In order to determine CBF velocities, cerebrovascular reactivity (CVR) and the pulsatility index (PI), the middle cerebral artery (MCA) was bilaterally insonated through the trans-temporal window with the use of a 2 MHz transducer (DWL Doppler box, DTC digital, Compumedics®, Germany). All measurements were recorded. Finally, a breath-holding test (BHT) was used. Participants were requested to hold their breath for at least 30 s to reach a maximal flow velocity (MFV). CVR was calculated as a percentage of baseline MFV and absolute changes by subtracting the baseline values from the maximum MFV during the BHT task as follows: CVR = ((MFVBHT − MFVrest)/MFVrest) × 100 [10 (link)]. A single operator performed all TCD assessments. A CVR score lower than 0.5% was considered abnormal, and it was managed as a continuous variable throughout the study. Participants that could not perform the BHT or did not have an adequate acoustic bone window were excluded.
Dwl doppler box
Manufactured by Compumedics
Sourced in Germany
The DWL Doppler Box is a diagnostic device designed for non-invasive vascular assessment. It utilizes Doppler ultrasound technology to measure blood flow velocities and waveforms in various blood vessels.
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Lab products found in correlation
5 protocols using dwl doppler box
1
Cerebrovascular Reactivity Assessment Protocol
2
Transcranial Doppler Detection of Microembolic Signals
3
Transcranial Doppler Assessment of Cerebral Hemodynamics
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To minimize operator bias, each TCD assessment was conducted by a physician specifically trained in TCD techniques. Measurements were taken three times through the temporal bone window at both sides of the skull and averaged for accuracy. Within 24 h of ICU admission, subjects underwent TCD evaluation while in a supine position with the bed head leveled. Cerebral hemodynamics were assessed using a 2-MHz ultrasound probe (DWL Doppler-Box; Compumedics). Focusing on the proximal M1 segments of the bilateral middle cerebral arteries, the evaluation recorded key hemodynamic parameters such as systolic peak velocity (Vs), end-diastolic velocity (Vd), mean blood flow velocity (Vm), pulsatility index (PI), and resistive index (RI), specifically from the side of the middle cerebral artery exhibiting higher Vm.
4
Multimodal Physiological Monitoring
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Other monitoring included beat-to-beat pulse oximetry (Oxypleth, NovaMetrix, MA), continuous non-invasive arterial blood pressure (PortaPres, Finapres Medical Systems, The Netherlands), electrocardiography (IntelliVue MP50, Philips Healthcare, The Netherlands), capnography (CO2SMO, NovaMetrix) and inspired/expired oxygen partial pressure (IntelliVue Anaesthetic Gas Module, Philips Healthcare). Transcranial Doppler (TCD) ultrasonography was used to measure middle cerebral artery flow velocity ipsilateral to the pHOS optode, as a surrogate of cerebral blood flow (DWL Doppler Box, Compumedics, Germany).
5
Multimodal Cerebral Monitoring in Neurological Trauma
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Systemic physiological monitoring included invasive arterial blood pressure (ABP) and pulse oximetry (SpO2) measured continuously, and measurement of arterial blood gases (ABGs), including carbon dioxide and oxygen partial pressures (paCO2 and paO2, respectively). Middle cerebral artery blood flow velocity (Vmca) was measured using transcranial Doppler ultrasonography (DWL Doppler Box, Compumedics, Singen, Germany). Invasive cerebral monitoring comprised pbrO2 (Licox, Integra Neurosciences, Plainsboro, USA) and measurement of LPR by cerebral microdialysis (M Dialysis AB, Stockholm, Sweden), with catheters implanted via a cranial access device (Technicam, Newton Abbot UK or Licox IP2, Integra Neurosciences) or surgically at time of craniotomy. In accordance with consensus guidelines, catheters were placed in peri-lesional tissue in patients with focal TBI or ICH, in the right frontal lobe in patients with diffuse TBI, or tissue thought to be at risk of ischaemia from vasospasm in patients with aneurysmal SAH.27 All non-invasive cerebral monitoring was conducted ipsilateral to the invasive monitoring.
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