Dupont Guillaume, Burnol Laetitia, Jospe Richard, Raphael Terrana, Auboyer Christian, Molliex Serge, Gergelé Laurent, Morel Jérôme
Department of Anesthesiology and Critical Care, University Hospital of Saint Etienne, Saint-Étienne Cedex, France.
J Neurosurg Anesthesiol. 2016 Apr;28(2):159-63. doi: 10.1097/ANA.0000000000000242.
Transcranial color duplex ultrasound (TCCD) is becoming an important tool for cerebral monitoring of brain-injured patients. To date, TCCD reproducibility has been studied in healthy volunteers or patients with subarachnoid hemorrhage and its efficiency in many brain injuries has not been proved. Our aim was to evaluate TCCD interobserver agreement in different brain injuries.
We performed a prospective monocentric trial conducted from January 2014 to September 2014 in intensive care unit (ICU) of Saint-Etienne university teaching hospital, France.Brain-damaged patients admitted in ICU were included, excluding those with decompressive craniectomy. Two randomized operators among the ICU medical staff consecutively performed measurements of cerebral blood flow velocities with TCCD.
One hundred measurements were obtained from 42 patients. Hemodynamic and end-tidal CO2 pressure were similar between both measurement set. The results obtained with the Bland-Altman method showed bias at 0.52 (95% confidence interval [CI], -4.19 to 3.16), 0.53 (95% CI, -1.86 to 2.92), and 0.002 (95% CI, -0.06 to 0.06) for mean velocity, diastolic velocity, and pulsatility index, respectively. The limits of agreement were (-32.4; 31.4), (-20.4; 21.4), (-0.5; 0.5) for mean velocity, diastolic velocity, and pulsatility index, respectively. The Passing and Bablok regression have shown a quasilinear relationship between measurements.
We reported the reliability of TCCD interobserver agreement in brain-damaged patients.
经颅彩色双功能超声（TCCD）正成为脑损伤患者脑监测的重要工具。迄今为止，已在健康志愿者或蛛网膜下腔出血患者中研究了TCCD的可重复性，其在许多脑损伤中的有效性尚未得到证实。我们的目的是评估TCCD在不同脑损伤中的观察者间一致性。
我们于2014年1月至2014年9月在法国圣艾蒂安大学教学医院的重症监护病房（ICU）进行了一项前瞻性单中心试验。纳入入住ICU的脑损伤患者，排除行减压颅骨切除术的患者。ICU医护人员中的两名随机操作人员连续用TCCD测量脑血流速度。
从42例患者中获得了100次测量结果。两组测量的血流动力学和呼气末二氧化碳分压相似。采用Bland-Altman方法得到的结果显示，平均速度、舒张期速度和搏动指数的偏差分别为0.52（95%置信区间[CI]，-4.19至3.16）、0.53（95%CI，-1.86至2.92）和0.002（95%CI，-0.06至0.06）。平均速度、舒张期速度和搏动指数的一致性界限分别为（-32.4；31.4）、（-20.4；21.4）、（-0.5；0.5）。Passing和Bablok回归显示测量值之间呈准线性关系。
我们报告了TCCD在脑损伤患者中观察者间一致性的可靠性。
