Abstract：
Intracranial pressure (ICP) monitoring is necessary for managing patients with traumatic brain injury (TBI). Although gold-standard methods include intraventricular or intraparenchymal transducers, these systems cannot be used in patients with coagulopathies or in those who are at high risk of catheter-related infections, nor can they be used in resource-constrained settings. Therefore, a non-invasive modality that is more widely available, cost effective, and safe would have tremendous impact. Among such non-invasive choices, transcranial Doppler (TCD) provides indirect ICP estimates through waveform analysis of cerebral hemodynamic changes. The objective of this scoping review is to describe the existing evidence for the use of TCD-derived methods in estimating ICP in adult TBI patients as compared with gold-standard invasive methods. This review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews, with a main search of PubMed and Embase. The search was limited to studies conducted in adult TBI patients published in any language between 2012 and 2022. Twenty-two studies were included for analysis, with most being prospective studies conducted in high-income countries. TCD-derived non-invasive ICP (nICP) methods are either mathematical or non-mathematical, with the former having slightly better correlation with invasive methods, especially when using time-trending ICP dynamics over one-time estimated values. Nevertheless, mathematical methods are associated with greater cost and complexity in their application. Formula-based methods showed promise in excluding elevated ICP, exhibiting a high negative predictive value. Therefore, TCD-derived methods could be useful in assessing ICP changes instead of absolute ICP values for high-risk patients, especially in low-resource settings.
摘要：
颅内压（ICP）监测对于管理颅脑外伤患者是必要的。尽管金标准方法包括心室内或实质内换能器，这些系统不能用于有凝血障碍或导管相关感染高风险的患者,也不能用于资源受限的环境.因此，一种更广泛可用的非侵入性模式，成本效益高,和安全将产生巨大的影响。在这些非侵入性选择中，经颅多普勒（TCD）通过对脑血流动力学变化的波形分析提供间接ICP估计。这项范围审查的目的是描述与金标准侵入性方法相比，使用TCD衍生方法估算成人TBI患者ICP的现有证据。这项审查是根据乔安娜·布里格斯研究所的范围审查方法进行的，主要搜索PubMed和EMBASE。该搜索仅限于在2012年至2022年间以任何语言发表的成人TBI患者中进行的研究。22项研究被纳入分析，大多数是在高收入国家进行的前瞻性研究。TCD衍生的NICP方法是数学或非数学的，前者与侵入性方法的相关性略好，特别是当使用时间趋势ICP动态超过一次性估计值时。然而，数学方法在其应用中具有更大的成本和复杂性。基于配方的方法显示出排除ICP升高的前景，表现出较高的阴性预测值。因此，TCD衍生的方法可用于评估ICP变化，而不是高危患者的绝对ICP值。尤其是在低资源环境中。
