A comparison of transcranial Doppler with near infrared spectroscopy and indocyanine green during hemorrhagic shock: a prospective experimental studyReport as inadecuate

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Critical Care

, 10:R18

First Online: 23 January 2006Received: 02 September 2005Revised: 14 November 2005Accepted: 03 January 2006


IntroductionThe present study was designed to compare cerebral hemodynamics assessed using the blood flow index BFI derived from the kinetics of the tracer dye indocyanine green ICG with transcranial Doppler ultrasound TCD in an established model of hemorrhagic shock.

MethodsAfter approval from the Animal Investigational Committee, 20 healthy pigs underwent a simulated penetrating liver trauma. Following hemodynamic decompensation, all animals received a hypertonic-isooncotic hydroxyethyl starch solution and either arginine vasopressin or norepinephrine, and bleeding was subsequently controlled. ICG passage through the brain was monitored by near infrared spectroscopy. BFI was calculated by dividing maximal ICG absorption change by rise time. Mean blood flow velocity FVmean of the right middle cerebral artery was recorded by TCD. FVmean and BFI were assessed at baseline BL, at hemodynamic decompensation, and repeatedly after control of bleeding.

ResultsAt hemodynamic decompensation, cerebral perfusion pressure CPP, FVmean and BFI dropped compared to BL mean ± standard deviation; CPP 16 ± 5 mmHg versus 70 ± 16 mmHg; FVmean 4 ± 5 cm·s versus 28 ± 9 cm·s; BFI 0.008 ± 0.004 versus 0.02 ± 0.006; p < 0.001. After pharmacological intervention and control of bleeding, FVmean and BFI increased close to baseline values FVmean 23 ± 9 cm·s; BFI 0.02 ± 0.01, respectively. FVmean and BFI were significantly correlated r = 0.62, p < 0.0001.

ConclusionFVmean and BFI both reflected the large variations in cerebral perfusion during hemorrhage and after resuscitation and were significantly correlated. BFI is a promising tool to monitor cerebral hemodynamics at the bedside.

AbbreviationsBFIblood flow index

CBFcerebral blood flow

COcardiac output

CPPcerebral perfusion pressure

CVcoefficient of variation

FiOfraction of inspired oxygen

FVmeanmean blood flow velocity

ICGindocyanine green

ICPintracranial pressure

ICUintensive care unit

MAPmean arterial pressure

NIRSnear infrared spectroscopy

PACpulmonary artery catheter

TCDtranscranial Doppler ultrasound.

Electronic supplementary materialThe online version of this article doi:10.1186-cc3980 contains supplementary material, which is available to authorized users.

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Author: Berthold Bein - Patrick Meybohm - Erol Cavus - Peter H Tonner - Markus Steinfath - Jens Scholz - Volker Doerges

Source: https://link.springer.com/

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