TY - JOUR
T1 - Transcranial Doppler Ultrasound during Critical Illness in Children
T2 - Survey of Practices in Pediatric Neurocritical Care Centers
AU - the Pediatric Neurocritical Care Research Group (PNCRG)
AU - Larovere, Kerri L.
AU - Tasker, Robert C.
AU - Wainwright, Mark
AU - Reuter-Rice, Karin
AU - Appavu, Brian
AU - Miles, Darryl
AU - Lidsky, Karen
AU - Vittner, Patrick
AU - Gundersen, Daniel
AU - O'Brien, Nicole F.
AU - Schober, Michelle
AU - Robertson, Courtney
AU - Kurz, Jonathan
AU - Pineda, Jose
AU - Wainwright, Mark
AU - Bell, Mike
N1 - Funding Information:
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/pccmjournal). Dr. Appavu's institution received funding from American Heart Association and Moberg ICU Solutions. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Publisher Copyright:
Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Objectives: The scope of transcranial Doppler ultrasound in the practice of pediatric neurocritical care is unknown. We have surveyed pediatric neurocritical care centers on their use of transcranial Doppler and analyzed clinical management practices. Design: Electronic-mail recruitment with survey of expert centers using web-based questionnaire. Setting: Survey of 43 hospitals (31 United States, 12 international) belonging to the Pediatric Neurocritical Care Research Group. Patients: None. Interventions: None. Measurements and Main Results: A 67% (29/43) hospital-response rate. Of these centers, 27 reported using transcranial Doppler in the PICU; two hospitals opted out due to lack of transcranial Doppler availability/use. The most common diagnoses for using transcranial Doppler in clinical care were intracranial/subarachnoid hemorrhage (20 hospitals), arterial ischemic stroke (14 hospitals), and traumatic brain injury (10 hospitals). Clinical studies were carried out and interpreted by credentialed individuals in 93% (25/27) and 78% (21/27) of the centers, respectively. A written protocol for performance of transcranial Doppler in the PICU was available in 30% (8/27 hospitals); of these, two of eight hospitals routinely performed correlation studies to validate results. In 74% of the centers (20/27), transcranial Doppler results were used to guide clinical care: that is, when to obtain a neuroimaging study (18 hospitals); how to manipulate cerebral perfusion pressure with fluids/vasopressors (13 hospitals); and whether to perform a surgical intervention (six hospitals). Research studies were also commonly performed for a range of diagnoses. Conclusions: At least 27 pediatric neurocritical care centers use transcranial Doppler during clinical care. In the majority of centers, studies are performed and interpreted by credentialed personnel, and findings are used to guide clinical management. Further studies are needed to standardize these practices.
AB - Objectives: The scope of transcranial Doppler ultrasound in the practice of pediatric neurocritical care is unknown. We have surveyed pediatric neurocritical care centers on their use of transcranial Doppler and analyzed clinical management practices. Design: Electronic-mail recruitment with survey of expert centers using web-based questionnaire. Setting: Survey of 43 hospitals (31 United States, 12 international) belonging to the Pediatric Neurocritical Care Research Group. Patients: None. Interventions: None. Measurements and Main Results: A 67% (29/43) hospital-response rate. Of these centers, 27 reported using transcranial Doppler in the PICU; two hospitals opted out due to lack of transcranial Doppler availability/use. The most common diagnoses for using transcranial Doppler in clinical care were intracranial/subarachnoid hemorrhage (20 hospitals), arterial ischemic stroke (14 hospitals), and traumatic brain injury (10 hospitals). Clinical studies were carried out and interpreted by credentialed individuals in 93% (25/27) and 78% (21/27) of the centers, respectively. A written protocol for performance of transcranial Doppler in the PICU was available in 30% (8/27 hospitals); of these, two of eight hospitals routinely performed correlation studies to validate results. In 74% of the centers (20/27), transcranial Doppler results were used to guide clinical care: that is, when to obtain a neuroimaging study (18 hospitals); how to manipulate cerebral perfusion pressure with fluids/vasopressors (13 hospitals); and whether to perform a surgical intervention (six hospitals). Research studies were also commonly performed for a range of diagnoses. Conclusions: At least 27 pediatric neurocritical care centers use transcranial Doppler during clinical care. In the majority of centers, studies are performed and interpreted by credentialed personnel, and findings are used to guide clinical management. Further studies are needed to standardize these practices.
KW - Doppler ultrasonography
KW - critical care
KW - intensive care units
KW - nervous system diseases
KW - pediatric
KW - pediatrics
KW - transcranial
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U2 - 10.1097/PCC.0000000000002118
DO - 10.1097/PCC.0000000000002118
M3 - Article
C2 - 31568242
AN - SCOPUS:85076695628
SN - 1529-7535
VL - 21
SP - 67
EP - 74
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 1
ER -