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Anaesthesiology Intensive Therapy
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Review article

Transcranial sonography: practical use in the intensive care unit

Aleksandra Baska
1
,
Krystian Sporysz-Janiec
1
,
Monika Figura
2
,
Paweł Andruszkiewicz
1
,
Mateusz Zawadka
1

  1. 2nd Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
  2. Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
Anaesthesiol Intensive Ther 2024; 56, 5: 267–276
Online publish date: 2025/01/17
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1. Robba C, Wong A, Poole D, Al Tayar A, Arntfield RT, Chew MS, et al. Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: consensus and expert recommendations of the European Society of Intensive Care Medicine. Intensive Care Med 2021; 47: 1347-1367. DOI: 10.1007/s00134-021-06486-z.
2. Rasulo FA, De Peri, E, Lavinio A. Transcranial Doppler ultrasono­graphy in intensive care. Eur J Anaesthesiol Suppl 2008; 42: 167-173. DOI: 10.1017/S0265021507003341.
3. Lau VI, Arntfield RB. Point-of-care transcranial Doppler by intensi­vists. Crit Ultrasound J 2017; 9: 21. DOI: 10.1186/s13089-017-0077-9.
4. Robba C, Cardim D, Sekhon M, Budohoski K, Czosnyka M. Trans­cranial Doppler: a stethoscope for the brain‐neurocritical care use. J Neurosci Res 2018; 96: 720-730. DOI: 10.1002/jnr.24148.
5. Robba C, Taccone FS. How I use transcranial Doppler. Crit Care 2019; 23: 420. DOI: 10.1186/s13054-019-2700-6.
6. Robba C, Goffi A, Geeraerts T, Cardim D, Via G, Czosnyka M, et al. Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review. Intensive Care Med 2019; 45: 913-927. DOI: 10.1007/s00134-019-05610-4.
7. Rasulo FA, Bertuetti R. Transcranial Doppler and optic nerve sonography. J Cardiothorac Vasc Anesth 2019; 33 Suppl 1: S38-S52. DOI: 10.1053/j.jvca.2019.03.040.
8. Robba C, Rigamonti A. Transcranial Doppler and transcranial color-coded duplex sonography. In: Challenging Topics in Neuroanesthesia and Neurocritical Care. Khan ZH (ed.). Springer; 2017, pp. 275-289. DOI: https://doi.org/10.1007/978-3-319-41445-4_24.
9. Robba C, Poole D, Citerio G, Taccone FS, Rasulo FA; Consensus on brain ultrasonography in critical care group. Brain ultrasonography consensus on skill recommendations and competence levels within the critical care setting. Neurocrit Care 2020; 32: 502-511. DOI: 10.1007/s12028-019-00766-9.
10. Calviello L, Cardim D, Czosnyka M, Preller J, Smielewski P, Siyal A, Damian MS. Feasibility of non-invasive neuromonitoring in general intensive care patients using a multi-parameter transcranial Doppler approach. J Clin Monit Comput 2022; 36: 1805-1815. DOI: 10.1007/s10877-022-00829-x.
11. Bertuetti R, Gritti P, Pelosi P, Robba C. How to use cerebral ultrasound in the ICU. Minerva Anestesiol 2020; 86: 327-340. DOI: 10.23736/ S0375-9393.19.13852-7.
12. Purkayastha S, Sorond F. Transcranial Doppler ultrasound: technique and application. Semin Neurol 2012; 32: 411-420. DOI: 10.1055/s-0032- 1331812.
13. Kirsch J, Mathur M, Johnson MH, Gowthaman G, Scoutt LM. Advances in transcranial Doppler US: imaging ahead. Radiographics 2013; 33: E1-E14. DOI: 10.1148/rg.331125071.
14. Rodriguez CN, Splittgerber R. Transcranial Doppler (TCD) and trancranial color-coded duplex sonography (TCCS): applied neuroanatomy. Neurosonology in Critical Care 2021; 117-146. DOI: https://doi.org/10.1007/978-3-030-81419-9_7.
15. Montrief T, Alerhand S, Jewell C, Scott J. Incorporation of trans­cranial Doppler into the ED for the neurocritical care patient. Am J Emerg Med 2019; 37: 1144-1152. DOI: 10.1016/j.ajem.2019.03.003.
16. Chen LM, Wang LJ, Hu Y, Jiang XH, Wang YZ, Xing YQ. Ultrasonic measurement of optic nerve sheath diameter: a non-invasive surrogate approach for dynamic, real-time evaluation of intracranial pressure. Br J Ophthalmol 2019; 103: 437-441. DOI: 10.1136/ bjophthalmol-2018-312934.
17. Toms DA. The mechanical index, ultrasound practices, and the ALARA principle. J Ultrasound Med 2006; 25: 560-561. DOI: 10.7863/ jum.2006.25.4.560.
18. Connolly F, Schreiber SJ, Leithner C, Bohner G, Vajkoczy P, Valdu-eza JM. Assessment of intracranial venous blood flow after subarachnoid hemorrhage: a new approach to diagnose vasospasm with transcranial color-coded duplex sonography. J Neurosurg 2018; 129: 1136-1142. DOI: 10.3171/2017.5.JNS17232.
19. Naqvi J, Yap KH, Ahmad G, Ghosh J. Transcranial Doppler ultrasound: a review of the physical principles and major applications in critical care. Int J Vasc Med 2013; 2013: 629378. DOI: 10.1155/ 2013/629378.
20. Rajajee V, Soroushmehr R, Williamson C, Najarian K, Ward K, Tiba H. Transcranial color-coded sonography with angle correction as a screening tool for raised intracranial pressure. Crit Care Explor 2023, 5: e0953. DOI: 10.1097/CCE.0000000000000953.
21. Samagh N, Bhagat H, Jangra K. Monitoring cerebral vasospasm: how much can we rely on transcranial Doppler. J Anaesthesiol Clin Pharmacol 2019; 35: 12-18. DOI: 10.4103/joacp.JOACP_192_17.
22. Stolz E. Intracranial pressure and veins. Vasa 2022; 51: 329-332. DOI: 10.1024/0301-1526/a001028.
23. Lau VI, Jaidka A, Wiskar K, Packer N, Tang JE, Koenig S, et al. Better with ultrasound: transcranial Doppler. Chest 2020; 157: 142-150. DOI: 10.1016/j.chest.2019.08.2204.
24. Chambers D, Huang C, Matthews G. Podstawy fizjologii dla aneste­zjologów, wydanie polskie. Warszawa: MediPage; 2017, pp. 214-215.
25. Kincaid MS, Souter MJ, Treggiati MM, Yanez ND, Moore A, Lam AM. Accuracy of transcranial Doppler ultrasonography and single-photon emission computed tomography in the diagnosis of angiographically demonstrated cerebral vasospasm. J Neurosurg 2009; 110: 67-72. DOI: 10.3171/2008.4.17520.
26. Macdonald RL. Origins of the concept of vasospasm. Stroke 2016; 47: e11-e15. DOI: 10.1161/STROKEAHA.114.006498.
27. Simm RF, de Aguair PHP, de Oliveira Lima M, Paiva BL. Transcranial Doppler as a routine in the treatment of vasospasm following subarachanoid hemorrhage (SAH). Acta Neurochir Suppl 2013; 115: 75-76. DOI: 10.1007/978-3-7091-1192-5_16.
28. Robba C, Frigieri G, Brasil S, Taccone FS. Early prognostic value of non-invasive intracranial pressure methods in brain-injured patients. Intensive Care Med 2022; 48: 1812-1814. DOI: 10.1007/s00134- 022-06899-4.
29. Tsaousi G, Tramontana A, Yamani F, Bilotta F. Cerebral perfusion and brain oxygen saturation monitoring with: jugular venous oxygen saturation, cerebral oximetry, and transcranial Doppler ultrasono­graphy. Anesthesiol Clin 2021; 39: 507-523. DOI: 10.1016/j.anclin. 2021.03.009.
30. D’Andrea A, Fabiani D, Cante L, Caputo A, Sabatella F, Riegler L, et al. Transcranial Doppler ultrasound: clinical applications from neurological to cardiological setting. J Clin Ultrasound 2022; 50: 1212-1223. DOI: 10.1002/jcu.23344.
31. Rajagopalan S, Sarwal A. Neuromonitoring in critically ill patients. Critical Care Med 2023; 51: 525-542. DOI: 10.1097/CCM. 0000000000005809.
32. Lindegaard KF. The role of transcranial Doppler in the management of patients with subarachnoid haemorrhage – a review. Acta Neurochir Suppl 1999; 72: 59-71. DOI: 10.1007/978-3-7091-6377-1_5.
33. Lin MP. Clinical application of transcranial Doppler in cerebrovascular diseases. In: Advances in Cerebral Aneurysm Treatment. IntechOpen; 2023.
34. Chan KH, Dearden NM, Miller JD, Midgley S, Piper IR. Transcranial Doppler waveform differences in hyperemic and nonhyperemic patients after severe head injury. Surg Neurol 1992; 38: 433-436. DOI: 10.1016/0090-3019(92)90111-y.
35. Soustiel S, Shik V, Shreiber R, Tavor Y, Goldsher D. Basilar vasospasm diagnosis: investigation of a modified “Lindegaard Index” based on imaging studies and blood velocity measurements of the basilar artery. Stroke 2002; 33: 72-77. DOI: 10.1161/hs0102.100484.
36. Llompart-Pou J, Galarza L, Amaya-Villar R, Godoy DA. Transcranial sonography in the critical patient. Med Intensiva 2024; 48: 165-173. DOI: 10.1016/j.medine.2023.07.003.
37. Czosnyka M, Matta BF, Smielewski P, Kirkpatrick PJ, Pickard JD. Cerebral perfusion pressure in head-injured patients: a noninvasive assessment using transcranial Doppler ultrasonography. J Neurosurg 1998; 88: 802-808. DOI: 10.3171/jns.1998.88.5.0802.
38. Xu W. Gerety P, Aleman T, Swanson J, Taylor J. Noninvasive methods of detecting increased intracranial pressure. Childs Nerv Syst 2016; 32: 1371-1386. DOI: 10.1007/s00381-016-3143-x.
39. Bellner J, Romner B, Reinstrup P, Kristiansson KA, Ryding E, Brandt L. Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP). Surg Neurol 2004; 62: 45-51. DOI: 10.1016/ j.surneu.2003.12.007.
40. Lochner P, Czosnyka M, Naldi A, Lyros E, Pelosi P, Mathur S, et al. Optic nerve sheath diameter: present and future perspectives for neuro­logists and critical care physicians. Neurol Sci 2019; 40: 2447-2457. DOI: 10.1007/s10072-019-04015-x.
41. Geeraerts T, Merceron S, Benhamou D, Vigué B, Duranteau J. Noninvasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Crit Care 2008; 34: 2062-2067. DOI: 10.1007/s00134-008-1149-x.
42. Geeraerts T, Launey Y, Martin L, Pottecher J, Vigué B, Duranteau J, Benhamou D. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med 2007; 33: 1704-1711. DOI: 10.1007/s00134-007-0797-6.
43. Bäuerle J, Lochner P, Kaps M, Nedelmann M. Intra‐and interobsever reliability of sonographic assessment of the optic nerve sheath diameter in healthy adults. J Neuroimaging 2012; 22: 42-45. DOI: 10.1111/j.1552-6569.2010.00546.x
44. Sobczyk D, Andruszkiewicz P, Andres J. Ultrasonografia w stanach zagrożenia życia i intensywnej terapii. Wydanie I. Kraków: Polska Rada Resuscytacji; 2012, pp. 269-271.
45. Hirzallah MI, Lochner P, Hafeez MU, Lee AG, Krogias C, Dongar- war D, et al. Optic nerve sheath diameter point-of-care ultrasonography quality criteria checklist: an international consensus statement on optic nerve sheath diameter imaging and measurement. Crit Care Med 2024; 52: 1543-1556. DOI: 10.1097/CCM.0000000000006345.
46. Copetti R, Cattarossi L. Optic nerve ultrasound: artifacts and real images. Intensive Care Med 2009; 35: 1488-1489. DOI: 10.1007/s00134- 009-1494-4.
47. Robba C, Santori G, Czosnyka M, Corradi F, Bragazzi N, Padayachy L, et al. Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis. Intensive Care Med 2018; 44: 1284-1294. DOI: 10.1007/s00134-018-5305-7.
48. Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 2008; 15: 201-204. DOI: 10.1111/j.1553-2712. 2007.00031.x.
49. Escudero D, Valentin MO, Escalante JL, Sanmartín A, Perez- Basterrechea M, de Gea J, et al. Intensive care practices in brain death diagnosis and organ donation. Anaesthesia 2015; 70: 1130-1139. DOI: 10.1111/anae.13065.
50. Munakomi S, Das JM. Intracranial pressure monitoring. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
51. Bonow RH, Young CC, Bass DI, Moore A, Levitt MR. Transcranial Doppler ultrasonography in neurological surgery and neurocritical care. Neurosurg Focus 2019; 47: E2. DOI: 10.3171/2019.9. FOCUS19611.
52. Caldas J, Rynkowski CB, Robba C. POCUS, how can we include the brain? An overview. J Anesth Analg Crit Care 2022; 2: 55. DOI: 10.1186/s44158-022-00082-3.
53. Wojczal J. Ultrasonograficzne kryteria rozpoznania zatrzymania krążenia mózgowego. Pol Przegl Neurol 2008; 4 Suppl A: 53-54.
54. Wiles MD. Ancillary tests to support the diagnosis of death using neurological criteria: certainty in uncertain times? Anaesthesia 2023; 78: 816-819. DOI: 10.1111/anae.15986.
55. Lewis A, Liebman J, Kreiger-Benson E, Kumpfbeck A, Bakkar A, Shemie SD, et al. Ancillary testing for determination of death by neurologic criteria around the world. Neurocrit Care 2021; 34: 473-484. DOI: 10.1007/s12028-020-01039-6.
56. Kasapoğlu US, Haliloğlu M, Bilgili B, Cinel I. The role of transcranial doppler ultrasonography in the diagnosis of brain death. Turk J Anaesthesiol Reanim 2019; 47: 367-374. DOI: 10.5152/TJAR. 2019.82258.
57. Lambeck J, Strecker C, Niesen WD, Bardutzky J. Exclusive color-coded duplex sonography of extracranial vessels reliably confirms brain death: a prospective study. Front Neurol 2022; 13: 992511. DOI: 10.3389/fneur.2022.992511.
58. Consensus Group on Transcranial Doppler in Diagnosis of Brain Death. Latin American Consensus on the use of transcranial Doppler in the diagnosis of brain death. Rev Bras Ter Intensiva 2014; 26: 240-252. DOI: 10.5935/0103-507x.20140035.
59. Pedicelli A, Bartocci M, Lozupone E, D’Argento F, Alexandre A, Garignano G, et al. The role of cervical color Doppler ultrasound in the diagnosis of brain death. Neuroradiology 2019; 61: 137-145. DOI: 10.1007/s00234-018-2111-4.
60. https://www.poltransplant.pl/Download/BD/Rozpoznanie_smierci_mozgu_uwagi_praktyczne.pdf (Accessed: 29.10.2023).
61. Motuel J, Biette I, Srairi M, Mrozek S, Kurrek MM, Chaynes P, et al. Assessment of brain midline shift using sonography in neurosurgical ICU patients. Crit Care 2014; 18: 676. DOI: 10.1186/s13054-014-0676-9.
62. Sigman EJ, Laghari FJ, Sarwal A. Neuro point-of-care ultrasound. Semin Ultrasound CT MRI 2024; 45: 29-45. DOI: 10.1053/j.sult. 2023.12.005.
63. Robba C, Citerio G. Echography and Doppler of the brain. Springer; 2021.
64. Caricato A, Mignani V, Bocci M, Pennisi MA, Sandroni C, Tersali A, et al. Usefulness of transcranial echography in patients with decompressive craniectomy: a comparison with computed tomography scan. Crit Care Med 2012; 40: 1745-1752. DOI: 10.1097/CCM. 0b013e318246b6ea.
65. Santamarina Pérez E, Delgado-Mederos R, Rubiera M, Delgado P, Ribó M, Maisterra O, et al. Transcranial duplex sonography for monitoring hyperacute intracerebral hemorrhage. Stroke 2009; 40: 987-990. DOI: 10.1161/STROKEAHA.108.524249.
66. Seidel G, Kaps M, Gerriets T, Hutzelmann A. Evaluation of the ventricular system in adults by transcranial duplex sonography. J Neuroimaging 1995; 5: 105-108. DOI: 10.1111/jon199552105.
67. Widehem R, Bory P, Greco F, Pavillard F, Chalard K, Mas A, et al. Transcranial sonographic assessment of the third ventricle in neuro-ICU patients to detect hydrocephalus: a diagnostic reliability pilot study. Ann Intensive Care 2021; 11: 69. DOI: 10.1186/s13613-021-00857-x.
68. Kiphuth IC, Huttner HB, Struffert T, Schwab S, Köhrmann M. Sonographic monitoring of ventricle enlargement in posthemorrhagic hydrocephalus. Neurology 2011; 76: 858-862. DOI: 10.1212/WNL. 0b013e31820f2e0f.
69. Robba C, Wong A, Poole D. Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: consensus and expert recommendations of the European Society of Intensive Care Medicine. Intensive Care Med 2021; 47: 1347-1367. DOI: 10.1007/s00134-021-06486-z.
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