Department of Postoperative and Intensive Care, Oslo University Hospital Ullevål, Oslo, Norway; Institute of Master and Postgraduate Nursing Studies, Lovisenberg Diaconal University College, Oslo, Norway.
Department of Anesthesiology, Oslo University Hospital Ullevål, Oslo, Norway.
World Neurosurg. 2022 Aug;164:e318-e325. doi: 10.1016/j.wneu.2022.04.108. Epub 2022 Apr 30.
To detect post-traumatic vasospasm in patients with traumatic brain injury (TBI), we implemented a simplified transcranial Doppler (TCD) surveillance protocol in a neurointensive care setting. In this study, we evaluate the yield of this protocol.
Adult patients with TBI admitted to the neurointensive care unit were examined with TCD by 2 intensive care nurses trained in TCD examinations. Flow velocities of the middle cerebral arteries were recorded. TCD suspected vasospasm was defined as the mean flow velocity >120 cm/s, and when detected, the protocol recommended a supplementary computed tomography angiography. The rate of detection of TCD suspected vasospasm and the subsequent rate of radiological diagnosis of vasospasm were recorded. In multivariate logistic regression analysis, we evaluated age, initial Glasgow Coma Scale, craniotomy, and decompressive craniectomy as potential predictors of developing increased TCD velocity.
A total of 84 patients with TBI with a median initial Glasgow Coma Scale score of 6 were examined by TCD. TCD suspected vasospasm was found in the middle cerebral arteries of 18% of examined patients. Two-thirds of patients with TCD suspected vasospasm were investigated with a subsequent computed tomography angiography, and 80% of these patients received a radiological diagnosis of vasospasm. In logistic regression analysis, decompressive craniectomy was significantly associated with increased risk of developing TCD suspected vasospasm (odds ratio: 11.57, 95% confidence interval: 2.59-51.73, P = 0.001).
The implementation of a simplified TCD surveillance protocol in a neurointensive care setting yielded an 18% detection rate of TCD suspected vasospasm. In our cohort of patients with TBI, decompressive craniectomy was associated with increased risk of developing TCD suspected vasospasm.
为了检测创伤性脑损伤（TBI）患者的创伤后血管痉挛，我们在神经重症监护病房实施了简化经颅多普勒（TCD）监测方案。本研究旨在评估该方案的效果。
将接受 TBI 治疗的成年患者收入神经重症监护病房，由经过 TCD 检查培训的 2 名重症监护护士对患者进行 TCD 检查。记录大脑中动脉的血流速度。将 TCD 疑似血管痉挛定义为平均血流速度＞120cm/s，当发现疑似血管痉挛时，建议进行补充性 CT 血管造影检查。记录 TCD 疑似血管痉挛的检出率以及随后血管痉挛的放射学诊断率。在多变量逻辑回归分析中，我们评估了年龄、初始格拉斯哥昏迷量表评分、开颅术和去骨瓣减压术作为血流速度增加的潜在预测因素。
共对 84 例 TBI 患者进行了 TCD 检查，这些患者的初始格拉斯哥昏迷量表评分为 6 分，中位数为 6 分。在接受检查的患者中，有 18%的患者出现了 TCD 疑似血管痉挛。66.7%的 TCD 疑似血管痉挛患者接受了后续 CT 血管造影检查，其中 80%的患者被诊断为血管痉挛。在逻辑回归分析中，去骨瓣减压术与 TCD 疑似血管痉挛的风险增加显著相关（优势比：11.57，95%置信区间：2.59-51.73，P=0.001）。
在神经重症监护病房实施简化 TCD 监测方案可使 TCD 疑似血管痉挛的检出率达到 18%。在本 TBI 患者队列中，去骨瓣减压术与 TCD 疑似血管痉挛的风险增加相关。
