Non-invasive estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography in children with severe traumatic brain injury
Non-invasive estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography in children with severe traumatic brain injury
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DOI：
10.1007/s00381-020-04524-7
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发表时间：
2020-01-30
影响因子：
1.4
通讯作者：
Maa, Tensing
中科院分区：
文献类型：
--
作者：
O'Brien, Nicole F.;Lovett, Marlina E.;Maa, Tensing
目的 确定是否可以通过使用经颅多普勒超声 (TCD) 参数计算的两种方法中的任何一种来无创估计脑灌注压 (CPP)。设计对先前前瞻性收集的数据进行回顾性审查。在三级转诊医院设置儿科重症监护病房。患者 23 名患有严重颅脑损伤 (TBI) 且有创颅内压 (ICP) 监测的儿童。干预措施 每天对大脑中动脉进行 TCD 评估。记录 TCD 检查时的 CPP。对于方法 1，估计脑灌注压 (CPPe) 计算如下：CPPe = MAP x (舒张流量 (Vd)/平均流量 (Vm)) + 14。对于方法 2，临界闭合压 (CrCP) 被确定为血压和流速参数线性回归线 x 轴上的截距点。然后将 CrCP/CPPe 计算为 MAP-CrCP。测量和主要结果 可获得一百八对测量结果。使用患者平均数据，CPP 和 CPPe 之间的相关性显着 (r = 0.78，p = < 0.001)。然而，在 Bland-Altman 图上，CPPe 的偏差为 3.7 mmHg，95% 的一致性限度为 - 17 至 + 25。使用患者平均数据，CPP 和 CrCP/CPPe 之间的相关性显着（r = 0.59，p = < 0.001），但偏倚再次较高，为 11 mmHg，95% 的一致性限度为 - 15 至 + 38 mmHg。结论 CPPe和CrCP/CPPe对于评估儿童TBI患者的绝对CPP没有临床价值。
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 x (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.