Transcranial Doppler Non-invasive Assessment of Intracranial Pressure, Autoregulation of Cerebral Blood Flow and Critical Closing Pressure during Orthotopic Liver Transplant

Danilo Cardim, Chiara Robba, Eric Schmidt, Bernhard Schmidt, Joseph Donnelly, John Klinck, Marek Czosnyka

Research output: Contribution to journalArticle

Abstract

Transcranial Doppler (TCD) ultrasonography allows continuous non-invasive monitoring of cerebral blood flow velocity in a variety of clinical conditions. Recently, signal processing of TCD signals has provided several comprehensive parameters for the assessment of cerebral haemodynamics. In this work, we applied a TCD multimodal approach in patients with acute liver failure undergoing orthotopic liver transplant (OLT) to assess the clinical feasibility of using TCD for cerebral haemodynamics assessment in this setting. We retrospectively studied six patients undergoing OLT with continuous monitoring of arterial blood pressure and blood flow velocity in the middle cerebral artery. The main cerebral haemodynamic parameters assessed were non-invasive intracranial pressure, cerebral perfusion pressure, cerebral autoregulation, pulsatility index, critical closing pressure and diastolic closing margin. TCD monitoring revealed marked alterations of these parameters in the OLT setting, which could provide relevant clinical information when there is imminent risk of neurologic impairment.

Original languageEnglish
Pages (from-to)1435-1445
Number of pages11
JournalUltrasound in Medicine and Biology
Volume45
Issue number6
DOIs
Publication statusPublished - Jun 1 2019

Keywords

  • Cerebral oedema
  • Cerebral perfusion pressure
  • Liver failure
  • Neuromonitoring
  • Transcranial Doppler

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Biophysics
  • Acoustics and Ultrasonics

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