Application of robotic transcranial Doppler for extended duration recording in moderate/severe traumatic brain injury: first experiences

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.

自动探头经颅多普勒超声在中重度颅脑损伤中的应用:初步研究

应用经颅多普勒(TCD)大脑中动脉(MCA)血流速度(CBFV)的长程监护充满挑战。传统上,TCD 的检测非常依靠医生的手动操作,使其在长程监护时获得不间断血流记录的能力十分有限。此外,鉴于床旁护理的复杂性,定期的床边护理及患者操作以及各种其他多模态监测装置的存在,TCD 在神经系统疾病中长时监护应用受到很大限制。在创伤性脑损伤(TBI)患者中尤其如此,因为这些患者通常需要采用广泛的多模态监测。在TBI 中,大多数TCD 记录使用标准的通用探头和头部支架,持续时间从30 分钟到1 小时不等,并且由于探头移位和信号丢失而经常中断。因此,我们通常会在TCD 检查中留下“快照”记录,这种
方式的检测限制了我们提取有价值的连续数据的能力,例如评估脑血流自动调节能力。

自动化技术的最新进展已经促使自动化驱动的TCD 探头的发展,目前已将其与用于MCA的脑动脉血流检测的自动算法集成,以优化使其记录到更好的信号。迄今为止,这些装置尚未切实地应用于神经病学,特别是中度和重度创伤性脑损伤(TBI)患者。然而,这一重要技术进步有可能大大提高我们在获取更长时间、不间断的TCD 血流信号记录的能力。

于本文内,我们回顾了我们在10个中度和重度TBI患者中应用德力凯最新研发的EMS-9D设备及其配置的自动探头的初步经验,这些患者同时也接受了多模式侵入/非侵入性颅脑监测。据我们所知,这是该设备在重症TBI人群中应用的第一手资料。

从2017 年11 月到2018 年1 月,我们使用德力凯EMS-9D 自动探头TCD 设备(EMS-9D 系统,深圳市德力凯医疗设备股份有限公司,中国,http://www.delicasz.com),用于剑桥大学Addenbrooke 医院神经医学重症监护病房(NCCU)的中重度TBI 患者中,用于记录双侧大脑中动脉CBFV,以代替我们的常规TCD 设备Doppler Box(DWL Compumedics,Singen,德国)和Neuroguard(Medasonic,Fremont,CA,美国)。
在此期间,共有10 名患者使用该装置进行了记录。TCD 监测被认为是标准NCCU 患者护理的一部分。应用基于TCD 的监测的时间因患者而异,通常在TBI 后24 小时至10 天之间开始。我们将研究重点设定在那些同时进行多模态监测的TBI 患者(参见下面的装置列表)。

英文原版-Application of robotic transcranial Doppler for extended duration recording in moderatesevere traumatic brain injury first experiences.pdf

中文翻译版-Application of robotic transcranial Doppler for extended duration recording in moderatesevere traumatic brain injury first experiences.pdf