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Pre-hospital transcranial Doppler in severe traumatic brain injury: a pilot study.
MedLine Citation:
PMID:  21288224     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Investigation of the feasibility and usefulness of pre-hospital transcranial Doppler (TCD) to guide early goal-directed therapy following severe traumatic brain injury (TBI). Methods: Prospective, observational study of 18 severe TBI patients during pre-hospital medical care. TCD was performed to estimate cerebral perfusion in the field and upon arrival at the Level 1 trauma centre. Specific therapy (mannitol, noradrenaline) aimed at improving cerebral perfusion was initiated if the initial TCD was abnormal (defined by a pulsatility index >1.4 and low diastolic velocity). Results: Nine patients had a normal initial TCD and nine an abnormal one, without a significant difference between groups in terms of the Glasgow Coma Scale or the mean arterial pressure. Among patients with an abnormal TCD, four presented with an initial areactive bilateral mydriasis. Therapy normalized TCD in five patients, with reversal of the initial mydriasis in two cases. Among these five patients for whom TCD was corrected, only two died within the first 48 h. All four patients for whom the TCD could not be corrected during transport died within 48 h. Only patients with an initial abnormal TCD required emergent neurosurgery (3/9). Mortality at 48 h was significantly higher for patients with an initial abnormal TCD. Conclusions: Our preliminary study suggests that TCD could be used in pre-hospital care to detect patients whose cerebral perfusion may be impaired.
Authors:
K Tazarourte; A Atchabahian; J-P Tourtier; J-S David; C Ract; D Savary; M Monchi; B Vigué
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-2
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  -     ISSN:  1399-6576     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 The Authors. Acta Anaesthesiologica Scandinavica. © 2011 The Acta Anaesthesiologica Scandinavica Foundation.
Affiliation:
Service d'aide médicale urgente (SAMU) 77, Pôle Urgence, Hôpital Marc Jacquet, Melun, France AP-HP, Département d'Anesthésie Réanimation, Université Paris Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre, France Department of Anesthesiology, NYU Medical Center, New York, NY.
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