Transcranial Doppler combined with quantitative EEG brain function monitoring and outcome prediction in patients with severe acute intracerebral hemorrhage

摘自:Chen et al. Critical Care (2018) 22:36 DOI 10.1186/s13054-018-1951-y
作者:Ying Chen, Weihai Xu, Lijuan Wang, Xiaoming Yin, Jie Cao, Fang Deng, Yingqi Xing and Jiachun Feng

Background: Neurological deterioration after intracerebral hemorrhage (ICH) is thought to be closely related to
increased intracranial pressure (ICP), decreased cerebral blood flow (CBF), and brain metabolism. Transcranial Doppler (TCD) is increasingly used as an indirect measure of ICP, and quantitative EEG (QEEG) can reflect the coupling of CBF and metabolism. We aimed to combine TCD and QEEG to comprehensively assess brain function after ICH and provide prognostic diagnosis.
Methods: We prospectively enrolled patients with severe acute supratentorial (SAS)-ICH from June 2015 to December
2016. Mortality was assessed at 90-day follow-up. We collected demographic data, serological data, and clinical factors, and performed neurophysiological tests at study entry. Quantitative brain function monitoring was performed using
a TCD-QEEG recording system at the patient’s bedside (NSD-8100; Delica, China). Univariate and multivariable
analyses and receiver operating characteristic (ROC) curves were employed to assess the relationships between
variables and outcome.
Results: Forty-seven patients (67.3 ± 12.6 years; 23 men) were studied. Mortality at 90 days was 55.3%. Statistical
results showed there were no significant differences in brain symmetry index between survivors and nonsurvivors, nor
between patients and controls (all p > 0.05). Only TCD indicators of the pulsatility index from unaffected hemispheres
(UPI) (OR 2.373, CI 1.299–4.335, p = 0.005) and QEEG indicators of the delta/alpha ratio (DAR) (OR 5.306, CI 1.533–18.360, p = 0.008) were independent predictors for clinical outcome. The area under the ROC curve after the combination of UPI and DAR was 0.949, which showed better predictive accuracy compared to individual variables.
Conclusions: In patients with SAS-ICH, multimodal neuromonitoring with TCD combined with QEEG indicated that
brain damage caused diffuse changes, and the predictive accuracy after combined use of TCD-QEEG was statistically
superior in performance to any single variable, whether clinical or neurophysiological.
Keywords: Transcranial Doppler, Quantitative electroencephalography, Intracerebral hemorrhage, Brain function

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