Thermal diffusion flowmetry (TDF) is an appealing candidate for monitoring of cerebral blood flow (CBF) in neurocritical-care patients as it provides absolute measurements with a high temporal resolution, potentially allowing for bedside intervention that could mitigate secondary injury. We performed a systematic review of TDF-regional(r)CBF measurements and their association with (1) patient functional outcome, (2) other neurophysiological parameters, and (3) imaging-based tissue outcomes. We searched MEDLINE, EMBASE, SCOPUS, BIOSIS, GlobalHealth, and the Cochrane Databases from inception to October 2018 and relevant conference proceedings published over the last 5 years. Nine articles that explored the relationship between TDF-rCBF, mortality, and Glasgow Outcome Scale (GOS) or GOS-Extended (GOS-E) at various intervals were included. Despite being based on an overall weak body of evidence, our analysis suggests a link between sustained low or high CBF and poor functional outcome. Twenty-five studies reporting associations with neurophysiological parameters were included. The available data also point to an association between low or high TDF-rCBF and intracranial hypertension. TDF-rCBF appears to correlate well with regional brain tissue oxygenation measurements. We found no studies reporting on imaging-based tissue outcome in relation to TDF. In conclusion, despite being based on a relatively weak body of evidence, the available literature suggests a link between consistently abnormal TDF-rCBF values, intracranial hypertension, and poor functional outcome. TDF-rCBF also appears to correlate well with regional measurements of brain tissue oxygenation. Currently, such monitoring should be considered experimental, requiring much further evaluation prior to widespread adoption.
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References
1.
BouzatP., SalaN., PayenJ.F., and OddoM. (2013). Beyond intracranial pressure: 0ptimization of cerebral blood flow, oxygen, and substrate delivery after traumatic brain injury. Ann. Int. Care, 3, 1–9.
2.
FigajiA., PadayachyL., FieggenG., and RohlwinkU. (2012). Continuous local cerebral blood flow monitoring in children with TBI. Child's Nerv. Syst. 28, 1590.
3.
FronteraJ., ZiaiW., O'PhelanK., LerouxP.D., KirkpatrickP.J., DiringerM.N., and SuarezJ.I. (2015). Regional brain monitoring in the neurocritical care unit. Neurocrit. Care, 22, 348–359.
4.
MillerC., ArmondaR., Le RouxP., MenonD.K., VespaP., CiterioG., BaderM.K., BrophyG.M., DiringerM.N., StocchettiN., VidettaW., BadjatiaN., BoeselJ., ChesnutR., ChouS., ClaassenJ., CzosnykaM., De GeorgiaM., FigajiA., FugateJ., HelbokR., HorowitzD., HutchinsonP., KumarM., McNettM., NaidechA., OddoM., OlsonD., O'PhelanK., ProvencioJ., PuppoC., RikerR., RobertsonC., SchmidtJ.M., and TacconeF. (2014). Monitoring of cerebral blood flow and ischemia in the critically ill. Neurocrit. Care, 21, 121–128.
5.
SteinerL.A., and CzosnykaM. (2002). Should we measure cerebral blood flow in head-injured patients?. Br. J. Neurosurg. 16, 429–439.
6.
Le RouxP., MenonD.K., CiterioG., VespaP., BaderM.K., BrophyG.M., DiringerM.N., StocchettiN., VidettaW., ArmondaR., BadjatiaN., BoeselJ., ChesnutR., ChouS., ClaassenJ., CzosnykaM., De GeorgiaM., FigajiA., FugateJ., HelbokR., HorowitzD., HutchinsonP., KumarM., McNettM., MillerC., NaidechA., OddoM., OlsonD., O'PhelanK., ProvencioJ.J., PuppoC., RikerR., RobertsonC., SchmidtM., TacconeF., Neurocritical Care Society, and European Society of Intensive Care Medicine. (2014). Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine. Intensive Care Med. 40, 1189–1209.
7.
HigginsJ.P.T.G.S. Cochrane Handbook for Systematic Reviews ofInterventions, version 5.1.0. http:handbook.cochrane.org (Last accessed October28, 2018).
8.
MoherD., LiberatiA, TetzlaffJ, and AltmanD.G. (2009). Preferred reporting items for systematic reviews and meta-analysis: the PRISMA statement. Ann. Int. Med. 151, 264–269.
9.
ViswanathanM., and BerkmanN.D. (2011). Development of the RTI Item Bank on Risk of Bias and Precision of Observational Studies. Report no. 11-EHC028-EF. Agency for Healthcare Research and Quality: Rockville, MD.
10.
AbdullahJ., ZamzuriI., AwangS., SayuthiS., GhaniA., TahirA., and NaingN.N. (2005). Preliminary report on spiegelberg pre and post-operative monitoring of severe head-injured patients who received decompressive craniectomy. In: Acta Neurochir. Suppl. 95, 311–314.
11.
DiasC., MaiaI., CerejoA., SmielewskiP., PaivaJ.A., and CzosnykaM. (2016). Plateau waves of intracranial pressure and multimodal brain monitoring. Acta Neurochir. Suppl. 122, 143–146.
12.
DiasC., SilvaM.J., PereiraE., MonteiroE., MaiaI., BarbosaS., SilvaS., HonradoT., CerejoA., AriesM.J., SmielewskiP., PaivaJ.A., and CzosnykaM. (2015). Optimal cerebral perfusion pressure management at bedside: a single-center pilot study. Neurocrit. Care, 23, 92–102.
13.
DiasC., SilvaM.J., PereiraE., SilvaS., CerejoA., SmielewskiP., RochaA.P., Rita GaioA., PaivaJ.-A., and CzosnykaM. (2014). Post-traumatic multimodal brain monitoring: response to hypertonic saline. J. Neurotrauma, 31, 1872–1880.
14.
DickmanC.A., CarterL.P., BaldwinH.Z., HarringtonT., and TallmanD. (1991). Continuous regional cerebral blood flow monitoring in acute craniocerebral trauma. Neurosurgery, 28, 467–472.
15.
GopinathS.P., ValadkaA., ContantC.F., and RobertsonC.S. (1999). Relationship between global and cortical cerebral blood flow in patients with head injuries. Neurosurgery, 44, 1273–1279.
16.
HinzmanJ.M., AndaluzN., ShutterL.A., OkonkwoD.O., PahlC., StrongA.J., DreierJ.P., and HartingsJ.A. (2014). Inverse neurovascular coupling to cortical spreading depolarizations in severe brain trauma. Brain, 137, 2960–2972.
17.
JaegerM., SoehleM., SchuhmannM.U., WinklerD., and MeixensbergerJ. (2005). Correlation of continuously monitored regional cerebral blood flow and brain tissue oxygen. Acta Neurochir. (Wein) 147, 51–56.
18.
KrasbergM., SenaB., MeadB., PappuS., NemotoE.M., OlinK., MalkoffM., StipplerM., and YonasH. (2013). Autoregulation of CBF following TBI: an important variable that is now clinically accessible. J. Neurotrauma, 30, A128.
19.
RosenthalG., HemphillJ.C.3rdSorani, M., MartinC., MorabitoD., ObristW.D., and ManleyG.T. (2008). Brain tissue oxygen tension is more indicative of oxygen diffusion than oxygen delivery and metabolism in patients with traumatic brain injury. Crit. Care Med. 36, 1917–1924.
20.
RosenthalG., Sanchez-MejiaR.O., PhanN., HemphillJ.C.3rdMartin, C., and ManleyG.T. (2011). Incorporating a parenchymal thermal diffusion cerebral blood flow probe in bedside assessment of cerebral autoregulation and vasoreactivity in patients with severe traumatic brain injury. J. Neurosurg. 114, 62–70.
21.
SchröderM.L., MuizelaarJ.P. (1993). Monitoring of regional cerebral blood flow in acute head injury by thermal diffusion. Acta Neurochir. Suppl., 47–49.
SoukupJ., BramsiepeI., BruckeM., SanchinL., and MenzelM. (2008). Evaluation of a bedside monitor of regional CBF as a measure of CO2 reactivity in neurosurgical intensive care patients. J. Neurosurg. Anesthesiol. 20, 249–255.
24.
TacklaR., HinzmanJ.M., ForemanB., MagnerM., AndaluzN., and HartingsJ.A. (2015). Assessment of cerebrovascular autoregulation using regional cerebral blood flow in surgically managed brain trauma patients. Neurocrit. Care, 23, 339–346.
25.
TenjinH., YamakiT., NakagawaY., KuboyamaT., EbisuT., KoboriN., UedaS., and MizukawaN. (1990). Impairment of CO2 reactivity in severe head injury patients: an investigation using thermal diffusion method. Acta Neurochir. (Wien) 104, 121–125.
26.
VajkoczyP., RothH., HornP., LuckeT., ThoméC., HubnerU., MartinG.T., ZappletalC., KlarE., SchillingL., and SchmiedekP. (2000). Continuous monitoring of regional cerebral blood flow: experimental and clinical validation of a novel thermal diffusion microprobe. J. Neurosurg. 93, 265–274.
27.
LeeS.C., ChenJ.F., and LeeS.T. (2005). Continuous regional cerebral blood flow monitoring in the neurosurgical intensive care unit. J. Clin. Neurosci. 12, 520–523.
28.
BrennanJ., TompkinsP., StevensF.A., and CarterL.P. (1998). Treatment of severe brain injury based upon cerebral blood flow. In: Acta Neurochirurgica Supplement; Intracranial pressure and neuromonitoring in brain injury. MarmarouA., BullockR., AvezaatC., et al. (eds). Springer-Verlag Wien: Vienna, pp. 384.
29.
CarterL.P., DickmanC., and WilliamsF.C. (1990). Feasibility of monitoring cerebral blood flow continuously in patients with severe head trauma. J. Trauma, 30, 916.
30.
Garcia-PerezM.L., MonteroM.J., Badenes QuilesR., De FezM., MaruendaA., and BeldaF.J. (2011). Cerebral blood flow by thermal diffusion in severe traumatic brain injury. Correlation with neuromonitoring and prognostic implications. European Society of Intensive Care Medicine 24th Annual Congress, September, Berlin, Germany. Int. Care Med. S46.
31.
HirschK.G., YueJ., ChoukalasC., and SinghV. (2013). Cerebral venous-to-arterial carbon dioxide gradient is a novel biomarker for brain injury. Neurocritical Care Society 11th Annual Meeting, October. 1–4, Philadelphia. Neurocrit. Care, S39.
32.
PhanN., RosenthalG., and ManleyG. (2009). Bedside assessment of cerebral pressure autoregulation and vasoreactivity in severe traumatic brain injury: insight in arterial vs. venous control. J. Neurotrauma, 26, A66.
33.
OshorovA.S., I;Popugaev, K.; PotapovA. (2014). Influence of hyperthermia on the parameters of MAP, CPP and Prx in patients with severe TBI. Brain Injury. 28.
34.
SenaB., KrasbergM., PappuS., OlinK., MeadB., NemotoE.M., and YonasH. (2013). Thermal dilution CBF in white matter is a useful clinical measurement that does provide new insight into ICP alterations. J. Neurotrauma, 30, A129.
35.
ValadkaA.B., HlatkyR., FuruyaY., and RobertsonC.S. (2002). Brain tissue PO2: correlation with cerebral blood flow. Acta Neurochir. Suppl. 81, 299–301.
36.
VoloviciV., HuijbenJ.A., ErcoleA., StocchettiN., DirvenC.M.F., van der JagtM., SteyerbergE.W., LingsmaH.F., MenonD.K., MaasA.I.R., and HaitsmaI.K. (2018). Ventricular Drainage Catheters versus Intracranial Parenchymal Catheters for Intracranial Pressure Monitoring-Based Management of Traumatic Brain Injury: A Systematic Review and Meta-Analysis. J. Neurotrauma. doi: 10.1089/neu.2018.6086 [Epub ahead of print].
37.
ZeilerF.A., ThelinE.P., HelmyA., CzosnykaM., HutchinsonP.J.A., and MenonD.K. (2017). A systematic review of cerebral microdialysis and outcomes in TBI: relationships to patient functional outcome, neurophysiologic measures, and tissue outcome. Acta Neurochir. (Wien) 159, 2245–2273.
38.
LangE.W., KasprowiczM., SmielewskiP., SantosE., PickardJ., and CzosnykaM. (2015). Short pressure reactivity index versus long pressure reactivity index in the management of traumatic brain injury. J. Neurosurg. 122, 588–594.
39.
ThelinE.P., ZeilerF.A., ErcoleA., MondelloS., BukiA., BellanderB.M., HelmyA., MenonD.K., and NelsonD.W. (2017). Serial sampling of serum protein biomarkers for monitoring human traumatic brain injury dynamics: a systematic review. Front. Neurol. 8, 300.
40.
FuruyaY., HlatkyR., ValadkaA.B., DiazP., and RobertsonC.S. (2003). Comparison of cerebral blood flow in computed tomographic hypodense areas of the brain in head-injured patients. Neurosurgery, 52, 340–345; discussion 345–346.
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