O'Brien Nicole F, Tshimanga Taty, Mangwangu Florette Yumsa, Mayindombe Ludovic, Ekandji Robert Tandjeka, Mbaka Jean Pongo, Phiri Tusekile, June Sylvester, Gushu Montfort Bernard, Wynkoop Hunter, Lovett Marlina
Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43502, USA.
Departement de Pediatrie, Cliniques Universitaires de Kinshasa, Hopital Pediatrique de Kalembe Lembe, Kinshasa, Congo.
Ultrasound J. 2025 May 30;17(1):27. doi: 10.1186/s13089-025-00430-8.
Transcranial doppler ultrasound (TCD) allows for the assessment of the cerebrovascular hemodynamics in critically ill children. Given the increasing availability of machines equipped with TCD capabilities globally, it may be a useful approach to detect cerebral hypoperfusion and guide neurologic resuscitation for pediatric patients in resource limited settings where other neuromonitoring techniques are unavailable. However, the current need to evaluate waveform characteristics and to age correct values to determine if a study is abnormal decreases the feasibility of using point of care TCD in this way. The brain shock index (BSI), a repurposing of the Lindegaard Ratio, overcomes these limitations.
We performed a prospective study of children with cerebral malaria (CM). On admission and daily thereafter, TCD was used to evaluate the middle cerebral (MCA) and extra-cranial carotid arteries (Ex-ICA), and the BSI was calculated bilaterally (MCA mean flow velocity ((Vm))/Ex-ICA Vm). Neurologic outcome at discharge was assessed.
A cohort of 291 children with CM were evaluated. BSI calculation was successful in all of them. The mean time to perform TCD and calculate the BSI was 4 ± 2 min. Overall, 222 participants (76%) had a good outcome and 69 (24%) a poor outcome. The BSI had an AUC of 0.98 (95% CI 0.97-0.99, p < 0.0001) to predict death or moderate to severe disability. The highest sensitivity and specificity of the BSI to predict adverse outcomes occurred at a cut off value ≤ 1.1. The adjusted odds ratio of poor outcome was 3.2 (95% CI 1.6-6.1, p = 0.001) if any BSI measurement during hospitalization fell below this threshold. No intracranial pressure monitoring was available to determine the relationship between the BSIs and an invasively measured cerebral perfusion pressure.
The BSI is a rapid, feasible point of care ultrasound measurement of cerebral hypoperfusion, with values ≤ 1.1 strongly correlating with poor neurologic outcomes in children with CM. Future studies should be performed to assess the utility of BSI to detect the presence and measure the severity of reduced cerebral perfusion pressure in other populations of critically ill children.
经颅多普勒超声（TCD）可用于评估危重症儿童的脑血管血流动力学。鉴于全球范围内配备TCD功能的机器越来越多，在资源有限且无法使用其他神经监测技术的环境中，TCD可能是检测小儿脑灌注不足并指导神经复苏的有用方法。然而，目前需要评估波形特征并对数值进行年龄校正以确定研究是否异常，这降低了以这种方式使用床旁TCD的可行性。脑休克指数（BSI）是对林德加德比率的重新应用，克服了这些局限性。
我们对患有脑型疟疾（CM）的儿童进行了一项前瞻性研究。入院时及此后每天，使用TCD评估大脑中动脉（MCA）和颅外颈动脉（Ex-ICA），并双侧计算BSI（MCA平均流速（Vm）/Ex-ICA Vm）。评估出院时的神经学结局。
对291名患有CM的儿童进行了队列研究。所有患儿均成功计算出BSI。进行TCD和计算BSI的平均时间为4±2分钟。总体而言，222名参与者（76%）预后良好，69名（24%）预后不良。BSI预测死亡或中度至重度残疾的AUC为0.98（95%CI 0.97-0.99，p<0.0001）。BSI预测不良结局的最高敏感性和特异性出现在临界值≤1.1时。如果住院期间任何BSI测量值低于该阈值，不良结局的调整后优势比为3.2（95%CI 1.6-6.1，p=0.001）。没有颅内压监测来确定BSI与有创测量的脑灌注压之间的关系。
BSI是一种快速、可行的床旁超声测量脑灌注不足的方法，其值≤1.1与CM患儿不良神经学结局密切相关。未来应开展研究，以评估BSI在检测其他危重症儿童群体中脑灌注压降低的存在情况及测量其严重程度方面的效用。
