Use of a Doppler‐Based Pulsatility Index to Evaluate Cerebral Hemodynamics in Neurocritical Patients After Hemicraniectomy

• Published in: Journal of ultrasound in medicine 2019-09, Vol.38 (9), p.2469-2475
• Main Authors: Gao, Yu‐zhi, Li, Qiang, Wu, Chun‐shuang, Liu, Shao‐yun, Zhang, Mao
• Format: Article
• Language: English
• Subjects: Blood Flow Velocity; Brain Diseases - diagnostic imaging; Brain Diseases - physiopathology; Brain Diseases - surgery; cerebral perfusion pressure; Cerebrovascular Circulation - physiology; craniectomy; Craniotomy; Critical Illness; Female; Humans; intracranial pressure; Male; Middle Aged; Original Research; Postoperative Care - methods; pulsatility index; Retrospective Studies; Ultrasonography, Doppler, Transcranial - methods
• ISSN: 0278-4297; 1550-9613
• DOI: 10.1002/jum.14945

Objectives As a noninvasive method for evaluation of cerebral hemodynamics, the correct interpretation of transcranial Doppler or transcranial imaging (TCI) data remains a major challenge. We explored how to interpret the pulsatility index (PI) derived via TCI during evaluations of cerebral hemodynamics in posthemicraniectomy patients. Methods We included patients who underwent invasive arterial pressure and intracranial pressure (ICP) monitoring and simultaneous TCI examinations after hemicraniectomy. We classified the PI of the middle cerebral artery (MCA) into ipsilateral (craniectomy side) and contralateral (opposite side) and analyzed both data sets. The statistical analysis was performed by the Bland‐Altman approach, by calculating intraclass correlation coefficients and Spearman correlations, and by drawing receiver operating characteristic curves. Pulsatility index probability charts were created for ICPs exceeding 20, 25, and 30 mm Hg and cerebral perfusion pressures (CPPs) lower than 70, 60, and 50 mm Hg; we thus explored defined ICP and CPP values. Results The ipsilateral and contralateral MCA PI data differed. Only the ipsilateral MCA PI showed a weak correlation with ICP (r = 0.378; P