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Noninvasive measurement of intracranial pressure via the pulsatility index on transcranial doppler sonography: Is improvement possible?
ABSTRACT Purpose We hypothesized that using hemodynamic variables could improve the prediction of intracranial pressure (ICP) from the middle cerebral artery pulsatility index (PI) measured with transcranial Doppler sonography. Methods In this prospective study, 39 patients with traumatic brain inju...
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| Published in: | Journal of clinical ultrasound 2016-01, Vol.44 (1), p.40-45 |
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| container_title | Journal of clinical ultrasound |
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| creator | Morgalla, Matthias H. Magunia, Harry |
| description | ABSTRACT
Purpose
We hypothesized that using hemodynamic variables could improve the prediction of intracranial pressure (ICP) from the middle cerebral artery pulsatility index (PI) measured with transcranial Doppler sonography.
Methods
In this prospective study, 39 patients with traumatic brain injury were routinely examined with transcranial Doppler sonography, and the middle cerebral artery PI was calculated. A multivariate model including hematocrit, mean arterial blood pressure, heart rate, and arterial CO2 pressure (PaCO2) was evaluated.
Results
Thirty‐nine comatose patients (16 women and 23 men; age range 18–73 years; median 44 years) were included, and 234 data pairs (consisting of ICP and corresponding PI values) were analyzed. ICP ranged from −3 mmHg to +52 mmHg, and PI from 0.6 to 2.85. We found a significant but weak correlation between PI and the square root of ICP (R2 between 0.29 and 0.34, p < 0.0001). A slightly stronger correlation was detected when hemodynamic variables were incorporated (R2 between 0.37 and 0.43). Of these variables, mean arterial blood pressure had the most significant influence.
Conclusions
In this study, PI was not a sufficiently strong predictor of ICP to be used in clinical practice. Its reliability did not improve even when hemodynamic variables were considered. Therefore, we recommend abandoning the use of PI for the noninvasive measurement of ICP in clinical practice. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:40–45, 2016 |
| doi_str_mv | 10.1002/jcu.22279 |
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Purpose
We hypothesized that using hemodynamic variables could improve the prediction of intracranial pressure (ICP) from the middle cerebral artery pulsatility index (PI) measured with transcranial Doppler sonography.
Methods
In this prospective study, 39 patients with traumatic brain injury were routinely examined with transcranial Doppler sonography, and the middle cerebral artery PI was calculated. A multivariate model including hematocrit, mean arterial blood pressure, heart rate, and arterial CO2 pressure (PaCO2) was evaluated.
Results
Thirty‐nine comatose patients (16 women and 23 men; age range 18–73 years; median 44 years) were included, and 234 data pairs (consisting of ICP and corresponding PI values) were analyzed. ICP ranged from −3 mmHg to +52 mmHg, and PI from 0.6 to 2.85. We found a significant but weak correlation between PI and the square root of ICP (R2 between 0.29 and 0.34, p < 0.0001). A slightly stronger correlation was detected when hemodynamic variables were incorporated (R2 between 0.37 and 0.43). Of these variables, mean arterial blood pressure had the most significant influence.
Conclusions
In this study, PI was not a sufficiently strong predictor of ICP to be used in clinical practice. Its reliability did not improve even when hemodynamic variables were considered. Therefore, we recommend abandoning the use of PI for the noninvasive measurement of ICP in clinical practice. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:40–45, 2016</description><identifier>ISSN: 0091-2751</identifier><identifier>EISSN: 1097-0096</identifier><identifier>DOI: 10.1002/jcu.22279</identifier><identifier>PMID: 26366515</identifier><identifier>CODEN: JCULDD</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; cerebral blood flow ; Coma ; Female ; Forecasting ; Humans ; Intracranial Pressure ; Male ; measurement accuracy ; Middle Aged ; Prospective Studies ; Pulsatile Flow ; pulsatility index ; Regression Analysis ; transcranial Doppler sonography ; Ultrasonic imaging ; Ultrasonography, Doppler, Transcranial - economics ; Ultrasonography, Doppler, Transcranial - standards ; Ultrasonography, Doppler, Transcranial - trends</subject><ispartof>Journal of clinical ultrasound, 2016-01, Vol.44 (1), p.40-45</ispartof><rights>2015 Wiley Periodicals, Inc.</rights><rights>2016 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4949-d47287ad8724d20290c7f7a4820f79ec625247d6387f077294d7bf4d84cc58ec3</citedby><cites>FETCH-LOGICAL-c4949-d47287ad8724d20290c7f7a4820f79ec625247d6387f077294d7bf4d84cc58ec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26366515$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Morgalla, Matthias H.</creatorcontrib><creatorcontrib>Magunia, Harry</creatorcontrib><title>Noninvasive measurement of intracranial pressure via the pulsatility index on transcranial doppler sonography: Is improvement possible?</title><title>Journal of clinical ultrasound</title><addtitle>J. Clin. Ultrasound</addtitle><description>ABSTRACT
Purpose
We hypothesized that using hemodynamic variables could improve the prediction of intracranial pressure (ICP) from the middle cerebral artery pulsatility index (PI) measured with transcranial Doppler sonography.
Methods
In this prospective study, 39 patients with traumatic brain injury were routinely examined with transcranial Doppler sonography, and the middle cerebral artery PI was calculated. A multivariate model including hematocrit, mean arterial blood pressure, heart rate, and arterial CO2 pressure (PaCO2) was evaluated.
Results
Thirty‐nine comatose patients (16 women and 23 men; age range 18–73 years; median 44 years) were included, and 234 data pairs (consisting of ICP and corresponding PI values) were analyzed. ICP ranged from −3 mmHg to +52 mmHg, and PI from 0.6 to 2.85. We found a significant but weak correlation between PI and the square root of ICP (R2 between 0.29 and 0.34, p < 0.0001). A slightly stronger correlation was detected when hemodynamic variables were incorporated (R2 between 0.37 and 0.43). Of these variables, mean arterial blood pressure had the most significant influence.
Conclusions
In this study, PI was not a sufficiently strong predictor of ICP to be used in clinical practice. Its reliability did not improve even when hemodynamic variables were considered. Therefore, we recommend abandoning the use of PI for the noninvasive measurement of ICP in clinical practice. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:40–45, 2016</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>cerebral blood flow</subject><subject>Coma</subject><subject>Female</subject><subject>Forecasting</subject><subject>Humans</subject><subject>Intracranial Pressure</subject><subject>Male</subject><subject>measurement accuracy</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Pulsatile Flow</subject><subject>pulsatility index</subject><subject>Regression Analysis</subject><subject>transcranial Doppler sonography</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography, Doppler, Transcranial - economics</subject><subject>Ultrasonography, Doppler, Transcranial - standards</subject><subject>Ultrasonography, Doppler, Transcranial - trends</subject><issn>0091-2751</issn><issn>1097-0096</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNqNkcFu1DAURS0EokNhwQ8gS2xgkdZxbD-HDUIDHVpVZUPF0vI4DvWQ2KmdDJ0v4LfxkE4XSEis3sLnXvv5IPSyJCclIfR0Y6YTSinUj9CiJDUUhNTiMVrkURYUeHmEnqW0IYQIzvlTdERFJQQv-QL9ugre-a1Obmtxb3Waou2tH3FosfNj1CZq73SHh2jT_hBvncbjjcXD1CU9us6Nu0w29g4Hj3PAp0OkCcPQ2YhT8OF71MPN7h0-T9j1Qwzb-ZYhpOTWnX3_HD1pdZfsi_t5jK7PPn1dfi4uv6zOlx8uC8NqVhcNAypBNxIoayihNTHQgmaSkhZqawTllEEjKgktAaA1a2DdskYyY7i0pjpGb-be_IbbyaZR9S4Z23Xa2zAlVQIIIaiU_D9QQSTPP1ll9PVf6CZM0edFMsWBZzewp97OlIl57WhbNUTX67hTJVF7kSqLVH9EZvbVfeO07m3zQB7MZeB0Bn66zu7-3aQulteHymJOuDTau4eEjj-UgAq4-na1UvJsBZzwC_Wx-g0vVrgI</recordid><startdate>201601</startdate><enddate>201601</enddate><creator>Morgalla, Matthias H.</creator><creator>Magunia, Harry</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>P64</scope><scope>7X8</scope><scope>7QO</scope></search><sort><creationdate>201601</creationdate><title>Noninvasive measurement of intracranial pressure via the pulsatility index on transcranial doppler sonography: Is improvement possible?</title><author>Morgalla, Matthias H. ; Magunia, Harry</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4949-d47287ad8724d20290c7f7a4820f79ec625247d6387f077294d7bf4d84cc58ec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>cerebral blood flow</topic><topic>Coma</topic><topic>Female</topic><topic>Forecasting</topic><topic>Humans</topic><topic>Intracranial Pressure</topic><topic>Male</topic><topic>measurement accuracy</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Pulsatile Flow</topic><topic>pulsatility index</topic><topic>Regression Analysis</topic><topic>transcranial Doppler sonography</topic><topic>Ultrasonic imaging</topic><topic>Ultrasonography, Doppler, Transcranial - economics</topic><topic>Ultrasonography, Doppler, Transcranial - standards</topic><topic>Ultrasonography, Doppler, Transcranial - trends</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Morgalla, Matthias H.</creatorcontrib><creatorcontrib>Magunia, Harry</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><jtitle>Journal of clinical ultrasound</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Morgalla, Matthias H.</au><au>Magunia, Harry</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Noninvasive measurement of intracranial pressure via the pulsatility index on transcranial doppler sonography: Is improvement possible?</atitle><jtitle>Journal of clinical ultrasound</jtitle><addtitle>J. Clin. Ultrasound</addtitle><date>2016-01</date><risdate>2016</risdate><volume>44</volume><issue>1</issue><spage>40</spage><epage>45</epage><pages>40-45</pages><issn>0091-2751</issn><eissn>1097-0096</eissn><coden>JCULDD</coden><abstract>ABSTRACT
Purpose
We hypothesized that using hemodynamic variables could improve the prediction of intracranial pressure (ICP) from the middle cerebral artery pulsatility index (PI) measured with transcranial Doppler sonography.
Methods
In this prospective study, 39 patients with traumatic brain injury were routinely examined with transcranial Doppler sonography, and the middle cerebral artery PI was calculated. A multivariate model including hematocrit, mean arterial blood pressure, heart rate, and arterial CO2 pressure (PaCO2) was evaluated.
Results
Thirty‐nine comatose patients (16 women and 23 men; age range 18–73 years; median 44 years) were included, and 234 data pairs (consisting of ICP and corresponding PI values) were analyzed. ICP ranged from −3 mmHg to +52 mmHg, and PI from 0.6 to 2.85. We found a significant but weak correlation between PI and the square root of ICP (R2 between 0.29 and 0.34, p < 0.0001). A slightly stronger correlation was detected when hemodynamic variables were incorporated (R2 between 0.37 and 0.43). Of these variables, mean arterial blood pressure had the most significant influence.
Conclusions
In this study, PI was not a sufficiently strong predictor of ICP to be used in clinical practice. Its reliability did not improve even when hemodynamic variables were considered. Therefore, we recommend abandoning the use of PI for the noninvasive measurement of ICP in clinical practice. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:40–45, 2016</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>26366515</pmid><doi>10.1002/jcu.22279</doi><tpages>6</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over cerebral blood flow Coma Female Forecasting Humans Intracranial Pressure Male measurement accuracy Middle Aged Prospective Studies Pulsatile Flow pulsatility index Regression Analysis transcranial Doppler sonography Ultrasonic imaging Ultrasonography, Doppler, Transcranial - economics Ultrasonography, Doppler, Transcranial - standards Ultrasonography, Doppler, Transcranial - trends |
| title | Noninvasive measurement of intracranial pressure via the pulsatility index on transcranial doppler sonography: Is improvement possible? |
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