Practice Recommendations for Transcranial Doppler Ultrasonography in Critically Ill Children in the Pediatric Intensive Care Unit: A Multidisciplinary Expert Consensus Statement

Abstract

Transcranial Doppler ultrasonography (TCD) is being used in many pediatric intensive care units (PICUs) to aid in the diagnosis and monitoring of children with known or suspected pathophysiological changes to cerebral hemodynamics. Standardized approaches to scanning protocols, interpretation, and documentation of TCD examinations in this setting are lacking. A panel of multidisciplinary clinicians with expertise in the use of TCD in the PICU undertook a three-round modified Delphi process to reach unanimous agreement on 34 statements and then create practice recommendations for TCD use in the PICU. Use of these recommendations will help to ensure that high quality TCD images are captured, interpreted, and reported using standard nomenclature. Furthermore, use will aid in ensuring reproducible and meaningful study results between TCD practitioners and across PICUs.

Keywords

transcranial doppler ultrasound - pediatric critical care - practice recommendations - protocol - pediatric intensive care unit

Publikationsverlauf

Eingereicht: 18. Mai 2020

Angenommen: 12. Juni 2020

Artikel online veröffentlicht:
04. September 2020

• References

• 1 Aaslid R, Markwalder TM, Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 1982; 57 (06) 769-774
• 2 Bode H, Wais U. Age dependence of flow velocities in basal cerebral arteries. Arch Dis Child 1988; 63 (06) 606-611
• 3 Vavilala MS, Kincaid MS, Muangman SL, Suz P, Rozet I, Lam AM. Gender differences in cerebral blood flow velocity and autoregulation between the anterior and posterior circulations in healthy children. Pediatr Res 2005; 58 (03) 574-578
• 4 O'Brien NF. Reference values for cerebral blood flow velocities in critically ill, sedated children. Childs Nerv Syst 2015; 31 (12) 2269-2276
• 5 Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P. Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir (Wien) 1989; 100 (1-2): 12-24
• 6 Sviri GE, Ghodke B, Britz GW. et al. Transcranial Doppler grading criteria for basilar artery vasospasm. Neurosurgery 2006; 59 (02) 360-366 , discussion 360–366
• 7 Adams R, McKie V, Nichols F. et al. The use of transcranial ultrasonography to predict stroke in sickle cell disease. N Engl J Med 1992; 326 (09) 605-610
• 8 Adams RJ, McKie VC, Hsu L. et al. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med 1998; 339 (01) 5-11
• 9 LaRovere KL, Tasker RC, Wainwright M. et al. Transcranial Doppler ultrasound during critical illness in children: survey of practices in pediatric neurocritical care centers. Pediatr Crit Care Med 2019; 21 (01) 67-74
• 10 LaRovere KL, O'Brien NF. Transcranial Doppler sonography in pediatric neurocritical care: a review of clinical applications and case illustrations in the pediatric intensive care unit. J Ultrasound Med 2015; 34 (12) 2121-2132
• 11 Abecasis F, Oliveira V, Robba C, Czosnyka M. Transcranial Doppler in pediatric emergency and intensive care unit: a case series and literature review. Childs Nerv Syst 2018; 34 (08) 1465-1470
• 12 LaRovere KL, O'Brien NF, Tasker RC. Current opinion and use of transcranial Doppler ultrasonography in traumatic brain injury in the pediatric intensive care unit. J Neurotrauma 2016; 33 (23) 2105-2114
• 13 O'Brien NF, Maa T, Reuter-Rice K. Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury. J Neurosurg Pediatr 2015; 16 (04) 420-425
• 14 Reuter-Rice K. Transcranial Doppler ultrasound use in pediatric traumatic brain injury. J Radiol Nurs 2017; 36 (01) 3-9
• 15 Reuter-Rice K, Regier M, Bennett E, Laskowitz D. The effect of the relationship of APOE polymorphisms and cerebral vasospasm on functional outcomes in children with traumatic brain injury. Biol Res Nurs 2018; 20 (05) 566-576
• 16 Lovett ME, Maa T, Chung MG, O'Brien NF. Cerebral blood flow velocity and autoregulation in paediatric patients following a global hypoxic-ischaemic insult. Resuscitation 2018; 126: 191-196
• 17 Lin JJ, Hsia SH, Wang HS, Chiang MC, Lin KL. Transcranial Doppler ultrasound in therapeutic hypothermia for children after resuscitation. Resuscitation 2015; 89: 182-187
• 18 LaRovere KL. Transcranial Doppler ultrasound in children with stroke and cerebrovascular disorders. Curr Opin Pediatr 2015; 27 (06) 712-718
• 19 Ma L, Roberts JS, Pihoker C. et al. Transcranial Doppler-based assessment of cerebral autoregulation in critically ill children during diabetic ketoacidosis treatment. Pediatr Crit Care Med 2014; 15 (08) 742-749
• 20 Ducharme-Crevier L, Mills MG, Mehta PM, Smith CM, Wainwright MS. Use of transcranial Doppler for management of central nervous system infections in critically ill children. Pediatr Neurol 2016; 65: 52-58.e2
• 21 O'Brien NF, Mutatshi Taty T, Moore-Clingenpeel M. et al. Transcranial Doppler ultrasonography provides insights into neurovascular changes in children with cerebral malaria. J Pediatr 2018; 203: 116-124.e3
• 22 Leliefeld PH, Gooskens RH, Peters RJ. et al. New transcranial Doppler index in infants with hydrocephalus: transsystolic time in clinical practice. Ultrasound Med Biol 2009; 35 (10) 1601-1606
• 23 Cheatham SL, Chisolm JL, O'Brien N. Cerebral blood flow following hybrid stage I palliation in infants with hypoplastic left heart syndrome. Pediatr Cardiol 2018; 39 (04) 837-843
• 24 Lau VI, Arntfield RT. Point-of-care transcranial Doppler by intensivists. Crit Ultrasound J 2017; 9 (01) 21
• 25 O'Brien N, Hall M. Cerebral blood flow in children requiring extracorporeal membrane oxygenation. Pediatr Crit Care Med 2013; 14: 126-134
• 26 Rilinger JF, Smith CM, deRegnier RAO. et al. Transcranial Doppler identification of neurologic injury during pediatric extracorporeal membrane oxygenation therapy. J Stroke Cerebrovasc Dis 2017; 26 (10) 2336-2345
• 27 O'Brien NF, Buttram SDW, Maa T, Lovett ME, Reuter-Rice K, LaRovere KL. Pediatric Neurocritical Care Research Group (PNCRG). Cerebrovascular physiology during pediatric extracorporeal membrane oxygenation: a multicenter study using transcranial doppler ultrasonography. Pediatr Crit Care Med 2019; 20 (02) 178-186
• 28 Itoh S, Suda K, Kishimoto S. et al. Microembolic signals measured by transcranial Doppler during transcatheter closure of atrial septal defect using the Amplatzer septal occluder. Cardiol Young 2011; 21 (02) 182-186
• 29 Wallace S, Døhlen G, Holmstrøm H, Lund C, Russell D. Cerebral microemboli detection and differentiation during transcatheter closure of atrial septal defect in a paediatric population. Cardiol Young 2015; 25 (02) 237-244
• 30 Adelson PD, Clyde B, Kochanek PM, Wisniewski SR, Marion DW, Yonas H. Cerebrovascular response in infants and young children following severe traumatic brain injury: a preliminary report. Pediatr Neurosurg 1997; 26 (04) 200-207
• 31 Adelson PD, Srinivas R, Chang Y, Bell M, Kochanek PM. Cerebrovascular response in children following severe traumatic brain injury. Childs Nerv Syst 2011; 27 (09) 1465-1476
• 32 Vavilala MS, Lee LA, Boddu K. et al. Cerebral autoregulation in pediatric traumatic brain injury. Pediatr Crit Care Med 2004; 5 (03) 257-263
• 33 Vavilala MS, Muangman S, Tontisirin N. et al. Impaired cerebral autoregulation and 6-month outcome in children with severe traumatic brain injury: preliminary findings. Dev Neurosci 2006; 28 (4-5): 348-353
• 34 Vavilala MS, Muangman S, Waitayawinyu P. et al. Neurointensive care; impaired cerebral autoregulation in infants and young children early after inflicted traumatic brain injury: a preliminary report. J Neurotrauma 2007; 24 (01) 87-96
• 35 Figaji AA, Zwane E, Fieggen AG. et al. Pressure autoregulation, intracranial pressure, and brain tissue oxygenation in children with severe traumatic brain injury. J Neurosurg Pediatr 2009; 4 (05) 420-428
• 36 Trabold F, Meyer PG, Blanot S, Carli PA, Orliaguet GA. The prognostic value of transcranial Doppler studies in children with moderate and severe head injury. Intensive Care Med 2004; 30 (01) 108-112
• 37 Chaiwat O, Sharma D, Udomphorn Y, Armstead WM, Vavilala MS. Cerebral hemodynamic predictors of poor 6-month Glasgow outcome score in severe pediatric traumatic brain injury. J Neurotrauma 2009; 26 (05) 657-663
• 38 Meyer PG, Ducrocq S, Rackelbom T, Orliaguet G, Renier D, Carli P. Surgical evacuation of acute subdural hematoma improves cerebral hemodynamics in children: a transcranial Doppler evaluation. Childs Nerv Syst 2005; 21 (02) 133-137
• 39 Figaji AA, Zwane E, Fieggen AG, Siesjo P, Peter JC. Transcranial Doppler pulsatility index is not a reliable indicator of intracranial pressure in children with severe traumatic brain injury. Surg Neurol 2009; 72 (04) 389-394
• 40 Melo JR, Di Rocco F, Blanot S. et al. Transcranial Doppler can predict intracranial hypertension in children with severe traumatic brain injuries. Childs Nerv Syst 2011; 27 (06) 979-984
• 41 Benedik MP, Zaletel M, Meglic NP, Podnar T. A right-to-left shunt in children with arterial ischaemic stroke. Arch Dis Child 2011; 96 (05) 461-467
• 42 Perkovič-Benedik M, Zaletel M, Pečarič-Meglič N, Podnar T. A right-to-left shunt and prothrombotic disorders in pediatric patients presenting with transient ischemic attack. Eur J Pediatr 2013; 172 (02) 239-245
• 43 Goh D, Minns RA. Cerebral blood flow velocity monitoring in pyogenic meningitis. Arch Dis Child 1993; 68 (01) 111-119
• 44 Robba C, Cardim D, Czosnyka M. et al. Ultrasound non-invasive intracranial pressure assessment in paediatric neurocritical care: a pilot study. Childs Nerv Syst 2020; 36 (01) 117-124
• 45 Fanelli A, Vonberg FW, LaRovere KL. et al. Fully automated, real-time, calibration-free, continuous noninvasive estimation of intracranial pressure in children. J Neurosurg Pediatr 2019; 23: 1-11
• 46 O'Brien NF, Maa T, Moore-Clingenpeel M, Rosenberg N, Yeates KO. Relationships between cerebral flow velocities and neurodevelopmental outcomes in children with moderate to severe traumatic brain injury. Childs Nerv Syst 2018; 34 (04) 663-672
• 47 Philip S, Chaiwat O, Udomphorn Y. et al. Variation in cerebral blood flow velocity with cerebral perfusion pressure >40 mm Hg in 42 children with severe traumatic brain injury. Crit Care Med 2009; 37 (11) 2973-2978
• 48 Lowe LH, Morello FP, Jackson MA, Lasky A. Application of transcranial Doppler sonography in children with acute neurologic events due to primary cerebral and West Nile vasculitis. AJNR Am J Neuroradiol 2005; 26 (07) 1698-1701
• 49 Polito A, Ricci Z, Di Chiara L. et al. Cerebral blood flow during cardiopulmonary bypass in pediatric cardiac surgery: the role of transcranial Doppler—a systematic review of the literature. Cardiovasc Ultrasound 2006; 4: 47
• 50 Kussman BD, Gauvreau K, DiNardo JA. et al. Cerebral perfusion and oxygenation after the Norwood procedure: comparison of right ventricle-pulmonary artery conduit with modified Blalock-Taussig shunt. J Thorac Cardiovasc Surg 2007; 133 (03) 648-655
• 51 Hillier SC, Burrows FA, Bissonnette B, Taylor RH. Cerebral hemodynamics in neonates and infants undergoing cardiopulmonary bypass and profound hypothermic circulatory arrest: assessment by transcranial Doppler sonography. Anesth Analg 1991; 72 (06) 723-728
• 52 Cheng HH, Wypij D, Laussen PC. et al. Cerebral blood flow velocity and neurodevelopmental outcome in infants undergoing surgery for congenital heart disease. Ann Thorac Surg 2014; 98 (01) 125-132
• 53 Misrahi S, Reuter-Rice K. Transcranial Doppler ultrasound use in pediatric patients with penetrating traumatic brain injuries. J Radiol Nurs 2020; 39 (01) 39-43
• 54 Lovett ME, Maa T, Moore-Clingenpeel M, O'Brien NF. Transcranial Doppler ultrasound findings in children with moderate-to-severe traumatic brain injury following abusive head trauma. Childs Nerv Syst 2020; 36 (05) 993-1000
• 55 Guyatt G, Oxman AD, Akl EA. et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64 (04) 383-394
• 56 ACR–AIUM–SPR–SRU Practice parameter for the performance of transcranial Doppler ultrasound. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/US-Transcranial.pdf?la=en
• 57 The Intersocietal Accreditation Commission, Guidelines for vascular testing. Available at: https://www.intersocietal.org/vascular/standards/html/2018/fs.htm
• 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 (03) 240-252
• 59 Ducrocq X, Hassler W, Moritake K. et al. Consensus opinion on diagnosis of cerebral circulatory arrest using Doppler-sonography: task force group on cerebral death of the Neurosonology Research Group of the World Federation of Neurology. J Neurol Sci 1998; 159 (02) 145-150
• 60 Nedelmann M, Stolz E, Gerriets T. et al; TCCS Consensus Group. Consensus recommendations for transcranial color-coded duplex sonography for the assessment of intracranial arteries in clinical trials on acute stroke. Stroke 2009; 40 (10) 3238-3244
• 61 Calleja S, Tembl JI, Segura T. Sociedad Española de Neurosonología. Recommendations of the use of transcranial Doppler to determine the existence of cerebral circulatory arrest as diagnostic support of brain death [in Spanish]. Neurologia 2007; 22 (07) 441-447
• 62 Sloan MA, Alexandrov AV, Tegeler CH. et al; Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2004; 62 (09) 1468-1481
• 63 Blanco P, Abdo-Cuza A. Transcranial Doppler ultrasound in neurocritical care. J Ultrasound 2018; 21 (01) 1-16
• 64 Kalanuria A, Nyquist PA, Armonda RA, Razumovsky A. Use of transcranial Doppler (TCD) ultrasound in the neurocritical care unit. Neurosurg Clin N Am 2013; 24 (03) 441-456
• 65 Rasulo FA, De Peri E, Lavinio A. Transcranial Doppler ultrasonography in intensive care. Eur J Anaesthesiol Suppl 2008; 42: 167-173
• 66 Saqqur M, Zygun D, Demchuk A. Role of transcranial Doppler in neurocritical care. Crit Care Med 2007; 35 (Suppl. 05) S216-S223
• 67 Bulas DI. Transcranial Doppler applications in neonates and children. Ultrasound Clin 2009; 4: 533-551
• 68 Verlhac S. Transcranial Doppler in children. Pediatr Radiol 2011; 41 (Suppl. 01) S153-S165
• 69 Bulas DI, Jones A, Seibert JJ, Driscoll C, O'Donnell R, Adams RJ. Transcranial Doppler (TCD) screening for stroke prevention in sickle cell anemia: pitfalls in technique variation. Pediatr Radiol 2000; 30 (11) 733-738
• 70 Lowe LH, Bulas DI. Transcranial Doppler imaging in children: sickle cell screening and beyond. Pediatr Radiol 2005; 35 (01) 54-65
• 71 Bulas D. Screening children for sickle cell vasculopathy: guidelines for transcranial Doppler evaluation. Pediatr Radiol 2005; 35 (03) 235-241
• 72 Tsivgoulis G, Alexandrov AV, Sloan MA. Advances in transcranial Doppler ultrasonography. Curr Neurol Neurosci Rep 2009; 9 (01) 46-54
• 73 Alexandrov AV, Sloan MA, Tegeler CH. et al; American Society of Neuroimaging Practice Guidelines Committee. Practice standards for transcranial Doppler (TCD) ultrasound. Part II. Clinical indications and expected outcomes. J Neuroimaging 2012; 22 (03) 215-224
• 74 Holey EA, Feeley JL, Dixon J, Whittaker VJ. An exploration of the use of simple statistics to measure consensus and stability in Delphi studies. BMC Med Res Methodol 2007; 7: 52
• 75 Kalaian SA, Kasim RM. Terminating sequential Delphi survey data collection. Pract Assess, Res Eval 2012; 17: 1-10
• 76 Bennett C, Vakil N, Bergman J. et al. Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology 2012; 143 (02) 336-346
• 77 Meshkat B, Cowman S, Gethin G. et al. Using an e-Delphi technique in achieving consensus across disciplines for developing best practice in day surgery in Ireland. J Hosp Adm 2014; 3: 1-8
• 78 Murphy MK, Black NA, Lamping DL. et al. Consensus development methods, and their use in clinical guideline development. Health Technol Assess 1998; 2 (03) i-iv , 1–88
• 79 Powell C. The Delphi technique: myths and realities. J Adv Nurs 2003; 41 (04) 376-382
• 80 Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101 (08) 1900-1920 , quiz 1943
• 81 Wood L, Bjarnason GA, Black PC. et al. Using the Delphi technique to improve clinical outcomes through the development of quality indicators in renal cell carcinoma. J Oncol Pract 2013; 9 (05) e262-e267
• 82 Graefe A, Armstrong JS. Comparing face-to-face meetings, nominal groups, Delphi and prediction markets on an estimation task. Int J Forecast 2016; 27: 183-195