Zeiler and Smielewski ?Crit Ultrasound J (2018) 10:16
F. A. Zeiler1,2,3* and P. Smielewski4
To the Editor,
Long duration application of transcranial Doppler (TCD) for recording of middle cerebral artery (MCA) cerebral blood flow velocity (CBFV) has been fraught with difficulties[1, 2]. Classically, TCD has been labor-intensive,with limited ability to obtain uninterrupted recordings for extended periods. Furthermore, application of TCD within neurocritically ill for long durations has been limited given the complexity of care, regular bedside nursing care/patient manipulations, and presence of various other multi-modal monitoring devices. This is especially the case in traumatic brain injury (TBI) patients, with the
adoption of extensive multi-modal monitoring. Within TBI, most TCD recordings, using standard widely available probes and holders, range from 30 min to 1-h duration and are frequently interrupted due to shifting of the probe and signal loss [3, 4]. Thus, we are typically left with a “snap-shot” recording with TCD examination, limiting our ability to extract valuable continuous variables,such as autoregulatory capacity [3–5].
Recent advances in robotics have led to the development of robotically driven TCD examination probes,integrated with automated algorithms for MCA CBFV detection and optimization of recorded signal intensity.To date, these devices have not been readily applied to the neurocritically ill, particularly moderate and severetraumatic brain injury (TBI) patients. However, given this advancement, they provide the potential to improve dramatically our ability to obtain longer, uninterrupted, TCD recordings in this population.
Within, we provide a review of our initial experience with the application of a new robotic TCD system, the Delica EMS 9D robotic TCD, in 10 moderate and severe TBI patients undergoing multi-modal invasive/non-invasive cranial monitoring. To our knowledge, this is the first account of the application of this device within the critically ill TBI population.
自動探頭經(jīng)顱多普勒超聲在中重度顱腦損傷中的應(yīng)用：初步研究
應(yīng)用經(jīng)顱多普勒（TCD）大腦中動脈（MCA）血流速度（CBFV）的長程監(jiān)護充滿挑戰(zhàn)。傳統(tǒng)上，TCD 的檢測非常依靠醫(yī)生的手動操作，使其在長程監(jiān)護時獲得不間斷血流記錄的能力十分有限。此外，鑒于床旁護理的復(fù)雜性，定期的床邊護理及患者操作以及各種其他多模態(tài)監(jiān)測裝置的存在，TCD 在神經(jīng)系統(tǒng)疾病中長時監(jiān)護應(yīng)用受到很大限制。在創(chuàng)傷性腦損傷（TBI）患者中尤其如此，因為這些患者通常需要采用廣泛的多模態(tài)監(jiān)測。在TBI 中，大多數(shù)TCD 記錄使用標(biāo)準(zhǔn)的通用探頭和頭部支架，持續(xù)時間從30 分鐘到1 小時不等，并且由于探頭移位和信號丟失而經(jīng)常中斷。因此，我們通常會在TCD 檢查中留下“快照”記錄，這種
方式的檢測限制了我們提取有價值的連續(xù)數(shù)據(jù)的能力，例如評估腦血流自動調(diào)節(jié)能力。
自動化技術(shù)的最新進展已經(jīng)促使自動化驅(qū)動的TCD 探頭的發(fā)展，目前已將其與用于MCA的腦動脈血流檢測的自動算法集成，以優(yōu)化使其記錄到更好的信號。迄今為止，這些裝置尚未切實地應(yīng)用于神經(jīng)病學(xué)，特別是中度和重度創(chuàng)傷性腦損傷（TBI）患者。然而，這一重要技術(shù)進步有可能大大提高我們在獲取更長時間、不間斷的TCD 血流信號記錄的能力。
于本文內(nèi)，我們回顧了我們在10個中度和重度TBI患者中應(yīng)用德力凱最新研發(fā)的EMS-9D設(shè)備及其配置的自動探頭的初步經(jīng)驗，這些患者同時也接受了多模式侵入/非侵入性顱腦監(jiān)測。據(jù)我們所知，這是該設(shè)備在重癥TBI人群中應(yīng)用的第一手資料。
從2017 年11 月到2018 年1 月，我們使用德力凱EMS-9D 自動探頭TCD 設(shè)備（EMS-9D 系統(tǒng)，深圳市德力凱醫(yī)療設(shè)備股份有限公司，中國，http://m.stmarylebonefestival.com），用于劍橋大學(xué)Addenbrooke 醫(yī)院神經(jīng)醫(yī)學(xué)重癥監(jiān)護病房（NCCU）的中重度TBI 患者中，用于記錄雙側(cè)大腦中動脈CBFV，以代替我們的常規(guī)TCD 設(shè)備Doppler Box（DWL Compumedics，Singen，德國）和Neuroguard（Medasonic，F(xiàn)remont，CA，美國）。
在此期間，共有10 名患者使用該裝置進行了記錄。TCD 監(jiān)測被認為是標(biāo)準(zhǔn)NCCU 患者護理的一部分。應(yīng)用基于TCD 的監(jiān)測的時間因患者而異，通常在TBI 后24 小時至10 天之間開始。我們將研究重點設(shè)定在那些同時進行多模態(tài)監(jiān)測的TBI 患者（參見下面的裝置列表）。
