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Acta Neurochirurgica

, Volume 152, Issue 6, pp 965–972 | Cite as

Transcranial color-coded duplex sonography allows to assess cerebral perfusion pressure noninvasively following severe traumatic brain injury

  • Giovanna Brandi
  • Markus Béchir
  • Susanne Sailer
  • Christoph Haberthür
  • Reto Stocker
  • John F. StoverEmail author
Clinical Article

Abstract

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 (paCO2 > 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: \( {\hbox{ICP}} = {1}0.{927} \times {\hbox{PI}}\left( {{\hbox{pulsatility}}\,{\hbox{index}}} \right) - {1}.{284} \) and \( {\hbox{CPP}} = {89}.{646} - {8}.{258} \times {\hbox{PI}} \) 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, \( {\hbox{eCPP}} = \left( {{\hbox{MABP}} \times {\hbox{EDV}}} \right)/{\hbox{mFV}} + {14} \) and \( {\hbox{eCPP}} = \left[ {{\hbox{mFV}}/\left( {{\hbox{mFV}} - {\hbox{EDV}}} \right)} \right] \times \left( {{\hbox{MABP}} - {\hbox{RRdiast}}} \right) \), 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 \( \left( {{\hbox{ICP}} = {1}0.{927} \times {\hbox{PI}} - {1}.{284}} \right) \) 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.

Keywords

Pulsatility index Secondary brain damage Transcranial Doppler 

Notes

Acknowledgements

The help of the ICU nursing staff in collecting clinical data is gratefully acknowledged.

Disclosure/Conflict of interest

None.

Funding

This study was supported in parts by grants from the Swiss National Research Foundation and the SUVA Fonds to JFS and RS.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Giovanna Brandi
    • 1
    • 2
  • Markus Béchir
    • 1
  • Susanne Sailer
    • 1
  • Christoph Haberthür
    • 3
  • Reto Stocker
    • 1
  • John F. Stover
    • 1
    • 4
    Email author
  1. 1.Surgical Intensive CareUniversity Hospital ZuerichZurichSwitzerland
  2. 2.Neurosurgical Intensive Care Unit, Department of Anesthesia and Critical Care MedicineFondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina ElenaMilanoItaly
  3. 3.Department of AnesthesiologyKantonsspitalLuzernSwitzerland
  4. 4.Chirurgische IntensivmedizinUniversitätsSpital ZürichZurichSwitzerland

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