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Neurosonology in Critical Care
Monitoring theNeurological Impact oftheCritical Pathology
CamiloN.Rodríguez ClaudioBaracchini Jorge H. Mejía Mantilla MarekCzosnyka José I. Suárez LászlóCsiba CorinaPuppo EvaBartels
Editors
123
Neurosonology in Critical Care
Camilo N. Rodríguez • Claudio Baracchini Jorge H. Mejía Mantilla • Marek Czosnyka José I. Suárez • László Csiba • Corina Puppo Eva Bartels
Editors
Neurosonology in Critical Care
Monitoring theNeurological Impact oftheCritical Pathology
Editors
Camilo N. Rodríguez Intensive Care Medicine Hospital Nacional Prof. Dr. A. Posadas University of Buenos Aires (UBA) Buenos Aires Argentina
Jorge H. Mejía Mantilla Head Neurointensive Care Unit Department of Critical Care and Anesthesiology Hospital Universitario Fundación Valle del Lili Cali Colombia
José I. Suárez Departments of Anesthesiology and Critical Care Medicine, Neurology and Neurosurgery The Johns Hopkins University School of Medicine Baltimore, MD USA
Corina Puppo Intensive Care Unit Clinics Hospital, Universidad de la Republica School of Medicine Montevideo Uruguay
Claudio Baracchini Stroke Unit & Neurosonology Lab University of Padua School of Medicine Padova Italy
Marek Czosnyka Department of Clinical Neurosciences Cambridge Biomedical Campus University of Cambridge Cambridge UK
László Csiba Hungarian Neurological Society Department of Neurology Clinical Center Debrecen University Debrecen Hungary
Eva Bartels Center for Neurological Vascular Diagnostics Munich Germany
ISBN 978-3-030-81418-2 ISBN 978-3-030-81419-9 (eBook)
https://doi.org/10.1007/978-3-030-81419-9
© Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Re: ESNCH endorsement of the NESSC Course
Dear Pro
fessorRodriguez,
It is ou Society of Neurosonolo “NEUROSONOLOGY IN Crical Pathology”
Please i printed and el
With bes
Claudio Baracchini, MD, PhD, FESO President of the ESNCH
Zagreb, 19. 12. 2018.
rpleasure to inform you, asthe President and the Secretary Generalof the European
gy and Cerebral Hemodynamics(ESNCH), that the course
CRITICAL CARE(NESCC): Monitoring the Neurological Impact of the
meets the requirements for ESNCH endorsement.
nclude the ESNCH logo and link to the ESNCH website (hp://www.esnch.org) on
ectronic materials related to the Course.
t wishes
Branko Malojcic, MD, PhD, FESO
ESNCH Secretary
v

Foreword

Transcranial Doppler, including TCD ow imaging modalities, allows us to access detailed information on the hemodynamics of the cerebral circulation. TCD was rst introduced in neuro-critical care to monitor vasospasm in patients after sub­arachnoid hemorrhage. Since the 1980’s, we have witnessed a remarkable widening of its range of applications. This book is a substantial documentation of this devel­opment, describing a true multidisciplinary approach to using TCD (and extracra­nial Doppler) as a tool to improve neuro-critical care for a broad range of trauma and diseases.
The book illustrates convincingly a paradigm change in how TCD is used in investigational studies as well as in clinical practice. Ultrasound Doppler used to be a relatively simple diagnostic handheld tool where the verdict was based on the measured velocities, the pulsatility, and eventual spectral broadening signaling disturbed ow. What led to a shift in paradigm is one of the most important advan­tages of TCD– the presence of the cranium (really!). In spite of its propensity to dampen the ultrasound and make signal acquisition a bit more difcult, the cra­nium provides an ideal platform for mounting monitoring TCD probes. And this monitoring can go on and on, and even be aided by robotic technology in an ambulatory setting without somebody there to keep that probe aimed right on its target.
So, early on, TCD invaded the territory of physiologists and pathophysiologists. This invasion of course met resistance, if not outright attempts to condemn TCD to the scrapheap of bad science: “Therefore, the slopes that Aaslid etal. calculated
have nothing to do with the rate of autoregulation of the cerebral vascular bed.” (Editorial, Stroke Jan. 1989). Hundreds of dynamic autoregulation studies later,
the facts speak for themselves. And the cerebral autoregulation in the non-anesthe­tized human is indeed an almost incredibly fast mechanism—contrary to the much slower response as measured in anesthetized cats by physiologists in the pre­TCD era.
There is still a lot to be learned about the cerebral circulation. TCD is a conve­nient non-invasive tool on this journey. It provides a lot of complex data that must
vii
viii
Foreword
be analyzed and understood. Particularly encouraging has been the way pioneering neuro-anesthesiologists have embraced the methodology. It speaks for the useful­ness of this window on the cerebral circulation.
RuneAaslid
Director of R&D at Hemodynamic ag
Bern, Switzerland
November 2020

Acknowledgments

A book such as this could only be developed through the commitment and humble dedication of a group of exceptional professionals, who, through their handwriting, their sacrice, the academic love for sharing, and the time dedicated, have honored each of its pages. I would like to thank my colleagues and editors for their belief and their magnicent work. Thanks go to ESNCH for their support and condence in this project. I would like to thank Springer for believing in us and for their profes­sionalism in this work. I would also like to thank Prof. Rune Aaslid for his contribu­tion and trust. Last but not least, my greatest thanks go to my wife, my son and my parents for their love and constant encouragement; without them, nothing would have been possible. And to my parents, the cornerstone of my essence and existence.
CamiloN.Rodríguez
ix

Contents

Part I Neurocritical Care: Concepts to Review
1 Neurocritical Patient in ICU: An Humanized View of Our
Medical Care as a Gold Standard . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Gabriel Heras La Calle and José Manuel Velasco Bueno
2 Neuro-ICU: Monitoring and Management of Intracranial
Pressure. A Practical Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Peter Le Roux
3 Intracerebral Hemorrhage (ICH) Approach: Bedside
Practical Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Thomas J. Cusack and Wendy Ziai
4 Organ Maintenance After Death by Neurological Criteria (DNC)
in Neuro- ICU: The Importance of Donation . . . . . . . . . . . . . . . . . . . 71
Vasso Zisimopoulou and Panayiotis N. Varelas
5 Neuropharmacology in the ICU: Monitoring the Therapeutic
Response and Neurological Hemodynamic Impact of Our
Therapeutic Decisions in Real Time . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Ryan Fillmore and Gretchen M. Brophy
Part II Neurosonology: Basic Principles
6 Transcranial Doppler Ultrasound: Physical Principles . . . . . . . . . . . 99
David H. Evans
7 Transcranial Doppler (TCD) and Trancranial Color-Coded
Duplex Sonography (TCCS): Applied Neuroanatomy . . . . . . . . . . . 117
Camilo N. Rodríguez and Ryan Splittgerber
8 Transcranial Doppler (TCD/TCCS) and Cerebral Blood Flow:
Applications in the Neurological Intensive Care Unit . . . . . . . . . . . . 147
Edward M. Manno and Farzeneh Sorond
xi
xii
Part III Neurosonology: Neurocritical Care Patient
9 Transcranial Doppler (TCD/TCCS) and Cerebral Blood
Flow Velocities: Parameters of Normality . . . . . . . . . . . . . . . . . . . . . 163
Jorge H. Mejía Mantilla, Pablo F. Amaya, and Leidy Gaviria Villarreal
10 Transcranial Doppler (TCD/TCCS) Approaches:
Acoustic Windows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Jorge Carrizosa
11 Neurocritical Patient in ICU: Transcranial Doppler
(TCD/TCCS) as the Brain Stethoscope . . . . . . . . . . . . . . . . . . . . . . . . 195
Chiara Robba and Danilo Cardim
12 Neurosonology in the ICU: Transcranial Doppler (TCD)
Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Corina Puppo
13 Transcranial Doppler (TCD/TCCS) Monitoring in the
Intensive Care Unit: Usefulness of Two-Dimensional
Ultrasound (2D) to Guide Neuromonitoring . . . . . . . . . . . . . . . . . . . 233
André Y. Denault, Antoine Halwagi, Francis Bernard, Stéphane Langevin, Etienne Couture, Milene Azzam, William Beaubien-Souligny, and Pierre Robillard
Contents
14 Neurosonology in ICU: Transcranial Color-Coded Duplex
Sonography (TCCS) Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Camilo N. Rodríguez and Deborah Pugin
15 Transcranial Color-Coded Duplex Sonography (TCCS):
Importance of Angle Correction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Piergiorgio Lochner, Antonio Siniscalchi, and Andrea Naldi
16 Neurocritical Care Monitoring in ICU: Measurement of the
Cerebral Autoregulation by Transcranial Doppler (TCD) . . . . . . . . 291
Leanne A. Calviello and Marek Czosnyka
17 Neuro-ICU: Cerebral Hemodynamics and Transcranial
Doppler (TCD/TCCS) Waveform Interpretation in the Most
Common Neurocritical Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
L. Luciano Ponce Mejia, Bahattin B. Ergin, and Lucía Rivera Lara
18 Non-invasive Multimodal Neuromonitoring in the ICU:
The Role of Transcranial Doppler (TCD/TCCS) . . . . . . . . . . . . . . . . 319
Demetrios J. Kutsogiannis
19 Acute Neurologic Injury in ICU: Vasomotor Reactivity
Testing by Transcranial Doppler (TCD/TCCS) . . . . . . . . . . . . . . . . . 333
Pedro Castro and Elsa Azevedo