Variability in Transcranial Doppler Technique in Neuro-Critical Care Patients

Study Overview
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Brief Summary
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This study aims to determine the inter- and intra-variability of Transcranial Doppler (TCD) ultrasound in neuro-critical care patients who are planned for consecutive daily TCD evaluations.

Detailed Description
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Patients enrolled in the study are recruited from the pool of neuro-critical care patients admitted to the surgical intensive care unit (SICU). When the patients are admitted in the surgical ICU, the study staff will determine eligibility based on the protocol inclusion criteria. Due to the nature of the disease, there is a high likelihood that patients are either unconscious, of limited mental capacity and/or have been intubated therefore when appropriate the legally authorized representative will be utilized to obtain research consent. To meet study inclusion, transcranial Doppler (TCD) testing will be ordered as part of the standard of care for these patients. The test will not be ordered solely for research purposes. There are no known side effects from the non-invasive measurement of cerebral blood flow using ultrasound Three different TCD technicians will do triplicate readings on 3 consecutive days on up to 12 patients already undergoing TCD as ordered by their treating team. Standard of care on specific neuro critical care patients (such as cerebral aneurysms) is to undergo daily TCD monitoring to assess for possible vasospasm. Patients will be in the supine position while measurements are obtained. The probe will be placed in the preauricular region of the temporal window

Official Title
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Inter- and Intra-Observer Variability in Transcranial Doppler (TCD) Technique in Neurocritical Care Patients

Conditions
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Cerebral Aneurysm, Stroke, Vasospasm, Cerebral, Subarachnoid Hemorrhage, Aneurysmal, Aneurysmal Subarachnoid Hemorrhage, Cerebral Ischemia

Intervention / Treatment
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* Diagnostic Test: Transcranial Doppler


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults 18 years of age or older Current hospitalization for a neurologic issue and admitted to the surgical intensive care unit. Undergoing daily transcranial Doppler imaging No English speaking patients and/or legally authorized representative (LAR) Exclusion Criteria: Less than 18 years of age Patient is unable to obtain consent and no LAR is identified to provide consent Non-English speaking patient or LAR Unable to perform the study due to lack of availability of TCD technologists

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Neuro-critical Care Patients<br>Up to 12 subjects will be recruited over a 1 year period. Patients enrolled in the study are recruited from the pool of neuro-critical care patients admitted to the surgical intensive care unit (SICU). To meet study inclusion, transcranial Doppler (TCD) testing will be ordered as part of the standard of care for these patients. The test will not be ordered solely for research purposes. There are no known side effects from the non-invasive measurement of cerebral blood flow using ultrasound. Three different TCD technicians will perform triplicate readings on 3 consecutive days on up to 12 patients already undergoing TCD as ordered by their treating team. Standard of care on specific neuro critical care patients (such as cerebral aneurysms) is to undergo daily TCD monitoring to assess for possible vasospasm. Patients will be in the supine position while measurements are obtained. The probe will be placed in the preauricular region of the temporal window. | Diagnostic Test: Transcranial Doppler<br>* Transcranial Doppler is a non-invasive, painless, ultrasound technique that uses high frequency sound waves to measure the rate and direction of blood flow vessels in the brain.<br>* Other names: Transcranial Doppler Study;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Determine the inter- and intra-variability of TCD ultrasound in neuro-critical care patients | This study aims to determine the inter- and intra-variability of Transcranial Doppler (TCD) ultrasound in 12 neuro- critical care patients who are planned for daily TCD evaluation. Up to 12 subjects will be recruited over a 1 year period. Patients enrolled in the study are recruited from the pool of neuro-critical care patients admitted to the surgical intensive care unit (SICU). The study aims to determine the inter- and intra-variability of TCD ultrasound in neuro critical care patients who are planned for daily TCD evaluation. The following measurements will be assessed: The peak and mean flow velocity of the middle cerebral artery (MCA) The peak and mean flow velocity of the posterior cerebral artery (PCA) The peak and mean flow velocity of the basilar arteries | Three different TCD technicians will do triplicate readings on 3 consecutive days on patients already undergoing TCD as ordered by their treating team | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Describe the change in velocity that prompts clinical intervention in symptomatic and asymptomatic vasospasm in neuro-critical care patients |  | Data will be assessed from TCD readings performed on triplicate readings on 3 consecutive days on patients already undergoing TCD as ordered by their treating team | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Transcranial Doppler, TCD, Interrater Variability, Intrarater Variability, Transcranial Doppler Ultrasound, Neurocritical Care, DCI, Delayed Cerebral Ischemia, MCA, PCA, Mean Flow Velocity