Transcranial Doppler ultrasonography for the management of severe traumatic brain injury after decompression craniectomy.

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Transcranial Doppler ultrasonography for the management of severe traumatic brain injury after decompression craniectomy.

World Neurosurg. 2019 Feb 18;:

Authors: Chang T, Li L, Yang Y, Li M, Qu Y, Gao L

Abstract
BACKGROUND: Cerebral hemodynamic transformation is a relatively common finding in traumatic brain injury (TBI) patients. Knowledge of cerebral hemodynamic disturbance might be good for predicting the management outcome. Transcranial Doppler ultrasonography (TCD) monitoring of TBI patients can be used to reveal various pathological hemodynamic changes.
OBJECTIVE: To compare the clinical outcomes of postoperative routine intracranial pressure (ICP) monitoring vs. ICP monitoring combined with TCD monitoring in patients with brain trauma after decompression craniectomy.
METHODS: This was a retrospective study of 30 TBI patients who underwent ICP combined with TCD monitoring (after 2015), compared with a historical control group of 30 patients who only underwent routine ICP monitoring (in 2013-2014). ICP, PaCO2, hemoglobin, and hematocrit values were monitored and recorded on a daily basis for 7 days after operation. Neuro-imaging was also performed at admission. The neurological outcome was assessed at 2 weeks and 6 months after operation using the Glasgow Outcome Score Extended (GOS-E). Unconditional multivariable logistic regression was conducted to analyze the factors for favorable clinical outcome.
RESULTS: Two weeks after operation, there were no differences in mortality rate between the two groups (P=0.643). When considering the GOS-E at 6 months, there were no differences in clinical prognosis between the two groups (P=0.101), but the ICP combined with TCD monitoring showed a higher frequency of patients with favorable outcome compared with the routine ICP monitoring (P=0.043). Unconditional multivariable logistic regression results showed that no factor was independently associated with GOS-E at 6 months.
CONCLUSIONS: TCD could be helpful for the serial monitoring of cerebral hemodynamic changes after decompressive craniectomy for TBI, which could be beneficial for neurological outcome improvement.

PMID: 30790743 [PubMed - as supplied by publisher]

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