155| © www.globalsciencepg.org Biolife | 2017 | Vol 5 | Issue 2 B I O L I F E R E S E A R C H A R T I C L E Evaluation of cerebral autoregulation using transcranial doppler ultrasound in patients with moderate and severe traumatic brain injuries Taysser Zaytoun 1 , Amr Abdalla 2 , Bassem Beshay 3 , Ahmed Elbeheiry 4 , Moustafa Shebl 5 1-3,5 Department of Critical Care Medicine, Faculty of Medicine, University of Alexandria. 2 Department of Radiodiagnosis, Faculty of Medicine, University of Alexandria Email: : doctor.islam.ahmed@gmail.com ABSTRACT Introduction: Traumatic brain injury (TBI) has been increasing with greater incidence. It remains a leading cause of death. Cerebral pressure autoregulation impairment is a well-known pathology after TBI that worsens the prognosis and outcome. Transcranial Doppler (TCD) can be used to assess Transient Hyperaemic response ratio (THRR) after carotid compression which is a well demonstrated valid index for cerebral autoregulation. A relative increase in mean flow velocity (MFV) of middle cerebral artery (MCA) above the baseline following the release of carotid compression denotes preserved autoregulation and sequentially predicts good outcome, whereas absence of such response indicates altered autoregulation with poor outcome. Design: Observational prospective cohort study Setting: Alexandria Main University Hospital, Department of Critical Care Medicine Patients & Methods: 120 patients with moderate or severe TBI according to Glasgow Coma Score (GCS) underwent daily TCD for 5 days post trauma. The primary end point is the Glasgow outcome score (GOS) as a measure of outcome to assess THRR after carotid compression as an indicator of cerebral pressure autoregulation as a predictor of GOS as well as a being prognostic tool. Other measures of TCD as MFV of MCA and Pulstility Index (PI) were also used as predictors of GOS and correlated with THRR. The length of stay as well as mortality were recorded and correlated to THRR. Results: There was a significant correlation between THRR and GOS (patients with THRR ≥ 1 had favorable outcome). There was also significant correlation between THRR and length of stay and mortality. Also significant correlation between THRR and MFV as well as PI was found. Conclusion: THRR provides a clinically useful index of cerebral autoregulation. THRR after carotid compression is a good predictor of GOS as well as being a prognostic tool in patients with moderate and severe TBI. Keywords: Critical; Trauma; Injury; Transcranial; Ultrasound INTRODUCTION Traumatic brain injury (TBI) is a major public health and socio-economic problem worldwide. It one of the leading causes of death and disability among young adults. Prolonged disability is common in those who survive. (1) Every year, approximately 1.5 million people die from TBI. The major burden (90%) is in developing countries. (2,3) It is well demonstrated that neurological outcome after TBI depends on the severity of initial injuries and the extent of secondary brain damage such as ischemia and hypoxia (4) . Prevention and treatment of such secondary injuries are mandatory and are considered a major concern of ICU management. In this situation, the maintenance of adequate cerebral blood flow (CBF) is critical (5,6) . AN INTERNATIONAL QUARTERLY JOURNAL OF BIOLOGY & LIFE SCIENCES 5(2):155-163 ISSN (online): 2320-4257 www.biolifejournal.com How to Site This Article: Taysser Zaytoun, Amr Abdalla, Bassem Beshay, Ahmed Elbeheiry, Moustafa Shebl (2017). Evaluation of cerebral autoregulation using transcranial doppler ultrasound in patients with moderate and severe traumatic brain injuries. Biolife. 5(2), pp 155-163. doi:10.17812/blj.2017.5202 Received: 5 Februaryy 2017; Accepted: 12 March, 2017; Published online: 5 April 2017