Kerri L LaRovere1, Robert C Tasker1,2, Mark Wainwright3, Karin Reuter-Rice4, Brian Appavu5, Darryl Miles6, Karen Lidsky7, Patrick Vittner1, Daniel Gundersen8, Nicole F O'Brien9. 1. Department of Neurology, Harvard Medical School and Boston Children's Hospital, Boston, MA. 2. Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School and Boston Children's Hospital, Boston, MA. 3. Division of Pediatric Neurology, Department of Neurology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA. 4. Division of Critical Care Medicine, Department of Pediatrics, Duke University School of Nursing, Durham, NC. 5. Department of Neurosciences, University of Arizona College of Medicine and Phoenix Children's Hospital, Phoenix, AZ. 6. Division of Critical Care Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX. 7. Division of Critical Care Medicine, Department of Pediatric Critical Care, University of Florida Jacksonville and Wolfson Children's Hospital, Jacksonville, FL. 8. Center for Population Sciences, Survey and Data Management Core, Harvard Medical School and Boston Children's Hospital, Boston, MA. 9. Division of Critical Care Medicine, Department of Pediatrics, Ohio State University and Nationwide Children's Hospital, Columbus, OH.
Abstract
OBJECTIVES: The scope of transcranial Doppler ultrasound in the practice of pediatric neurocritical care is unknown. We have surveyed pediatric neurocritical care centers on their use of transcranial Doppler and analyzed clinical management practices. DESIGN: Electronic-mail recruitment with survey of expert centers using web-based questionnaire. SETTING: Survey of 43 hospitals (31 United States, 12 international) belonging to the Pediatric Neurocritical Care Research Group. PATIENTS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A 67% (29/43) hospital-response rate. Of these centers, 27 reported using transcranial Doppler in the PICU; two hospitals opted out due to lack of transcranial Doppler availability/use. The most common diagnoses for using transcranial Doppler in clinical care were intracranial/subarachnoid hemorrhage (20 hospitals), arterial ischemic stroke (14 hospitals), and traumatic brain injury (10 hospitals). Clinical studies were carried out and interpreted by credentialed individuals in 93% (25/27) and 78% (21/27) of the centers, respectively. A written protocol for performance of transcranial Doppler in the PICU was available in 30% (8/27 hospitals); of these, two of eight hospitals routinely performed correlation studies to validate results. In 74% of the centers (20/27), transcranial Doppler results were used to guide clinical care: that is, when to obtain a neuroimaging study (18 hospitals); how to manipulate cerebral perfusion pressure with fluids/vasopressors (13 hospitals); and whether to perform a surgical intervention (six hospitals). Research studies were also commonly performed for a range of diagnoses. CONCLUSIONS: At least 27 pediatric neurocritical care centers use transcranial Doppler during clinical care. In the majority of centers, studies are performed and interpreted by credentialed personnel, and findings are used to guide clinical management. Further studies are needed to standardize these practices.
OBJECTIVES: The scope of transcranial Doppler ultrasound in the practice of pediatric neurocritical care is unknown. We have surveyed pediatric neurocritical care centers on their use of transcranial Doppler and analyzed clinical management practices. DESIGN: Electronic-mail recruitment with survey of expert centers using web-based questionnaire. SETTING: Survey of 43 hospitals (31 United States, 12 international) belonging to the Pediatric Neurocritical Care Research Group. PATIENTS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A 67% (29/43) hospital-response rate. Of these centers, 27 reported using transcranial Doppler in the PICU; two hospitals opted out due to lack of transcranial Doppler availability/use. The most common diagnoses for using transcranial Doppler in clinical care were intracranial/subarachnoid hemorrhage (20 hospitals), arterial ischemic stroke (14 hospitals), and traumatic brain injury (10 hospitals). Clinical studies were carried out and interpreted by credentialed individuals in 93% (25/27) and 78% (21/27) of the centers, respectively. A written protocol for performance of transcranial Doppler in the PICU was available in 30% (8/27 hospitals); of these, two of eight hospitals routinely performed correlation studies to validate results. In 74% of the centers (20/27), transcranial Doppler results were used to guide clinical care: that is, when to obtain a neuroimaging study (18 hospitals); how to manipulate cerebral perfusion pressure with fluids/vasopressors (13 hospitals); and whether to perform a surgical intervention (six hospitals). Research studies were also commonly performed for a range of diagnoses. CONCLUSIONS: At least 27 pediatric neurocritical care centers use transcranial Doppler during clinical care. In the majority of centers, studies are performed and interpreted by credentialed personnel, and findings are used to guide clinical management. Further studies are needed to standardize these practices.
Authors: Jennifer C Laws; Lori C Jordan; Lindsay M Pagano; John C Wellons; Michael S Wolf Journal: Pediatr Neurol Date: 2022-02-02 Impact factor: 3.372
Authors: Matthew P Kirschen; Kerri LaRovere; Binod Balakrishnan; Jennifer Erklauer; Conall Francoeur; Saptharishi Lalgudi Ganesan; Anuj Jayakar; Marlina Lovett; Matthew Luchette; Craig A Press; Michael Wolf; Peter Ferrazzano; Mark S Wainwright; Brian Appavu Journal: Pediatr Neurol Date: 2021-11-12 Impact factor: 4.210
Authors: Nicole Fortier O'Brien; Karin Reuter-Rice; Mark S Wainwright; Summer L Kaplan; Brian Appavu; Jennifer C Erklauer; Suman Ghosh; Matthew Kirschen; Brandi Kozak; Karen Lidsky; Marlina Elizabeth Lovett; Amy R Mehollin-Ray; Darryl K Miles; Craig A Press; Dennis W Simon; Robert C Tasker; Kerri Lynn LaRovere Journal: J Pediatr Intensive Care Date: 2020-09-04
Authors: Nicole F O'Brien; Yudy Fonseca; Hunter C Johnson; Douglas Postels; Gretchen L Birbeck; Yamikani Chimalizeni; Karl B Seydel; Montfort Bernard Gushu; Tusekile Phiri; Sylvester June; Karen Chetcuti; Lorenna Vidal; Manu S Goyal; Terrie E Taylor Journal: Malar J Date: 2022-06-21 Impact factor: 3.469