Practice Recommendations for Transcranial Doppler Ultrasonography in Critically Ill Children in the Pediatric Intensive Care Unit: A Multidisciplinary Expert Consensus Statement

Nicole Fortier O'Brien; Karin Reuter-Rice; Mark S Wainwright; Summer L Kaplan; Brian Appavu; Jennifer C Erklauer; Suman Ghosh; Matthew Kirschen; Brandi Kozak; Karen Lidsky; Marlina Elizabeth Lovett; Amy R Mehollin-Ray; Darryl K Miles; Craig A Press; Dennis W Simon; Robert C Tasker; Kerri Lynn LaRovere

doi:10.1055/s-0040-1715128

Practice Recommendations for Transcranial Doppler Ultrasonography in Critically Ill Children in the Pediatric Intensive Care Unit: A Multidisciplinary Expert Consensus Statement

J Pediatr Intensive Care. 2021 Jun;10(2):133-142. doi: 10.1055/s-0040-1715128. Epub 2020 Sep 4.

Authors

Nicole Fortier O'Brien¹, Karin Reuter-Rice², Mark S Wainwright³, Summer L Kaplan⁴, Brian Appavu⁵, Jennifer C Erklauer⁶, Suman Ghosh⁷, Matthew Kirschen⁸, Brandi Kozak⁹, Karen Lidsky¹⁰, Marlina Elizabeth Lovett¹, Amy R Mehollin-Ray¹¹, Darryl K Miles¹², Craig A Press¹³, Dennis W Simon¹⁴, Robert C Tasker¹⁵, Kerri Lynn LaRovere¹⁶

Affiliations

¹ Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University, Ohio, United States.
² Department of Pediatrics, Division of Pediatric Critical Care, School of Medicine, School of Nursing, Duke University, Duke Institute for Brain Sciences, North Carolina, United States.
³ Department of Neurology, University of Washington, Seattle Children's Hospital, Washington, United States.
⁴ Department of Radiology, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Pennsylvania, United States.
⁵ Department of Pediatrics, Division of Critical Care Medicine, Barrow Neurological Institute at Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Arizona, United States.
⁶ Department of Pediatrics, Division of Critical Care Medicine and Neurology, Baylor College of Medicine, Texas Children's Hospital, Texas, United States.
⁷ Department of Pediatrics, Division of Pediatric Neurology, University of Florida, College of Medicine, Florida, United States.
⁸ Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Neurology, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Pennsylvania, United States.
⁹ Department of Radiology, Ultrasound Division, Center for Pediatric Contrast Ultrasound, The Children's Hospital of Philadelphia, Pennsylvania, United States.
¹⁰ Department of Pediatrics, Division of Pediatric Critical Care, Wolfson Children's Hospital, University of Florida, Florida, United States.
¹¹ Department of Radiology, Baylor College of Medicine, E.B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Texas, United States.
¹² Department of Pediatrics/Division of Critical Care, UT Southwestern Medical Center, Texas, United States.
¹³ Department of Pediatrics, Section of Child Neurology, University of Colorado, Children's Hospital Colorado, Colorado, United States.
¹⁴ Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pennsylvania, United States.
¹⁵ Departments of Neurology & Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Massachusetts, United States.
¹⁶ Department of Neurology, Boston Children's Hospital, Harvard Medical School, Massachusetts, United States.

Abstract

Transcranial Doppler ultrasonography (TCD) is being used in many pediatric intensive care units (PICUs) to aid in the diagnosis and monitoring of children with known or suspected pathophysiological changes to cerebral hemodynamics. Standardized approaches to scanning protocols, interpretation, and documentation of TCD examinations in this setting are lacking. A panel of multidisciplinary clinicians with expertise in the use of TCD in the PICU undertook a three-round modified Delphi process to reach unanimous agreement on 34 statements and then create practice recommendations for TCD use in the PICU. Use of these recommendations will help to ensure that high quality TCD images are captured, interpreted, and reported using standard nomenclature. Furthermore, use will aid in ensuring reproducible and meaningful study results between TCD practitioners and across PICUs.

Keywords: pediatric critical care; pediatric intensive care unit; practice recommendations; protocol; transcranial doppler ultrasound.