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Journal of Intensive Care Medicine
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Role of Transcranial Doppler in Optimizing Treatment of Cerebral Vasospasm in Subarachnoid Hemorrhage

Ribal S. Darwish, MD

Department of Anesthesiology, Critical Care Medicine, Rdarwish{at}anes.umm.edu

Edward Ahn, MD

Department of Neurosurgery, University of Maryland Medical Center

Nana S. Amiridze, MD, PhD

Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland

This study was undertaken to evaluate the role of transcranial Doppler ultrasonography in arterial blood pressure management during hypervolemia/hypertension/ hemodilution therapy in patients with vasospasm from subarachnoid hemorrhage and correlate this data with neurologic outcome. The study included 18 adult patients, Hunt and Hess grades III-IV. Complete neurologic assessment was performed. Transcranial Doppler indices were calculated by standard formulas. On the basis of our results, resistance area product can be used to estimate the optimal arterial blood pressure in hypervolemia/hypertension/hemodilution therapy. An increase in the cerebral blood flow index was associated with better performance on neurologic examination. Estimated cerebral perfusion pressure from transcranial Doppler data analysis showed poor correlation with cerebral perfusion pressure derived from direct measurement of intracranial pressure in patients with cerebral vasospasm ({rho} = 0.15; 95% CI, 0.11-0.39; P = .2590).

Key Words: cerebral blood flow index • cerebral perfusion pressure • cerebral vasospasm • transcranial Doppler ultrasonography • triple-H therapy

This version was published on July 1, 2008

Journal of Intensive Care Medicine, Vol. 23, No. 4, 263-267 (2008)
DOI: 10.1177/0885066608318516
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