Monitoring of Cerebral Blood Flow and Ischemia in the Critically Ill

The Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Secondary ischemic injury is common after acute brain injury and can be evaluated with the use of neuromonitoring devices. This manuscript provides guidelines for the use of devices to monitor cerebral blood flow (CBF) in critically ill patients. A Medline search was conducted to address essential pre-specified questions related to the utility of CBF monitoring. Peer-reviewed recommendations were constructed according to the GRADE criteria based upon the available supporting literature. Transcranial Doppler ultrasonography (TCD) and transcranial color-coded duplex sonography (TCCS) are predictive of angiographic vasospasm and delayed ischemic neurological deficits after aneurysmal subarachnoid hemorrhage. TCD and TCCS may be beneficial in identifying vasospasm after traumatic brain injury. TCD and TCCS have shortcomings in identifying some secondary ischemic risks. Implantable thermal diffusion flowmetry (TDF) probes may provide real-time continuous quantitative assessment of ischemic risks. Data are lacking regarding ischemic thresholds for TDF or their correlation with ischemic injury and clinical outcomes.TCD and TCCS can be used to monitor CBF in the neurocritical care unit. Better and more developed methods of continuous CBF monitoring are needed to limit secondary ischemic injury in the neurocritical care unit.

Original languageEnglish (US)
Pages (from-to)121-128
Number of pages8
JournalNeurocritical Care
Issue number2
StatePublished - Oct 1 2014
Externally publishedYes


  • Cerebral blood flow
  • Ischemia
  • Multimodality monitoring
  • Neurocritical care
  • Thermal diffusion flowmetry
  • Transcranial Doppler

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Clinical Neurology


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