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Monitoring of Cerebral Blood Flow and Ischemia in the Critically Ill

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Abstract

Secondary ischemic injury is common after acute brain injury and can be evaluated with the use of neuromonitoring devices. This manuscript provides guidelines for the use of devices to monitor cerebral blood flow (CBF) in critically ill patients. A Medline search was conducted to address essential pre-specified questions related to the utility of CBF monitoring. Peer-reviewed recommendations were constructed according to the GRADE criteria based upon the available supporting literature. Transcranial Doppler ultrasonography (TCD) and transcranial color-coded duplex sonography (TCCS) are predictive of angiographic vasospasm and delayed ischemic neurological deficits after aneurysmal subarachnoid hemorrhage. TCD and TCCS may be beneficial in identifying vasospasm after traumatic brain injury. TCD and TCCS have shortcomings in identifying some secondary ischemic risks. Implantable thermal diffusion flowmetry (TDF) probes may provide real-time continuous quantitative assessment of ischemic risks. Data are lacking regarding ischemic thresholds for TDF or their correlation with ischemic injury and clinical outcomes.TCD and TCCS can be used to monitor CBF in the neurocritical care unit. Better and more developed methods of continuous CBF monitoring are needed to limit secondary ischemic injury in the neurocritical care unit.

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Conflicts of interest

Neither author reports any conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Neurology and Neurosurgery, Wexner Medical Center at the Ohio State University, 395 W 12th Avenue, Room 782, Columbus, OH, 43210, USA

    Chad Miller

  2. MedStar-Washington Hospital Center and Georgetown University Hospital Center, Washington, DC, USA

    Rocco Armonda

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Consortia

The Participants in the International Multi-disciplinary Consensus Conference on Multimodality Monitoring

Corresponding author

Correspondence to Chad Miller.

Additional information

The Participants in the International Multi-disciplinary Consensus Conference on Multimodality Monitoring are listed in “Appendix” section.

Appendix: Participants in the International Multi-disciplinary Consensus Conference on Multimodality Monitoring

Appendix: Participants in the International Multi-disciplinary Consensus Conference on Multimodality Monitoring

Peter Le Roux, MD, FACS

Brain and Spine Center

Suite 370, Medical Science Building

Lankenau Medical Center

100 East Lancaster Avenue, Wynnewood, PA 19096, USA

Tel: +1 610 642 3005;

Fax: 610 642 3057

lerouxp@mlhs.org

David K Menon MD PhD FRCP FRCA FFICM FMedSci

Head, Division of Anaesthesia, University of Cambridge

Consultant, Neurosciences Critical Care Unit

Box 93, Addenbrooke’s Hospital

Cambridge CB2 2QQ, UK

dkm13@wbic.cam.ac.uk

Paul Vespa, MD, FCCM, FAAN, FNCS

Professor of Neurology and Neurosurgery

Director of Neurocritical Care

David Geffen School of Medicine at UCLA

Los Angeles, CA 90095, USA

PVespa@mednet.ucla.edu

Giuseppe Citerio

Director NeuroIntensive Care Unit

Department of Anesthesia and Critical Care

Ospedale San Gerardo, Monza

Via Pergolesi 33, Monza 20900, Italy

g.citerio@hsgerardo.org

Mary Kay Bader, RN, MSN, CCNS, FAHA, FNCS

Neuro/Critical Care CNS

Mission Hospital

Mission Viejo, CA 92691, USA

Marykay.Bader@stjoe.org

Gretchen M. Brophy, PharmD, BCPS, FCCP, FCCM

Professor of Pharmacotherapy & Outcomes Science and Neurosurgery

Virginia Commonwealth University

Medical College of Virginia Campus

410 N. 12th Street

Richmond, VA 23298-0533, USA

gbrophy@vcu.edu

Michael N. Diringer, MD

Professor of Neurology, Neurosurgery & Anesthesiology

Chief, Neurocritical Care Section

Washington University

Department of Neurology, Campus Box 8111

660 S Euclid Ave

St Louis, MO 63110, USA

diringerm@neuro.wustl.edu

Nino Stocchetti, MD

Professor of Anesthesia and Intensive Care

Department of physiopathology and transplant,

Milan University

Director Neuro ICU

Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico

Via F Sforza, 35, 20122 Milan, Italy

stocchet@policlinico.mi.it

Walter Videtta, MD

ICU Neurocritical Care

Hospital Nacional ‘Prof. a. Posadas’

El Palomar - Pcia. de Buenos Aires

Argentina

wvidetta@ar.inter.net

Rocco Armonda, MD

Department of Neurosurgery

MedStar Georgetown University Hospital

Medstar Health, 3800 Reservoir Road NW

Washington DC, 20007 USA

Rocco.Armonda@gmail.com

Neeraj Badjatia, MD

Department of Neurology

University of Maryland Medical Center

22 S Greene St

Baltimore, MD 21201, USA

nbadjatia@umm.edu

Julian Boesel, MD

Department of Neurology

Ruprect-Karls University

Hospital Heidelberg, Im Neuenheimer Feld 400

D-69120 Heidelberg, Germany

Julian.Boesel@med.uni-heidelberg.de

Randal Chesnut, MD, FCCM, FACS

Harborview Medical Center

University of Washington Mailstop 359766

325 Ninth Ave

Seattle, WA 98104-2499, USA

chesnutr@u.washington.edu

Sherry Chou, MD, MMSc

Department of Neurology

Brigham and Women’s Hospital

75 Francis Street

Boston, MA 02115, USA

schou1@partners.org

Jan Claassen, MD, PhD, FNCS

Assistant Professor of Neurology and Neurosurgery

Head of Neurocritical Care and Medical Director of the Neurological Intensive Care Unit

Columbia University College of Physicians & Surgeons

177 Fort Washington Avenue, Milstein 8 Center room 300

New York, NY 10032, USA

jc1439@cumc.columbia.edu

Marek Czosnyka, PhD

Department of Neurosurgery

University of Cambridge,

Addenbrooke’s Hospital, Box 167

Cambridge CB20QQ, UK

mc141@medschl.cam.ac.uk

Michael De Georgia, MD

Professor of Neurology

Director, Neurocritical Care Center

Co-Director, Cerebrovascular Center

University Hospital Case Medical Center

Case Western Reserve University School of Medicine

11100 Euclid Avenue

Cleveland, OH 44106, USA

michael.degeorgia@uhhospitals.org

Anthony Figaji, MD, PhD

Head of Pediatric Neurosurgery

University of Cape Town

617 Institute for Child Health

Red Cross Children’s Hospital

Rondebosch, 7700 Cape Town, South Africa

anthony.figaji@uct.ac.za

Jennifer Fugate, DO

Department of Neurology

Mayo Clinic

200 First Street SW

Rochester, MN 55905, USA

Fugate.Jennifer@mayo.edu

Raimund Helbok, MD

Department of Neurology, Neurocritical Care Unit

Innsbruck Medical University

Anichstr. 35

6020 Innsbruck, Austria

raimund.helbok@uki.at

David Horowitz, MD

Associate Chief Medical Officer

University of Pennsylvania Health System

3701 Market Street

Philadelphia, PA 19104, USA

david.horowitz@uphs.upenn.edu

Peter Hutchinson, MD

Professor of Neurosurgery

NIHR Research Professor

Department of Clinical Neurosciences

University of Cambridge

Box 167 Addenbrooke’s Hospital

Cambridge CB2 2QQ, UK

pjah2@cam.ac.uk

Monisha Kumar, MD

Department of Neurology

Perelman School of Medicine, University of Pennsylvania,

3 West Gates

3400 Spruce Street

Philadelphia, PA 19104, USA

monisha.kumar@uphs.upenn.edu

Molly McNett, RN, PhD

Director, Nursing Research

The MetroHealth System

2500 MetroHealth Drive

Cleveland, OH 44109, USA

mmcnett@metrohealth.org

Chad Miller, MD

Department of Neurology and Neurosurgery

The Ohio State University

395 W. 12th Ave, 7th Floor

Columbus, OH 43210, USA

chad.miller2@ohiohealth.com

Andrew Naidech, MD, MSPH

Department of Neurology

Northwestern University Feinberg SOM 710

N Lake Shore Drive, 11th floor

Chicago, IL 60611, USA

ANaidech@nmff.org

Mauro Oddo, MD

Department of Intensive Care Medicine

CHUV University Hospital, BH 08-623

Faculty of Biology and Medicine University of Lausanne

1011 Lausanne, Switzerland

Mauro.Oddo@chuv.ch

DaiWai Olson, RN, PhD

Associate Professor of Neurology, Neurotherapeutics and Neurosurgery

University of Texas Southwestern

5323 Harry Hines Blvd.

Dallas, TX 75390-8897, USA

daiwai.olson@utsouthwestern.edu

Kristine O’Phelan, MD

Director of Neurocritical Care

Associate Professor, Department of Neurology

University of Miami, Miller School of Medicine

JMH, 1611 NW 12th Ave, Suite 405

Miami, FL 33136, USA

kophelan@med.miami.edu

Javier Provencio, MD

Associate Professor of Medicine

Cerebrovascular Center and Neuroinflammation Research Center

Lerner College of Medicine

Cleveland Clinic,

9500 Euclid Ave, NC30

Cleveland, OH 44195, USA

provenj@ccf.org

Corina Puppo, MD

Assistant Professor, Intensive Care Unit

Hospital de Clinicas, Universidad de la República

Montevideo, Uruguay

coripuppo@gmail.com

Richard Riker, MD

Critical Care Medicine

Maine Medical Center,

22 Bramhall Street

Portland, ME 04102-3175, USA

RRiker@cmamaine.com

Claudia Robertson, MD

Department of Neurosurgery

Medical Director of Center for Neurosurgical Intensive Care

Ben Taub Hospital

Baylor College of Medicine

1504 Taub Loop, Houston, TX 77030, USA

claudiar@bcm.tmc.edu

J. Michael Schmidt, PhD, MSc

Director of Neuro-ICU Monitoring and Informatics

Columbia University College of Physicians and Surgeons

Milstein Hospital 8 Garden South, Suite 331

177 Fort Washington Avenue,

New York, NY 10032, USA

mjs2134@columbia.edu

Fabio Taccone, MD

Department of Intensive Care, Laboratoire de Recherche Experimentale

Erasme Hospital

Route de Lennik, 808

1070 Brussels, Belgium

ftaccone@ulb.ac.be

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Miller, C., Armonda, R. & The Participants in the International Multi-disciplinary Consensus Conference on Multimodality Monitoring. Monitoring of Cerebral Blood Flow and Ischemia in the Critically Ill. Neurocrit Care 21 (Suppl 2), 121–128 (2014). https://doi.org/10.1007/s12028-014-0021-9

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