16 Transcranial Doppler in the Intensive Care Unit

Ayan Sen, JoDee Winter, and Ryan Hess

Abstract

Transcranial Doppler (TCD) ultrasonography allows for noninvasive, reproducible evaluation of cerebrovascular blood flow and hemodynamics. It is limited by cranial acoustic window availability as well as the need for well-trained sonographers and physicians. This has a variety of intensive care unit (ICU) applications due in part to how rapidly results can be collected. The spectral waveform produced indicates the peak systolic velocity, end diastolic velocity, and mean flow velocity. These values can be used to indirectly measure cerebral blood flow and degree of vessel narrowing. These values have also been used to experimentally estimate and model intracranial pressure, cerebrospinal fluid (CSF) dynamics, cerebral autoregulation, and critical closing pressure. Evaluation of the degree of vessel narrowing is especially important in the rapid evaluation of vasospasm, a common cause of secondary brain injury following subarachnoid hemorrhage and traumatic brain injury. TCD can also be used in diagnosis, prognosis, and treatment of ischemic stroke through various applications, including cause of anterior circulation occlusion, response to thrombolytics, and prediction of need for decompressive hemicraniectomy. Finally, TCD has been used in a variety of other neuromonitoring applications such as detection of sickle cell crisis, emboli during carotid endarterectomy, and sepsis-associated encephalopathy. When used appropriately, TCD is a valuable and versatile tool in neurocritical care.

Schlüsselwörter

transcranial doppler - neurocritical care - cerebral blood flow - vasospasm - ischemic stroke

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