scholarly journals Preliminary experience of the estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography

2001 ◽  
Vol 70 (2) ◽  
pp. 198-204 ◽  
Author(s):  
E A Schmidt
Keyword(s):  
Cerebral Perfusion Pressure ◽  
Transcranial Doppler ◽  
Cerebral Perfusion ◽  
Doppler Ultrasonography ◽  
Perfusion Pressure ◽  
Transcranial Doppler Ultrasonography

Transcranial Doppler ultrasonography in raised intra-cranial pressure and in intracranial circulatory arrest

1988 ◽  
Vol 68 (5) ◽  
pp. 745-751 ◽  
Author(s):  
Werner Hassler ◽  
Helmuth Steinmetz ◽  
Jan Gawlowski
Keyword(s):  
Intracranial Pressure ◽  
Brain Death ◽  
Intracranial Hypertension ◽  
Cerebral Perfusion Pressure ◽  
Transcranial Doppler ◽  
Cerebral Perfusion ◽  
Doppler Ultrasonography ◽  
Perfusion Pressure ◽  
Circulatory Arrest ◽  
Transcranial Doppler Ultrasonography

✓ Transcranial Doppler ultrasonography was used to monitor 71 patients suffering from intracranial hypertension with subsequent brain death. Among these, 29 patients were also assessed for systemic arterial pressure and epidural intracranial pressure, so that a correlation between cerebral perfusion pressure and the Doppler ultrasonography waveforms could be established. Four-vessel angiography was also performed in 33 patients after clinical brain death. With increasing intracranial pressure, the transcranial Doppler ultrasonography waveforms exhibited different characteristic high-resistance profiles with first low, then zero, and then reversed diastolic flow velocities, depending on the relationship between intracranial pressure and blood pressure (that is, cerebral perfusion pressure). This study shows that transcranial. Doppler ultrasonography may be used to assess the degree of intracranial hypertension. This technique further provides a practicable, noninvasive bedside monitor of therapeutic measures.

Cerebral perfusion pressure in head-injured patients: a noninvasive assessment using transcranial Doppler ultrasonography

1998 ◽  
Vol 88 (5) ◽  
pp. 802-808 ◽  
Author(s):  
Marek Czosnyka ◽  
Basil F. Matta ◽  
Piotr Smielewski ◽  
Peter J. Kirkpatrick ◽  
John D. Pickard
Keyword(s):  
Intracranial Pressure ◽  
Cerebral Perfusion Pressure ◽  
Transcranial Doppler ◽  
Cerebral Perfusion ◽  
Doppler Ultrasonography ◽  
Perfusion Pressure ◽  
Content Type ◽  
Head Injured ◽  
Injured Patients ◽  
Fine Print

Object. The authors studied the reliability of a new method for noninvasive assessment of cerebral perfusion pressure (CPP) in head-injured patients in which mean arterial blood pressure (ABP) and transcranial Doppler middle cerebral artery mean and diastolic flow velocities are measured. Methods. Cerebral perfusion pressure was estimated (eCPP) over periods of continuous monitoring (20 minutes—2 hours, 421 daily examinations) in 96 head-injured patients (Glasgow Coma Scale score < 13) who were admitted to the intensive care unit. All patients were sedated, paralyzed, and ventilated. The eCPP and the measured CPP (ABP minus intracranial pressure, measured using an intraparenchymal microsensor) were compared. The correlation between eCPP and measured CPP was r = 0.73; p < 10−6. In 71% of the examinations, the estimation error was less than 10 mm Hg and in 84% of the examinations, the error was less than 15 mm Hg. The method had a high positive predictive power (94%) for detecting low CPP (< 60 mm Hg). The eCPP also accurately reflected changes in measured CPP over time (r > 0.8; p < 0.001) in situations such as plateau and B waves of intracranial pressure, arterial hypotension, and refractory intracranial hypertension. A good correlation was found between the average measured CPP and eCPP when day-by-day variability was assessed in a group of 41 patients (r = 0.71). Conclusions. Noninvasive estimation of CPP by using transcranial Doppler ultrasonography may be of value in situations in which monitoring relative changes in CPP is required without invasive measurement of intracranial pressure.

EVALUATION OF NONINVASIVE TRANSCRANIAL DOPPLER AND BLOOD PRESSURE-BASED METHOD FOR THE ASSESSMENT OF CEREBRAL PERFUSION PRESSURE IN PREGNANT WOMEN

2001 ◽  
Vol 20 (1) ◽  
pp. 139-140
Author(s):  
Michael A. Belfort ◽  
Cathy Tooke-Miller ◽  
Michael Varner ◽  
George Saade ◽  
Charlotta Grunewald ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pregnant Women ◽  
Cerebral Perfusion Pressure ◽  
Transcranial Doppler ◽  
Cerebral Perfusion ◽  
Perfusion Pressure

Abstract 369: Noninvasive Cerebral Perfusion Pressure and Neurologic Outcome in Post-cardiac Arrest Patients with Targeted Temperature Management

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Minjung K Chae ◽  
Sung Eun Lee ◽  
Sumin Cho ◽  
Taeyoung Kim ◽  
Dukyong Yoon
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Flow Velocity ◽  
Cerebral Perfusion Pressure ◽  
Transcranial Doppler ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Cerebral Monitoring

Introduction: Hypoxic ischemic brain injury (HIBI) is the leading cause of mortality and long-term neurologic disability in survivors of cardiac arrest. Recently, the role of cerebral monitoring is emphasized for individualizing therapy and mitigating secondary brain injury in HIBI patients after return of spontaneous circulation (ROSC). The first step of cerebral monitoring is checking the driving force by cerebral perfusion pressure (CPP). However, as CPP is calculated by mean arterial pressure (MAP) minus intracranial pressure (ICP), the process of obtaining ICP is invasive. Noninvasive CPP can be estimated by parameters obtained from transcranial doppler (TCD). Therefore, we aimed to investigate non-invasively measured CPP from TCD and its association with neurologic outcome in post cardiac arrest patients that underwent targeted temperature management (TTM). Methods: This retrospective single-center study included patients who had been treated with TTM following cardiac arrest and who underwent TCD evaluation between July 2017 and July 2019. We aimed to perform TCD evaluation within 48h of ROSC, but sometimes this could not be achieved due to limited resources. Patients with TCD that was performed after 72 hours were excluded. The MFV was calculated using the peak systolic flow velocity (PSV) and the end-diastolic flow velocity (EDV) as below. Two methods of estimating CPP non-invasively was calculated as below.MFV = PSV+(EDVх2) / 3 eCPP_A= MAP*diastolic FVmca/MFVmca + 14eCPP_B= MFVmca*(MAP-DBP)/FVmean-FVdia Results: Table 1. Baseline characteristics of study population Data are presented as mean (standard deviation), number (%) or median (interquartile range).OHCA, out of hospital cardiac arrest; CPR, cardiopulmonary resuscitation; AED, automated external defibrillator; TCD, transcranial doppler; CPP, cerebral perfusion pressure. Table 2. Cut off values and diagnostic values in predicting poor neurologic outcome with 100% specificityCPP, cerebral perfusion pressure. Conclusion: eCPP cut off values of <50 mmHg and <60mmHg predicted poor neurological outcome with high specificity. This study suggests that eCPP obtained from TCD may be feasible to predict neurologic outcome.

EVALUATION OF A NONINVASIVE TRANSCRANIAL DOPPLER AND BLOOD PRESSURE-BASED METHOD FOR THE ASSESSMENT OF CEREBRAL PERFUSION PRESSURE IN PREGNANT WOMEN

2000 ◽  
Vol 19 (3) ◽  
pp. 331-340 ◽  
Author(s):  
Michael A. Belfort ◽  
Cathy Tooke-Miller ◽  
Michael Varner ◽  
George Saade ◽  
Charlotta Grunewald ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pregnant Women ◽  
Cerebral Perfusion Pressure ◽  
Transcranial Doppler ◽  
Cerebral Perfusion ◽  
Perfusion Pressure

Utility of Transcranial Doppler in Estimating Cerebral Perfusion Pressure in Traumatic Brain Injury: A Prospective Observational Trial

2017 ◽  
Vol 14 (02/03) ◽  
pp. 152-155
Author(s):  
Rajagopal Ramanan ◽  
Mathew Joseph
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cerebral Perfusion Pressure ◽  
Transcranial Doppler ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Estimation Error ◽  
Icp Monitoring ◽  
Observational Trial ◽  
Flow Velocities

Abstract Title Utility of transcranial Doppler (TCD) in estimating cerebral perfusion pressure (eCPP) in traumatic brain injury—a prospective observational trial. Aim To validate the utility of a noninvasive technique of eCPP estimation using transcranial Doppler (TCD). Materials and Methods Eighteen patients with severe traumatic brain injury (TBI) requiring intracranial pressure (ICP) monitoring as per the Brain Trauma Foundation guidelines were prospectively recruited for the study. ICP was measured in all patients using an intraventricular catheter. Mean arterial pressure (MAP) was recorded from an intra-arterial catheter. Cerebral perfusion pressure (CPP) was calculated as the difference between MAP and ICP. Middle cerebral blood flow velocities were recorded using TCD, and CPP was estimated from the middle cerebral artery (MCA) flow velocities (eCPP) using the formula eCPP = (MAP × end diastolic velocity [EDV]/mean velocity [MV]) + 14. Total 185 simultaneous readings of CPP and eCPP were available for analysis. Reliability statistics between CPP and eCPP were computed to calculate the intraclass correlation (ICC). Results The average CPP measured using intraventricular catheter was 73.2 (+/−12.4), and the mean estimated eCPP was 76.7 (+/−10.9). We found a very good Pearson's correlation between CPP and eCPP (r = 0.743) with a Cronbach's α of 0.843. In 86.2% of examinations, the estimation error of measuring CPP was within 10 mm Hg, and in 93.1% examinations, it was within 15 mm Hg. Conclusion eCPP estimated using TCD can serve as reliable noninvasive alternative in situations in which ICP monitoring is not available, even in moderate or mild head injury.

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