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Clinical Usefulness of Transcranial Doppler as a Screening Tool for Early Cerebral Hypoxic Episodes in Patients with Moderate and Severe Traumatic Brain Injury

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Abstract

Background

Brain tissue oxygenation (PbtO2) in traumatic brain injury (TBI) is known to be dependent on cerebral blood flow (CBF) which remains difficult to assess during the very early phase of TBI management. This study evaluates if blood flow velocity measurement with 2D color-coded transcranial Doppler (TCD) can predict cerebral hypoxic episodes in moderate-to-severe TBI measured with a PbtO2 probe.

Methods

This is a prospective observational study of serial TCD measurements to assess blood flow velocity and its association with PbtO2. Measurements were done bilaterally on the middle cerebral artery (MCA) early after the insertion of PbtO2 monitoring, daily for 5 days and during dynamic challenge tests. Physiological parameters affecting PbtO2 and Doppler velocities were collected simultaneously (PaO2, PaCO2, hemoglobin [Hb] level, intracranial pressure, and cerebral perfusion pressure [CPP]).

Results

We enrolled 17 consecutive patients with a total of 85 TCD studies. Using 2D color-coded TCD, signal acquisition was successful in 96% of the cases. Twenty-nine (34%) TCD measures were performed during an episode of cerebral hypoxia (PbtO2 ≤ 20 mmHg). For early episodes of cerebral hypoxia (occurring ≤ 24 h from trauma), all Vmean < 40 cm/s were associated with an ipsilateral PbtO2 ≤ 20 mmHg (positive predictive value 100%). However, when considering all readings over the course of the study, however, we found no correlation between PbtO2 and MCA’s mean blood flow velocity (Vmean). Vmean is also positively correlated with PaCO2, whereas PbtO2 is also correlated with PaO2, CPP, and Hb level.

Conclusions

Early TCD measurements compatible with low CBF (mean velocity < 40 cm/s) detect brain tissue hypoxia early after TBI (≤ 24 h) and could potentially be used as a screening tool before invasive monitoring insertion to help minimize time-sensitive secondary injury. Various factors influence the relationship between Vmean and PbtO2, affecting interpretation of their interaction after 24 h.

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Authors and Affiliations

  1. Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Nord-de-l’Ile-de-Montréal, 5400 Boul Gouin O, Montréal, Québec, H4J 1C5, Canada

    C. Sokoloff, K. Serri, M. Albert, E. Charbonney & F. Bernard

  2. Research Center, Hôpital du Sacré-Coeur de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Nord-de-l’Ile-de-Montréal, Montréal, Canada

    D. Williamson, K. Serri, M. Albert, E. Charbonney & F. Bernard

  3. Pharmacy Faculty, Université de Montréal, Montréal, Canada

    D. Williamson

  4. Faculty of Medicine, Université de Montréal, Montréal, Canada

    K. Serri, M. Albert, E. Charbonney & F. Bernard

  5. Department of Medicine, Centre Hospitalier de l’Université de Montréal, Montréal, Canada

    C. Odier

  6. Faculty of Neurosciences, Université de Montréal, Montréal, Canada

    C. Odier

Authors
  1. C. Sokoloff
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  2. D. Williamson
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  7. F. Bernard
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for the ÉRESI Reseach Group (Équipe de Recherche En Soins Intensifs)

Contributions

CS, DW, and FB design the study. KS, MA, CO, and EC provided significant feedback on study design. CS collected the data, and FB vouches for the accurateness of it. All authors participated in interpreting the data. CS and FB drafted the article. DW, KS, MA, CO, and EC read the papers and provided critical feedback and suggestions to improve the manuscript. The final manuscript was approved by all authors.

Corresponding author

Correspondence to F. Bernard.

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Sokoloff, C., Williamson, D., Serri, K. et al. Clinical Usefulness of Transcranial Doppler as a Screening Tool for Early Cerebral Hypoxic Episodes in Patients with Moderate and Severe Traumatic Brain Injury. Neurocrit Care 32, 486–491 (2020). https://doi.org/10.1007/s12028-019-00763-y

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