Review Article
Volume 5 Issue 5 - 2021
Brain Ultrasound and Transcranial Doppler in Critically Ill Patients
Walid Shibl1*, Yahya Tawab Mohammed2, Sherif Ibrahim HO3 and Mohamed Ibrahim4
1ICU Consultant Maadi Medical Complex, Egypt
2Senior Consultant ICU Maadi Medical Complex, Egypt
3Qaser El Eni Hospital, Cairo University, Egypt
4ICU Resident, Qaser El Eni Hospital, Cairo University, Egypt
*Corresponding Author: Walid Shibl, ICU Consultant Maadi Medical Complex, Egypt.
Received: January 25, 2021; Published: April 30, 2021


In the last years, Critical Care U/S has become an essential branch of critical care Medicine and has gained general acceptance. Its use, both as a diagnostic tool and for hemodynamic monitoring, has increased markedly, greatly influencing contemporary cardiorespiratory management. The RUSH Protocol for undifferentiated shock, the BLUE- protocol for the management of acute respiratory failure. Moreover, as judged by the American College of Radiology Appropriateness Criteria, renal Doppler ultrasonography is the most appropriate imaging test in the evaluation of AKI and has the highest level of recommendation. However, brain imaging by brain U/S is still not used in general intensive care setting.

There are 2 types of brain U/S, TCD and TCCD. In contrast to TCD which was introduced in clinical practice approximately 40 years ago, TCCD identifies the cerebral arteries “blindly” based on arterial depth, direction and waveform analysis and is mainly a spectral Doppler. Trans cranial color-coded duplex (TCCD) is better than the conventional TCD examination because it shows the images of the intracranial anatomy by 2D image and arteries by duplex B-mode, while still having the capacity to measure the blood flow velocity. TCCD is not used frequently in intensive care setting, moreover, it is not included in both European [EDEC] and American [CCEeXAM] certification for advanced critical care Echo.

MRI and CT- Brain are the gold standard to diagnose important diseases in ICU setting like CVS, but recently, especially in COVID-19 era, there was a large number of patients who are on high setting mechanical ventilator and cannot be transferred to radiology department. Thus, nowadays we need to decrease mobilization of infected patients between departments so, brain U/S could be an alternative for the patients who cannot be mobilized safely to radiology department.

The main obstacle to brain U/S is due to absence of temporal window, in 12- 20% of the patients especially elderly females, but, with improvement of technology of U/S machines and the appearance of new mode [Harmonic], it is expected to decrease the number of failed studies due to absence temporal window.

Brain ultrasonography can be used to evaluate cerebral anatomy and pathology, as well as cerebral circulation through analysis of blood flow velocities. Trans cranial color-coded duplex sonography is a generally safe, repeatable, non-invasive, bedside technique that has a strong potential in neurocritical care patients in many clinical scenarios.

In this review we will discuss the value of TCCD in ICU daily practice. In the first section, we will illustrate the clinical applications as Doppler mode, and in the second part will enumerate the different uses as B-mode to assess the brain tissues and ventricles.


Keywords: TCCD; CVS; Brain U/S; ICU


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Citation: Walid Shibl., et al. “Brain Ultrasound and Transcranial Doppler in Critically Ill Patients”. EC Emergency Medicine and Critical Care 5.5 (2021): 82-92.

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