Transcranial Doppler Ultrasonography for the Management of Severe Traumatic Brain Injury After Decompressive Craniectomy

Abstract

Cerebral hemodynamic transformation is a relatively common finding in patients with traumatic brain injury (TBI). Knowledge of cerebral hemodynamic disturbance may assist in predicting the management outcome. Transcranial Doppler ultrasonography (TCD) monitoring of patients with TBI can be used to reveal various pathologic hemodynamic changes. The objective of this study was to compare the clinical outcomes of postoperative routine intracranial pressure (ICP) monitoring versus ICP monitoring combined with TCD monitoring in patients with brain trauma after decompressive craniectomy. This was a retrospective study of 30 patients with TBI who underwent ICP combined with TCD monitoring (after 2015) compared with a historical control group of 30 patients who only underwent routine ICP monitoring (in 2013-2014). ICP, partial pressure of carbon dioxide, hemoglobin, and hematocrit values were monitored and recorded on a daily basis for 7 days after operation. Neuroimaging was also performed at admission. Neurologic outcome was assessed at 2 weeks and 6 months after operation using the Glasgow Outcome Score Extended (GOS-E). Unconditional multivariable logistic regression was conducted to analyze the factors for favorable clinical outcome. Two weeks after operation, there were no differences in mortality rate between the 2 groups (P=0.643). When considering the GOS-E score at 6 months, there were no differences in clinical prognosis between the 2 groups (P= 0.101), but the ICP combined with TCD monitoring group showed a higher frequency of patients with favorable outcome compared with the routine ICP monitoring group (P= 0.043). Unconditional multivariable logistic regression results showed that no factor was independently associated with GOS-E at 6 months. TCD could be helpful for the serial monitoring of cerebral hemodynamic changes after decompressive craniectomy for TBI, which could be beneficial for neurologic outcome improvement.