9/17/2023 0 Comments Transcranial doppler equipmentIn case of impaired CA, we use TCD to target blood pressure to a level corresponding to the patient’s individual optimal autoregulatory status. We assess cerebral autoregulation (CA) at the bedside as altered CA is related with a poor outcome in many diseases and may increase the risk of cerebral damage. Finally, we perform repeated TCD assessment rather than a single examination (i.e., every 1–2 h) to better understand the changes in the brain hemodynamics following an increase in ICP or after specific ICP-directed therapies. Moreover, we also estimate ICP using formulas combining FV and blood pressure, but only as “confirmatory” findings before additional validation of their accuracy will be available. As such, after having considered these conditions, we use the combination of elevated PI and low diastolic FV (< 20 cm/s) to suggest elevated ICP at the bedside. We do not rely on only PI (i.e., PI > 1.4), because other conditions (Additional file 1: Table S1) could affect this parameter. However, when indications are unclear or invasive methods are not available (i.e., low-income countries) or contraindicated (i.e., severe coagulopathy), we use TCD as a “triage” tool to non-invasively discriminate patients who are at risk of developing intracranial hypertension. When the indications for invasive intracranial pressure (ICP) monitoring are met, we recommend intraparenchymal or intraventricular probes, as TCD cannot substitute invasive ICP measurement.
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