Document Detail

Transcranial color-coded duplex sonography allows to assess cerebral perfusion pressure noninvasively following severe traumatic brain injury.
MedLine Citation:
PMID:  20379747     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Assess optimal equation to noninvasively estimate intracranial pressure (eICP) and cerebral perfusion pressure (eCPP) following severe traumatic brain injury (TBI) using transcranial color-coded duplex sonography (TCCDS). DESIGN AND SETTING: This is an observational clinical study in a university hospital. PATIENTS: A total of 45 continuously sedated (BIS < 50), normoventilated (paCO(2) > 35 mmHg), and non-febrile TBI patients. METHODS: eICP and eCPP based on TCCDS-derived flow velocities and arterial blood pressure values using three different equations were compared to actually measured ICP and CPP in severe TBI patients subjected to standard treatment. Optimal equation was assessed by Bland-Altman analysis. RESULTS: The equations: ICP = 10:927 x PI(pulsatility index) - 1:284 and CPP = 89:646 - 8:258 PI resulted in eICP and eCPP similar to actually measured ICP and CPP with eICP 10.6 +/- 4.8 vs. ICP 10.3 +/- 2.8 and eCPP 81.1 +/- 7.9 vs. CPP 80.9 +/- 2.1 mmHg, respectively. The other two equations, eCPP = (MABP x EDV)/mFV + 14 and eCPP = mFV / (mFV - EDV)] x (MABP - RRdiast), resulted in significantly decreased eCPP values: 72.9 +/- 10.1 and 67 +/- 19.5 mmHg, respectively. Superiority of the first equation was confirmed by Bland-Altman revealing a smallest standard deviations for eCPP and eICP. CONCLUSIONS: TCCDS-based equation (ICP = 10.927 x PI - 1.284) allows to screen patients at risk of increased ICP and decreased CPP. However, adequate therapeutic interventions need to be based on continuously determined ICP and CPP values.
Giovanna Brandi; Markus Béchir; Susanne Sailer; Christoph Haberthür; Reto Stocker; John F Stover
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-04-09
Journal Detail:
Title:  Acta neurochirurgica     Volume:  152     ISSN:  0942-0940     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-18     Completed Date:  2010-08-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  965-72     Citation Subset:  IM    
Surgical Intensive Care, University Hospital Zuerich, Zurich, Switzerland.
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MeSH Terms
Blood Flow Velocity / physiology
Blood Pressure / physiology*
Brain / blood supply*
Brain Injuries / mortality,  therapy,  ultrasonography*
Brain Injury, Chronic / ultrasonography
Intensive Care
Intracranial Pressure / physiology*
Middle Aged
Middle Cerebral Artery / ultrasonography
Prospective Studies
Pulsatile Flow / physiology
Regional Blood Flow / physiology*
Sensitivity and Specificity
Survival Rate
Ultrasonography, Doppler, Color* / statistics & numerical data
Ultrasonography, Doppler, Transcranial* / statistics & numerical data
Young Adult

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