCLUSION These data suggest that, in prematurely born adults, 8-h exposure to hypobaric, as opposed to normobaric hypoxia, provokes greater reductions in systemic oxygenation and antioxidant capacity. Further studies investigating prolonged hypobaric exposures in this population are warranted. REGISTRATION NCT02780908 (ClinicalTrials.gov).
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9
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Singh Y, Tissot C, Fraga MV, Yousef N, Cortes RG, Lopez J, Sanchez-de-Toledo J, Brierley J, Colunga JM, Raffaj D, Da Cruz E, Durand P, Kenderessy P, Lang HJ, Nishisaki A, Kneyber MC, Tissieres P, Conlon TW, De Luca D. International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 2020; 24:65. [PMID: 32093763 PMCID: PMC7041196 DOI: 10.1186/s13054-020-2787-9] [Citation(s) in RCA: 281] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. METHODS Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document. RESULTS Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). CONCLUSIONS Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.
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Affiliation(s)
- Yogen Singh
- Department of Paediatrics - Neonatology and Paediatric Cardiology, Cambridge University Hospitals and University of Cambridge School of Clinical Medicine, Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
- Addenbrooke's Hospital, Box 402, Cambridge, UK.
| | - Cecile Tissot
- Paediatric Cardiology, Centre de Pédiatrie, Clinique des Grangettes, Geneva, Switzerland
| | - María V Fraga
- Department of Paediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Nadya Yousef
- Division of Paediatrics and Neonatal Critical Care, APHP - Paris Saclay University Hospitals, "A. Béclère" Medical centre, Paris, France
| | - Rafael Gonzalez Cortes
- Department of Paediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Jorge Lopez
- Department of Paediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain
| | | | - Joe Brierley
- Department of Paediatric Intensive Care, Great Ormond Street Hospital, London, UK
| | - Juan Mayordomo Colunga
- Department of Paediatric Intensive Care, Hospital Universitario Central de Asturias, Oviedo. CIBER-Enfermedades Respiratorias. Instituto de Salud Carlos III, Madrid. Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Dusan Raffaj
- Department of Paediatric Intensive Care, Nottingham University Hospitals, Nottingham, UK
| | - Eduardo Da Cruz
- Department of Paediatric and Cardiac Intensive Care, Children's Hospital Colorado, Aurora, USA
| | - Philippe Durand
- Division of Paediatric Critical Care, APHP - Paris Saclay University Hospitals, "Kremlin Bicetre" Medical Centre, Paris, France
| | - Peter Kenderessy
- Department of Paediatric Anaesthesia and Intensive Care, Children's Hospital Banska Bystrica, Banska Bystrica, Slovakia
| | - Hans-Joerg Lang
- Department of Paediatrics, Medicins Sans Frontieres (Suisse), Geneva, Switzerland
| | - Akira Nishisaki
- Department of Anaesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Martin C Kneyber
- Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pierre Tissieres
- Division of Paediatric Critical Care, APHP - Paris Saclay University Hospitals, "Kremlin Bicetre" Medical Centre, Paris, France
| | - Thomas W Conlon
- Department of Anaesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, APHP - Paris Saclay University Hospitals, "A. Béclère" Medical centre, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM Unit U999, South Paris Medical School, Paris Saclay University, Paris, France
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10
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Kondrashova T, Makar M, Proctor C, Bridgmon KA, Pazdernik V. Dynamic assessment of cerebral blood flow and intracranial pressure during inversion table tilt using ultrasonography. J Neurol Sci 2019; 404:150-156. [PMID: 31398694 DOI: 10.1016/j.jns.2019.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/11/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Inversion tables are used as treatment for back pain, but there is a lack of agreement on systemic effects of inversion. OBJECTIVE To assess intracranial pressure (ICP) and cerebral blood flow using ultrasonography during inversion table tilt. METHODS Optic nerve sheath diameter (ONSD), heart rate (HR), blood pressure, internal carotid artery (ICA) and middle cerebral artery (MCA) blood flow of participants were measured in 3 positions: supine before inversion, during inversion with head down, and supine post-inversion. ONSD was evaluated with ocular ultrasonography and blood flow (ICA and MCA) with Doppler ultrasonography. RESULTS The ONSD changed significantly between the supine position, at 3 min of inversion, and after returning to supine position (all P < .001). The post-inversion HR was less than pre-inversion (P = .03) and 3-min inversion HR (P = .003). There were significant changes in ICA and MCA flow caused by inversion, which affected blood flow velocity, resistance, and pulsatility index (all P ≤ .005). CONCLUSION Inversion caused significant changes in ICP and blood flow. Thus, increased chance of complications may exist when using inversion as a therapeutic tool or during surgical procedures in patients with previous history of elevated ICP. These results demonstrate that inversion therapy should be used with caution.
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Affiliation(s)
- Tatyana Kondrashova
- Department of Family Medicine, Preventive Medicine, and Community Health, Kirksville College of Osteopathic Medicine, A.T. Still University, 800 W. Jefferson St., Kirksville, MO 63501, USA.
| | - Monica Makar
- Kirksville College of Osteopathic Medicine, A.T. Still University, 800 W. Jefferson St., Kirksville, MO 63501, USA.
| | - Carlie Proctor
- Kirksville College of Osteopathic Medicine, A.T. Still University, 800 W. Jefferson St., Kirksville, MO 63501, USA.
| | - Kenneth A Bridgmon
- Kirksville College of Osteopathic Medicine, A.T. Still University, 800 W. Jefferson St., Kirksville, MO 63501, USA.
| | - Vanessa Pazdernik
- Department of Research Support, A.T. Still University, 800 W. Jefferson St., Kirksville, MO 63501, USA.
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11
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Yang D, Rundek T, Patel SR, Cabral D, Redline S, Testai FD, Cai J, Wallace DM, Zee PC, Ramos AR. Cerebral Hemodynamics in Sleep Apnea and Actigraphy-Determined Sleep Duration in a Sample of the Hispanic Community Health Study/ Study of Latinos. J Clin Sleep Med 2019; 15:15-21. [PMID: 30621830 DOI: 10.5664/jcsm.7560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES We sought to evaluate cerebral hemodynamics in obstructive sleep apnea (OSA) and actigraphy-defined short sleep duration using transcranial Doppler ultrasound (TCD) blood flow velocity in a subsample of Hispanics/Latinos without stroke and cardiovascular disease. METHODS The sample consisted of consecutive participants at the Miami site of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) with overnight home sleep testing and 7 days of wrist actigraphy in the Sueño sleep ancillary study. Ninety-five participants had sleep data and TCD determined cerebral hemodynamics. We evaluated the association between OSA (apnea-hypopnea index [AHI] ≥ 5 events/h) and short sleep duration (< 6.8 hours; sample median) with cerebral blood flow velocities (CBFV) and pulsatility index (PI) for the middle cerebral (MCA) and basilar arteries (BA). RESULTS Median age was 48 years (range 20-64) with 71% females. Twenty-eight percent of the sample had OSA (AHI ≥ 5 events/h) with median AHI of 10.0 (range 5.0-51.7) events/h. In unadjusted analyses, participants with OSA had lower median CBFV in the BA (30.5 cm/s [interquartile range:10.2] versus 39.4 cm/s [13.3] P < .05), but not the MCA, whereas short sleepers had higher median vascular resistance in the MCA (PI = 0.92 [0.18] versus 0.86 [0.14] P < .05) and BA (PI = 1.0 [0.17] versus 0.93 [0.24] P < .05). After full adjustment, OSA was associated with decreased CBFV (β [SE] = -5.1 [2.5] P < .05) in the BA. Short sleep was associated with increased PI (β [SE] = 0.05 [0.02] P < .05) in the MCA. CONCLUSIONS In this sample of Hispanic/Latinos, OSA was associated with decreased daytime blood flow velocity in the BA, whereas actigraphy-defined short sleep duration was associated with increased cerebrovascular pulsatility in the MCA.
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Affiliation(s)
- Dixon Yang
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
| | - Sanjay R Patel
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Digna Cabral
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
| | - Susan Redline
- Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois at Chicago Medical Center, Chicago, Illinois
| | - Jianwen Cai
- Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, North Carolina
| | - Douglas M Wallace
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
| | - Phyllis C Zee
- Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alberto R Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
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12
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Blanco P, Abdo-Cuza A. Transcranial Doppler ultrasound in the ICU: it is not all sunshine and rainbows. Crit Ultrasound J 2018; 10:2. [PMID: 29340797 PMCID: PMC5770348 DOI: 10.1186/s13089-018-0085-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/09/2018] [Indexed: 01/04/2023] Open
Affiliation(s)
- Pablo Blanco
- Ecodiagnóstico-Centro de Diagnóstico por Imágenes, 3272, 50 St., Necochea, 7630 Argentina
| | - Anselmo Abdo-Cuza
- Centro de Investigaciones Médico-Quirúrgicas, 11-13 and 216 St., Siboney, La Habana, 12100 Cuba
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13
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Lau VI, Arntfield RT. Point-of-care transcranial Doppler by intensivists. Crit Ultrasound J 2017; 9:21. [PMID: 29030715 PMCID: PMC5640565 DOI: 10.1186/s13089-017-0077-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/06/2017] [Indexed: 11/10/2022] Open
Abstract
In the unconscious patient, there is a diagnostic void between the neurologic physical exam, and more invasive, costly and potentially harmful investigations. Transcranial color-coded sonography and two-dimensional transcranial Doppler imaging of the brain have the potential to be a middle ground to bridge this gap for certain diagnoses. With the increasing availability of point-of-care ultrasound devices, coupled with the need for rapid diagnosis of deteriorating neurologic patients, intensivists may be trained to perform point-of-care transcranial Doppler at the bedside. The feasibility and value of this technique in the intensive care unit to help rule-in specific intra-cranial pathologies will form the focus of this article. The proposed scope for point-of-care transcranial Doppler for the intensivist will be put forth and illustrated using four representative cases: presence of midline shift, vasospasm, raised intra-cranial pressure, and progression of cerebral circulatory arrest. We will review the technical details, including methods of image acquisition and interpretation. Common pitfalls and limitations of point-of-care transcranial Doppler will also be reviewed, as they must be understood for accurate diagnoses during interpretation, as well as the drawbacks and inadequacies of the modality in general.
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Affiliation(s)
- Vincent Issac Lau
- Department of Medicine, Division of Critical Care, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
- London Health Sciences Centre, Victoria Hospital Rm, D2-528, 800 Commissioners Road East, London, ON N6A 5W9 Canada
| | - Robert Thomas Arntfield
- Department of Medicine, Division of Critical Care, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
- London Health Sciences Centre, Victoria Hospital Rm, D2-528, 800 Commissioners Road East, London, ON N6A 5W9 Canada
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14
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Reuter-Rice K. Transcranial Doppler Ultrasound Use in Pediatric Traumatic Brain Injury. JOURNAL OF RADIOLOGY NURSING 2017; 36:3-9. [PMID: 28947894 PMCID: PMC5609698 DOI: 10.1016/j.jradnu.2016.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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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Affiliation(s)
- Karin Reuter-Rice
- Associate Professor, Duke University, School of Nursing, School of Medicine, Dept. of Pediatrics, Duke Institute for Brain Science, 307 Trent Drive, DUMC 3322, Durham, NC, 27710
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15
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Yang D, Cabral D, Gaspard EN, Lipton RB, Rundek T, Derby CA. Cerebral Hemodynamics in the Elderly: A Transcranial Doppler Study in the Einstein Aging Study Cohort. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1907-14. [PMID: 27417737 PMCID: PMC5500193 DOI: 10.7863/ultra.15.10040] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/07/2015] [Indexed: 05/19/2023]
Abstract
OBJECTIVES We sought to describe the relationship between age, sex, and race/ethnicity with transcranial Doppler hemodynamic characteristics from major intracerebral arterial segments in a large elderly population with varying demographics. METHODS We analyzed 369 stroke-free participants aged 70 years and older from the Einstein Aging Study. Single-gate, nonimaging transcranial Doppler sonography, a noninvasive sonographic technique that assesses real-time cerebrovascular hemodynamics, was used to interrogate 9 cerebral arterial segments. Individual Doppler spectra and cerebral blood flow velocities were acquired, and the pulsatility index and resistive index were calculated by the device's automated waveform-tracking function. Multiple linear regression models were used to examine the independent associations of age, sex, and race/ethnicity with transcranial Doppler measures, adjusting for hypertension, history of myocardial infarction or revascularization, and history of diabetes. RESULTS Among enrolled participants, 303 individuals had at least 1 vessel insonated (mean age [SD], 80 [6] years; 63% women; 58% white; and 32% black). With age, transcranial Doppler measures of mean blood flow velocity were significantly decreased in the basilar artery (P = .001) and posterior cerebral artery (right, P = .003; left, P = .02). Pulsatility indices increased in the left middle cerebral artery (P = .01) and left anterior cerebral artery (P = .03), and the resistive index was increased in the left middle cerebral artery (P = .007) with age. Women had higher pulsatility and resistive indices compared to men in several vessels. CONCLUSIONS We report a decreased mean blood flow velocity and weakly increased arterial pulsatility and resistance with aging in a large elderly stroke-free population. These referential trends in cerebrovascular hemodynamics may carry important implications in vascular diseases associated with advanced age, increased risk of cerebrovascular disease, cognitive decline, and dementia.
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Affiliation(s)
- Dixon Yang
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida USA
| | - Digna Cabral
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida USA
| | - Emmanuel N Gaspard
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York USA
| | - Richard B Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York USA, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida USA
| | - Carol A Derby
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York USA, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York USA
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16
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Harris C. Neuromonitoring indications and utility in the intensive care unit. Crit Care Nurse 2015; 34:30-9; quiz 40. [PMID: 24882827 DOI: 10.4037/ccn2014506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Information on the use of neuromonitoring in intensive care units is scattered but significant. Nurses who do not care for neurologically impaired patients on a daily basis may not have a strong understanding of the utility of various neuromonitoring techniques, why they are used, or how they are interpreted. Two main types of neuromonitoring that are frequently seen but poorly understood are reviewed here: transcranial Doppler sonography and electrophysiology. Information on these 2 techniques tends to be either superficial with limited applicability to the critical care setting or very technical. This review provides information about neuromonitoring to help guide critical care nurses providing care to neurologically impaired patients.
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Affiliation(s)
- Catherine Harris
- Catherine Harris is an assistant professor at Jefferson School of Nursing and an acute care nurse practitioner in the neurocritical care unit at Jefferson Hospital for Neuroscience in Philadelphia, Pennsylvania.
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17
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Blanco P. Cerebral Circulatory Arrest Detected by Transcranial Color-Coded Duplex Sonography: A Feasible Diagnosis for Intensivists. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1337-1340. [PMID: 26112640 DOI: 10.7863/ultra.34.7.1337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Pablo Blanco
- Intensive Care Unit, Hospital Dr Emilio Ferreyra, Necochea, Argentina
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18
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Wang Y, Duan YY, Zhou HY, Yuan LJ, Zhang L, Wang W, Li LH, Li L. Middle cerebral arterial flow changes on transcranial color and spectral Doppler sonography in patients with increased intracranial pressure. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2131-2136. [PMID: 25425369 DOI: 10.7863/ultra.33.12.2131] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Intracranial pressure usually increases after severe brain injury. However, a method for noninvasive evaluation of intracranial pressure is still lacking. The purpose of this study was to explore the potential role of transcranial color Doppler sonography in assessing intracranial pressure by observing the middle cerebral artery blood flow parameters in patients with increased intracranial pressure of varying etiology. METHODS The hemodynamic changes in the middle cerebral artery in patients with varying degrees of increased intracranial pressure were investigated by transcranial color Doppler sonography in 93 patients who had emergency surgery for brain injury. RESULTS Middle cerebral artery Doppler flow spectra changed regularly as intracranial pressure increased. The pulsatility index (PI) and resistive index (RI) had a significantly positive correlation with intracranial pressure (r = 0.90 and 0.89, respectively; P< .001), whereas the middle cerebral artery diastolic velocity showed a significant negative correlation with intracranial pressure (r = -0.52; P< .01). A receiver operating characteristic curve showed that the RI and PI cutoff values were 0.705 and 1.335, respectively, for predicting increased intracranial pressure, with sensitivity of 0.885 and specificity of 0.970. CONCLUSIONS In addition to the PI and RI, middle cerebral artery diastolic flow velocity measurement by transcranial color Doppler sonography may also be a useful variable for evaluating intracranial pressure in patients with acute brain injury.
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Affiliation(s)
- Yu Wang
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yun-You Duan
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
| | - Hai-Yan Zhou
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Li-Jun Yuan
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
| | - Li Zhang
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Wang
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Li-Hong Li
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Liang Li
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
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19
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Wang Y, Zhang H, Tang S, Liu X, O'Neil A, Turner A, Chai F, Chen F, Berk M. Assessing regional cerebral blood flow in depression using 320-slice computed tomography. PLoS One 2014; 9:e107735. [PMID: 25251476 PMCID: PMC4175469 DOI: 10.1371/journal.pone.0107735] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 08/15/2014] [Indexed: 12/17/2022] Open
Abstract
While there is evidence that the development and course of major depressive disorder (MDD) symptomatology is associated with vascular disease, and that there are changes in energy utilization in the disorder, the extent to which cerebral blood flow is changed in this condition is not clear. This study utilized a novel imaging technique previously used in coronary and stroke patients, 320-slice Computed-Tomography (CT), to assess regional cerebral blood flow (rCBF) in those with MDD and examine the pattern of regional cerebral perfusion. Thirty nine participants with depressive symptoms (Hamilton Depression Rating Scale 24 (HAMD24) score > 20, and Self-Rating Depression Scale (SDS) score > 53) and 41 healthy volunteers were studied. For all subjects, 3 ml of venous blood was collected to assess hematological parameters. Transcranial Doppler (TCD) ultrasound was utilized to measure parameters of cerebral artery rCBFV and analyse the Pulsatility Index (PI). 16 subjects (8 = MDD; 8 = healthy) also had rCBF measured in different cerebral artery regions using 320-slice CT. Differences among groups were analyzed using ANOVA and Pearson's tests were employed in our statistical analyses. Compared with the control group, whole blood viscosity (including high\middle\low shear rate)and hematocrit (HCT) were significantly increased in the MDD group. PI values in different cerebral artery regions and parameters of rCBFV in the cerebral arteries were decreased in depressive participants, and there was a positive relationship between rCBFV and the corresponding vascular rCBF in both gray and white matter. rCBF of the left gray matter was lower than that of the right in MDD. Major depression is characterized by a wide range of CBF impairments and prominent changes in gray matter blood flow. 320-slice CT appears to be a valid and promising tool for measuring rCBF, and could thus be employed in psychiatric settings for biomarker and treatment response purposes.
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Affiliation(s)
- Yiming Wang
- Department of Psychiatry, Hospital Affiliated to Guiyang Medical University, Guiyang, Guizhou, China
- * E-mail: (YW); (XL)
| | - Hongming Zhang
- Department of Cardiology, The General Hospital of Jinan Military Region, Jinan, China
| | - Songlin Tang
- Department of Psychiatry, Hospital Affiliated to Guiyang Medical University, Guiyang, Guizhou, China
- Department of Neurology, First People's Hospital of Shaoyang, Shaoyang, Hunan, China
| | - Xingde Liu
- Department of Cardiology, Hospital Affiliated to Guiyang Medical University, Guiyang City, Guizhou, China
- * E-mail: (YW); (XL)
| | - Adrienne O'Neil
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alyna Turner
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Fangxian Chai
- Department of Psychiatry, Hospital Affiliated to Guiyang Medical University, Guiyang, Guizhou, China
| | - Fanying Chen
- Mental Health Education And Counseling Center, Guiyang Medical University, Guiyang City, Guizhou, China
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- Department of Psychiatry, Orygen Youth Health Research Centre, The University of Melbourne, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
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20
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Saedon M, Dilshad A, Tiivas C, Virdee D, Hutchinson CE, Singer DRJ, Imray CHE. Prospective validation study of transorbital Doppler ultrasound imaging for the detection of transient cerebral microemboli. Br J Surg 2014; 101:1551-5. [PMID: 25224848 DOI: 10.1002/bjs.9634] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/06/2014] [Accepted: 07/25/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Transient cerebral microemboli are independent biomarkers of early risk of ischaemic stroke in acute carotid syndromes. Transcranial Doppler imaging (TCD) through the temporal bone is the standard method for detection of cerebral microemboli, but an acoustic temporal bone window for TCD is not available in around one in seven patients. Transorbital Doppler imaging (TOD) has been used when TCD is not possible. The aim of this study was to validate the use of TOD against TCD for detecting cerebral microemboli. METHODS The study included patients undergoing elective carotid endarterectomy; all had confirmed temporal and orbital acoustic windows. Subjects gave written informed consent to postoperative TCD and TOD monitoring, which was performed simultaneously for 30 min by two vascular scientists. RESULTS The study included 100 patients (mean(s.e.m.) age 72(1) years; 65 men). Microemboli were detected by one or both methods in 40·0 per cent of patients: by TOD and TCD in 24 patients, by TOD alone in ten and by TCD alone in six. For detecting microemboli, TOD had a sensitivity of 80·0 per cent, specificity of 86·1 per cent, positive predictive value of 71·6 per cent and negative predictive value of 91·2 per cent. Bland-Altman analysis revealed no significant bias (bias 0·11 (95 per cent c.i. -0·52 to 0·74) microemboli; P = 0·810) with upper and lower limits of agreement of +6 and -6 microemboli. CONCLUSION TOD appears a valid alternative to TCD for detecting microembolic signals in patients with no suitable temporal acoustic window.
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Affiliation(s)
- M Saedon
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
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21
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Bradstreet JJ, Pacini S, Ruggiero M. A New Methodology of Viewing Extra-Axial Fluid and Cortical Abnormalities in Children with Autism via Transcranial Ultrasonography. Front Hum Neurosci 2014; 7:934. [PMID: 24459462 PMCID: PMC3892177 DOI: 10.3389/fnhum.2013.00934] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 12/24/2013] [Indexed: 11/17/2022] Open
Abstract
Background: Autism spectrum disorders (ASDs) are developmental conditions of uncertain etiology which have now affected more than 1% of the school-age population of children in many developed nations. Transcranial ultrasonography (TUS) via the temporal bone appeared to be a potential window of investigation to determine the presence of both cortical abnormalities and increased extra-axial fluid (EAF). Methods: TUS was accomplished using a linear probe (10–5 MHz). Parents volunteered ASD subjects (N = 23; males 18, females 5) for evaluations (mean = 7.46 years ± 3.97 years), and 15 neurotypical siblings were also examined (mean = 7.15 years ± 4.49 years). Childhood Autism Rating Scale (CARS2®) scores were obtained and the ASD score mean was 48.08 + 6.79 (Severe). Results: Comparisons of the extra-axial spaces indicated increases in the ASD subjects. For EAF we scored based on the gyral summit distances between the arachnoid membrane and the cortical pia layer (subarachnoid space): (1) <0.05 cm, (2) 0.05–0.07 cm, (3) 0.08–0.10 cm, (4) >0.10 cm. All of the neurotypical siblings scored 1, whereas the ASD mean score was 3.41 ± 0.67. We also defined cortical dysplasia as the following: hypoechoic lesions within the substance of the cortex, or disturbed layering within the gray matter. For cortical dysplasia we scored: (1) none observed, (2) rare hypoechogenic lesions and/or mildly atypical cortical layering patterns, (3) more common, but separated areas of cortical hypoechogenic lesions, (4) very common or confluent areas of cortical hypoechogenicity. Again all of the neurotypical siblings scored 1, while the ASD subjects’ mean score was 2.79 ± 0.93. Conclusion: TUS may be a useful screening technique for children at potential risk of ASDs which, if confirmed with repeated studies and high resolution MRI, provides rapid, non-invasive qualification of EAF, and cortical lesions.
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Affiliation(s)
- James Jeffrey Bradstreet
- Newport Brain Research Laboratory , Newport Beach, CA , USA ; Brain Treatment Center , Newport Beach, CA , USA ; Brain Treatment Center , Buford, GA , USA
| | - Stefania Pacini
- Department of Experimental and Clinical Medicine, University of Florence , Florence , Italy
| | - Marco Ruggiero
- Department of Experimental and Clinical Biomedical Sciences, University of Florence , Florence , Italy ; Immuno Biotech Ltd., Saint Peter Port , Guernsey
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