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Practice Recommendations for Transcranial Doppler Ultrasonography in Critically Ill Children in the Pediatric
Nicole Fortier O'Brien1, Karin Reuter-Rice2, Mark S Wainwright3
1Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University, Ohio, United States.
Insights
Standardized guidelines for transcranial Doppler ultrasonography (TCD) in pediatric intensive care units (PICUs) are needed. This study developed consensus-based recommendations to improve TCD use for diagnosing and monitoring pediatric cerebral hemodynamics.
Area of Science:
- Pediatric Intensive Care
- Neurology
- Medical Imaging
Background:
- Transcranial Doppler (TCD) ultrasonography is increasingly utilized in pediatric intensive care units (PICUs).
- TCD aids in diagnosing and monitoring cerebral hemodynamic changes in critically ill children.
- Current TCD practice lacks standardized protocols for scanning, interpretation, and documentation in PICUs.
Purpose of the Study:
- To establish consensus-based practice recommendations for TCD use in the PICU.
- To address the need for standardized approaches in TCD examinations for pediatric critical care.
Main Methods:
- A modified Delphi process involving multidisciplinary clinicians with TCD expertise was employed.
- Three rounds of consensus-building were conducted to achieve unanimous agreement on statements.
- The process focused on developing practice recommendations for TCD in the PICU setting.
Main Results:
- Unanimous agreement was reached on 34 statements regarding TCD use in PICUs.
- Practice recommendations for TCD application in pediatric intensive care were created.
- The developed recommendations aim to standardize TCD procedures.
Conclusions:
- Implementation of these recommendations will enhance the quality of TCD image acquisition, interpretation, and reporting.
- Standardized nomenclature and practices will improve the reproducibility and meaningfulness of TCD study results.
- These guidelines will foster consistency in TCD practice across different practitioners and PICUs.
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.
