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Transcranial Doppler in Critical Care

Transcranial Doppler ultrasound can be used to monitor brain perfusion in real-time at the bedside in critically ill patients. It is a non-invasive method to evaluate blood flow to the brain both statically and dynamically. Quantitative TCD values combined with optic nerve sheath diameter measurements can help guide resuscitation efforts by indicating changes in intracranial pressure and cerebral perfusion pressure. Point-of-care ultrasound including TCD and focused cardiac ultrasound helps physicians make timely and appropriate clinical decisions for resuscitation.

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Isnaini Naini
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133 views45 pages

Transcranial Doppler in Critical Care

Transcranial Doppler ultrasound can be used to monitor brain perfusion in real-time at the bedside in critically ill patients. It is a non-invasive method to evaluate blood flow to the brain both statically and dynamically. Quantitative TCD values combined with optic nerve sheath diameter measurements can help guide resuscitation efforts by indicating changes in intracranial pressure and cerebral perfusion pressure. Point-of-care ultrasound including TCD and focused cardiac ultrasound helps physicians make timely and appropriate clinical decisions for resuscitation.

Uploaded by

Isnaini Naini
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Role transcranial doppler

for brain resuscitation in


critical care

TEUKU YASIR
JAKRATA JCCA 2017
Pasien ICU
pasien kritis yang perlu monitoring ketat
real time monitorTindakan segera (resusitasi )
ultrasound bedsite dan real time
murah dan portable
USstetoscope
evaluasi menyeluruh anatomi dan fisiologi
organ vitalotak )TCD), jantung (FATE) paru
(BLUE)
PROBLEM HYPOPERFUSI DI
CRITICAL ILL
MEMPENGARUHI FUNGSI ORGAN
MODS
MOF
HYPOPERFUSI PADA OTAK CACAT
PERMANEN
KESULITAN DALAM MONITORING
PERFUSI
ULTRASOUND
PUNYA POTENSI BESAR UNTUK
MONITORING DAN RESUSITASI OTAK
MELIHAT PEUBAHAN PERUBAHAN
TEKANAN DI DLAM OTAK (ONSD)
MELIHAT PERUBAHAN ALIRAN PADA
(SIRKULUS WILLISI)TCCD
APA ITU TRANSCRANIAL
DOPPLER…?
• ADALAH SUATU METODE DENGAN
MENGGUNAKAN DOPPLER ULTRASOUND
UNTUK MENILAI ALIRAN DARAH KE OTAK
BAIK STATIK ATAU DINAMIK
• DIPERKENALKAN OLEH ASLID 1982
• MENGGUNAKAN PROBE ULTRASOUND
FREKWENSI 1-2 MHz
• NON INVASIF
BAGAIMANA CARA
MELAKUKANNNYA
TRANS TEMPORAL
TRANS ORBITA
RETROMANDIBULA
TRANSFORAMINA
QUANTITATIVE VALUE TCCD
TCD BISA DIKOMBINASIKAN
DENGAN ONSD

 BISA DIPAKAI UNTUK RESUSITASI


OTAK
 KARENA ONSD BERHUBUNGAN
DENGAN PENINGKATAN TEKANAN
INTRA CRANIAL
ONSD (OPTICAL NERVE
SHIELD DIAMETER)
PERFUSI OTAK

CPP = MAP- ICP


50 = 65 - 15
50 = 85 - 25
SEHINGGA DAPAT DILAKUKAN
INTERVENSI

MEMBERIKAN VASOPRESOR
MEBERIKAN TERAPI HYPEROSMOLAR
LUMBAR/SPINAL DRAIN
CRANIOTOMY DECOMPRESI
70 mm
ONSD

S
LC
CE
NA
AI
DR
DECREASED CPP

Hassler Neurosurg 1989; 71(2):195–201).


cardac ultrasound
Main cardiac views
 Parasternal
 Subcostal
 Apical
Main cardiac views
 Parasternal
 Subcostal
 Apical
Wall Motion
 Normal
 Hyperkinetic
 Akinetic
 Dyskinetic: may fail to contract,
bulges outward at systole
 Hypokinetic
Orientation
 Subcostal or subxiphoid view
 Best all around imaging window
 Good for identification of:
 Circumferential pericardial effusion
 Overall wall motion
 Easy to obtain – liver is the acoustic window\
Subcostal View
 Most practical in
trauma setting
 Away from airway and
neck/chest procedures
Subcostal View

 Liver as acoustic
window
 Alternative to apical 4
chamber view
Subcostal View
Subcostal View
Subcostal View
 Angle probe right to see
IVC
 Response of IVC to sniff
indicates central venous
pressure
 No collapse
 Tamponade
 CHF
 PE
 Pneumothorax
Parasternal Views
 Next best imaging window
 Good for imaging LV
 Comparing chamber sizes
 Localized effusions
 Differentiating pericardial from pleural effusions
Parasternal Long Axis
 Near sternum
 3rd or 4th left intercostal space
 Marker pointed to patient’s right shoulder (or left hip if screen is
not reversed for cardiac imaging)
 Rotate enough to elongate cardiac chambers
Parasternal Long Axis
Parasternal Long Axis View
Parasternal Short Axis
 Obtained by 90° clockwise rotation of the probe towards the left
shoulder (or right hip)

 Sweep the beam from the base of the heart to the apex for different
cross sectional views
Parasternal Short Axis View
Parasternal Short Axis
Apical View
 Difficult view to obtain
 Allows comparison of ventricular chamber size
 Good window to assess septal/wall motion abnormalities
Apical Views
 Patient in left lateral
decubitus position
 Probe placed at PMI
 Probe marker at 6
o’clock (or right
shoulder)
 4 chamber view
Apical 4 chamber view
 Marker pointed to the
floor
 Similar to parasternal
view but apex well
visualized
 Angle beam superiorly
for 5 chamber view
Apical 4 chamber view
kesimpulan
 POCUS ADALAH TUNTUTAN ZAMAN YANG HARUS DI
FAHAMI OLEH DOKTER
 US MEMBANTU DOKTER UNTUK MENGAMBIL
TINDAKAN YANG TEPAT DAN CEPAT
 TCD DAN FATE ADALAH TINDAKAN POCUS YANG
PENTING UTK RESUSITASI
s ih
k a
i m a
T er

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