The usefulness of early Transcranial Doppler (TCD)-directed therapy was examined in a study of adults with severe TBI. TCD measurements were available within 18 ± 11 minutes after admission and were considered abnormal when two out of three measures were outside the following range: Vmean < 30 cm/s, Vd 1.4. Patients with abnormal TCD received treatment to increase cerebral perfusion pressure and/or decrease cerebral edema. Cerebral invasive monitoring was available at ~4 hours after admission and showed similar cerebral perfusion pressure and jugular venous oxygen saturation between the two groups despite increased intracranial pressure in patients with abnormal TCD.
These findings show that early TCD monitoring can help prevent cerebral hypoperfusion, which may help reduce the extent of secondary ischemic injuries in TBI patients with elevated ICP. TCD measures predictive of clinical outcome that can be used as therapeutic targets in clinical trials of TBI will have a significant impact on how we manage TBI in the future.
Purkayastha S, Sorond F. Transcranial Doppler ultrasound: technique and application. Semin Neurol. 2012;32(4):411–420. doi:10.1055/s-0032-1331812