The Prediction of Intracranial Pressure and Clinical Outcome by Transcranial Doppler in Neurocritical Patients
Transcranial Doppler (TCD) and Transcranial color-coded duplex sonography (TCCS) play an
important part in neurocritical monitoring systems. Currently there are studies using flow
velocities and pulsatility index (PI) to predict intracranial pressure (ICP) and clinical
outcome. But the use of B-mode in such prediction is not yet investigated. The purposes of
this study are to establish the correlation among clinical data, CT findings and information
collected by TCCS, and to predict ICP and neurological outcome using such information. The
focus would be on 3rd ventricle size, midline shift and anteroposterior-transverse ration of
midbrain (midbrain index) obtained by B-mode of TCCS. This study is a prospective clinical
study targeting on 30 neurocritical patients admitted to intensive care units in one year.
The timing of performance of TCCS will be (1) within 6 hours after admission, (2) within 6
hours after each CT examination, and (3) when ICP is higher than 20 mmHg for more than 5
minutes. Glasgow coma scale (GCS), heart rate, blood pressure (systolic, diastolic, and
mean), body temperature, central venous pressure (CVP), brain temperature, ICP, cerebral
perfusion pressure (CPP), mean velocity (MV) of bilateral middle cerebral arteries (MCAs),
PI, midline shift, 3rd ventricular dimension, anteroposterior to transverse ratio of
midbrain (midbrain index, MI) are recorded. The latter three parameters are also obtained
from CT scans, and compared with those obtained from TCCS. Outcome is evaluated with
extended Glasgow outcome scale (GOSE), and analyzed with previous records. This study is
going to prove that TCCS is a safe, convenient, real-time and cheap tool in clinical care
for neurocritical patients. It also provides prediction of ICP and clinical outcome.
Observational
Observational Model: Cohort, Time Perspective: Prospective
Yi-Hsin Tsai, M.D.
Principal Investigator
Department of Traumatology, National Taiwan University Hospital
Taiwan: Department of Health
200901010R
NCT00886054
December 2009
December 2010
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