Non-invasive estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography in children with severe traumatic brain injury
Objective To identify if cerebral perfusion pressure (CPP) can be non-invasively estimated by either of two methods calculated using transcranial Doppler ultrasound (TCD) parameters. Design Retrospective review of previously prospectively gathered data. Setting Pediatric intensive care unit in a ter...
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| Veröffentlicht in: | Child's nervous system 2020-09, Vol.36 (9), p.2063-2071 |
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| creator | O’Brien, Nicole F Lovett, Marlina E. Chung, Melissa Maa, Tensing |
| description | Objective
To identify if cerebral perfusion pressure (CPP) can be non-invasively estimated by either of two methods calculated using transcranial Doppler ultrasound (TCD) parameters.
Design
Retrospective review of previously prospectively gathered data.
Setting
Pediatric intensive care unit in a tertiary care referral hospital.
Patients
Twenty-three children with severe traumatic brain injury (TBI) and invasive intracranial pressure (ICP) monitoring in place.
Interventions
TCD evaluation of the middle cerebral arteries was performed daily. CPP at the time of the TCD examination was recorded. For method 1, estimated cerebral perfusion pressure (CPPe) was calculated as: CPPe = MAP × (diastolic flow (Vd)/mean flow (Vm)) + 14. For method 2, critical closing pressure (CrCP) was identified as the intercept point on the
x
-axis of the linear regression line of blood pressure and flow velocity parameters. CrCP/CPPe was then calculated as MAP-CrCP.
Measurements and main results
One hundred eight paired measurements were available. Using patient averaged data, correlation between CPP and CPPe was significant (
r
= 0.78,
p
= |
| doi_str_mv | 10.1007/s00381-020-04524-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7223617</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2348797669</sourcerecordid><originalsourceid>FETCH-LOGICAL-c446t-cfaf8ea6226d428503850c1d321531a4bf55d1e05fc90746153b1026f1738cb83</originalsourceid><addsrcrecordid>eNp9UcuO1DAQtBCIHQZ-gAPykUug_UxyQUK7vKQVXOBsOU5nxqOMHexk0PwFn4zDLCu4cHHL3dVVrSpCnjN4xQDq1xlANKwCDhVIxWVVPyAbJoWoQCh4SDbAla5qkHBFnuR8AGCq4e1jciVY2-q2bjfk5-cYKh9ONvsTUsyzP9rZx0DjQB0m7JId6YRpWPLanRLmvCSk5Rt2dE42ZFceX1A3cZpGTHQZSzvHEHfJTvsz9YG6vR_7hIH-8POeZjwV5nV5WcUcLSIF5MNhSeen5NFgx4zP7uqWfHv_7uv1x-r2y4dP129vKyelnis32KFBqznXveSNKk4ocKwXnCnBrOwGpXqGoAbXQi116XYMuB5YLRrXNWJL3lx4p6U7Yu8wlHtGM6ViQDqbaL35dxL83uziydScC11YtuTlHUGK35finDn67HAcbcC4ZMOFbOq21rotUH6BuhRzTjjcyzAwa5TmEqUpUZrfUZqV_8XfB96v_MmuAMQFkMso7DCZQ1xSKKb9j_YXWjeu9w</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2348797669</pqid></control><display><type>article</type><title>Non-invasive estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography in children with severe traumatic brain injury</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>O’Brien, Nicole F ; Lovett, Marlina E. ; Chung, Melissa ; Maa, Tensing</creator><creatorcontrib>O’Brien, Nicole F ; Lovett, Marlina E. ; Chung, Melissa ; Maa, Tensing</creatorcontrib><description>Objective
To identify if cerebral perfusion pressure (CPP) can be non-invasively estimated by either of two methods calculated using transcranial Doppler ultrasound (TCD) parameters.
Design
Retrospective review of previously prospectively gathered data.
Setting
Pediatric intensive care unit in a tertiary care referral hospital.
Patients
Twenty-three children with severe traumatic brain injury (TBI) and invasive intracranial pressure (ICP) monitoring in place.
Interventions
TCD evaluation of the middle cerebral arteries was performed daily. CPP at the time of the TCD examination was recorded. For method 1, estimated cerebral perfusion pressure (CPPe) was calculated as: CPPe = MAP × (diastolic flow (Vd)/mean flow (Vm)) + 14. For method 2, critical closing pressure (CrCP) was identified as the intercept point on the
x
-axis of the linear regression line of blood pressure and flow velocity parameters. CrCP/CPPe was then calculated as MAP-CrCP.
Measurements and main results
One hundred eight paired measurements were available. Using patient averaged data, correlation between CPP and CPPe was significant (
r
= 0.78,
p
= < 0.001). However, on Bland-Altman plots, bias was 3.7 mmHg with 95% limits of agreement of − 17 to + 25 for CPPe. Using patient averaged data, correlation between CPP and CrCP/CPPe was significant (
r
= 0.59,
p
= < 0.001), but again bias was high at 11 mmHg with wide 95% limits of agreement of − 15 to + 38 mmHg.
Conclusions
CPPe and CrCP/CPPe do not have clinical value to estimate the absolute CPP in pediatric patients with TBI.</description><identifier>ISSN: 0256-7040</identifier><identifier>EISSN: 1433-0350</identifier><identifier>DOI: 10.1007/s00381-020-04524-7</identifier><identifier>PMID: 31996979</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Blood Flow Velocity ; Blood Pressure ; Brain Injuries, Traumatic - diagnostic imaging ; Cerebrovascular Circulation ; Child ; Humans ; Intracranial Pressure ; Medicine ; Medicine & Public Health ; Middle Cerebral Artery - diagnostic imaging ; Neurosciences ; Neurosurgery ; Original ; Original Article ; Retrospective Studies ; Ultrasonography, Doppler, Transcranial</subject><ispartof>Child's nervous system, 2020-09, Vol.36 (9), p.2063-2071</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c446t-cfaf8ea6226d428503850c1d321531a4bf55d1e05fc90746153b1026f1738cb83</citedby><cites>FETCH-LOGICAL-c446t-cfaf8ea6226d428503850c1d321531a4bf55d1e05fc90746153b1026f1738cb83</cites><orcidid>0000-0002-8826-8671</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00381-020-04524-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00381-020-04524-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31996979$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>O’Brien, Nicole F</creatorcontrib><creatorcontrib>Lovett, Marlina E.</creatorcontrib><creatorcontrib>Chung, Melissa</creatorcontrib><creatorcontrib>Maa, Tensing</creatorcontrib><title>Non-invasive estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography in children with severe traumatic brain injury</title><title>Child's nervous system</title><addtitle>Childs Nerv Syst</addtitle><addtitle>Childs Nerv Syst</addtitle><description>Objective
To identify if cerebral perfusion pressure (CPP) can be non-invasively estimated by either of two methods calculated using transcranial Doppler ultrasound (TCD) parameters.
Design
Retrospective review of previously prospectively gathered data.
Setting
Pediatric intensive care unit in a tertiary care referral hospital.
Patients
Twenty-three children with severe traumatic brain injury (TBI) and invasive intracranial pressure (ICP) monitoring in place.
Interventions
TCD evaluation of the middle cerebral arteries was performed daily. CPP at the time of the TCD examination was recorded. For method 1, estimated cerebral perfusion pressure (CPPe) was calculated as: CPPe = MAP × (diastolic flow (Vd)/mean flow (Vm)) + 14. For method 2, critical closing pressure (CrCP) was identified as the intercept point on the
x
-axis of the linear regression line of blood pressure and flow velocity parameters. CrCP/CPPe was then calculated as MAP-CrCP.
Measurements and main results
One hundred eight paired measurements were available. Using patient averaged data, correlation between CPP and CPPe was significant (
r
= 0.78,
p
= < 0.001). However, on Bland-Altman plots, bias was 3.7 mmHg with 95% limits of agreement of − 17 to + 25 for CPPe. Using patient averaged data, correlation between CPP and CrCP/CPPe was significant (
r
= 0.59,
p
= < 0.001), but again bias was high at 11 mmHg with wide 95% limits of agreement of − 15 to + 38 mmHg.
Conclusions
CPPe and CrCP/CPPe do not have clinical value to estimate the absolute CPP in pediatric patients with TBI.</description><subject>Blood Flow Velocity</subject><subject>Blood Pressure</subject><subject>Brain Injuries, Traumatic - diagnostic imaging</subject><subject>Cerebrovascular Circulation</subject><subject>Child</subject><subject>Humans</subject><subject>Intracranial Pressure</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Cerebral Artery - diagnostic imaging</subject><subject>Neurosciences</subject><subject>Neurosurgery</subject><subject>Original</subject><subject>Original Article</subject><subject>Retrospective Studies</subject><subject>Ultrasonography, Doppler, Transcranial</subject><issn>0256-7040</issn><issn>1433-0350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UcuO1DAQtBCIHQZ-gAPykUug_UxyQUK7vKQVXOBsOU5nxqOMHexk0PwFn4zDLCu4cHHL3dVVrSpCnjN4xQDq1xlANKwCDhVIxWVVPyAbJoWoQCh4SDbAla5qkHBFnuR8AGCq4e1jciVY2-q2bjfk5-cYKh9ONvsTUsyzP9rZx0DjQB0m7JId6YRpWPLanRLmvCSk5Rt2dE42ZFceX1A3cZpGTHQZSzvHEHfJTvsz9YG6vR_7hIH-8POeZjwV5nV5WcUcLSIF5MNhSeen5NFgx4zP7uqWfHv_7uv1x-r2y4dP129vKyelnis32KFBqznXveSNKk4ocKwXnCnBrOwGpXqGoAbXQi116XYMuB5YLRrXNWJL3lx4p6U7Yu8wlHtGM6ViQDqbaL35dxL83uziydScC11YtuTlHUGK35finDn67HAcbcC4ZMOFbOq21rotUH6BuhRzTjjcyzAwa5TmEqUpUZrfUZqV_8XfB96v_MmuAMQFkMso7DCZQ1xSKKb9j_YXWjeu9w</recordid><startdate>20200901</startdate><enddate>20200901</enddate><creator>O’Brien, Nicole F</creator><creator>Lovett, Marlina E.</creator><creator>Chung, Melissa</creator><creator>Maa, Tensing</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8826-8671</orcidid></search><sort><creationdate>20200901</creationdate><title>Non-invasive estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography in children with severe traumatic brain injury</title><author>O’Brien, Nicole F ; Lovett, Marlina E. ; Chung, Melissa ; Maa, Tensing</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c446t-cfaf8ea6226d428503850c1d321531a4bf55d1e05fc90746153b1026f1738cb83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Blood Flow Velocity</topic><topic>Blood Pressure</topic><topic>Brain Injuries, Traumatic - diagnostic imaging</topic><topic>Cerebrovascular Circulation</topic><topic>Child</topic><topic>Humans</topic><topic>Intracranial Pressure</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Cerebral Artery - diagnostic imaging</topic><topic>Neurosciences</topic><topic>Neurosurgery</topic><topic>Original</topic><topic>Original Article</topic><topic>Retrospective Studies</topic><topic>Ultrasonography, Doppler, Transcranial</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>O’Brien, Nicole F</creatorcontrib><creatorcontrib>Lovett, Marlina E.</creatorcontrib><creatorcontrib>Chung, Melissa</creatorcontrib><creatorcontrib>Maa, Tensing</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Child's nervous system</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>O’Brien, Nicole F</au><au>Lovett, Marlina E.</au><au>Chung, Melissa</au><au>Maa, Tensing</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Non-invasive estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography in children with severe traumatic brain injury</atitle><jtitle>Child's nervous system</jtitle><stitle>Childs Nerv Syst</stitle><addtitle>Childs Nerv Syst</addtitle><date>2020-09-01</date><risdate>2020</risdate><volume>36</volume><issue>9</issue><spage>2063</spage><epage>2071</epage><pages>2063-2071</pages><issn>0256-7040</issn><eissn>1433-0350</eissn><abstract>Objective
To identify if cerebral perfusion pressure (CPP) can be non-invasively estimated by either of two methods calculated using transcranial Doppler ultrasound (TCD) parameters.
Design
Retrospective review of previously prospectively gathered data.
Setting
Pediatric intensive care unit in a tertiary care referral hospital.
Patients
Twenty-three children with severe traumatic brain injury (TBI) and invasive intracranial pressure (ICP) monitoring in place.
Interventions
TCD evaluation of the middle cerebral arteries was performed daily. CPP at the time of the TCD examination was recorded. For method 1, estimated cerebral perfusion pressure (CPPe) was calculated as: CPPe = MAP × (diastolic flow (Vd)/mean flow (Vm)) + 14. For method 2, critical closing pressure (CrCP) was identified as the intercept point on the
x
-axis of the linear regression line of blood pressure and flow velocity parameters. CrCP/CPPe was then calculated as MAP-CrCP.
Measurements and main results
One hundred eight paired measurements were available. Using patient averaged data, correlation between CPP and CPPe was significant (
r
= 0.78,
p
= < 0.001). However, on Bland-Altman plots, bias was 3.7 mmHg with 95% limits of agreement of − 17 to + 25 for CPPe. Using patient averaged data, correlation between CPP and CrCP/CPPe was significant (
r
= 0.59,
p
= < 0.001), but again bias was high at 11 mmHg with wide 95% limits of agreement of − 15 to + 38 mmHg.
Conclusions
CPPe and CrCP/CPPe do not have clinical value to estimate the absolute CPP in pediatric patients with TBI.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31996979</pmid><doi>10.1007/s00381-020-04524-7</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-8826-8671</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Child's nervous system, 2020-09, Vol.36 (9), p.2063-2071 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Blood Flow Velocity Blood Pressure Brain Injuries, Traumatic - diagnostic imaging Cerebrovascular Circulation Child Humans Intracranial Pressure Medicine Medicine & Public Health Middle Cerebral Artery - diagnostic imaging Neurosciences Neurosurgery Original Original Article Retrospective Studies Ultrasonography, Doppler, Transcranial |
| title | Non-invasive estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography in children with severe traumatic brain injury |
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