Applications of Transcranial Doppler Ultrasonography in Sickle Cell Disease, Stroke, and Critical Illness in Children

Abstract

Transcranial Doppler (TCD) ultrasonography has an established clinical role in reducing a first ever stroke in children with sickle cell disease (SCD) by identifying those at high risk who benefit from blood transfusion. In this chapter, we will review the literature related to this topic. Beyond SCD, other potential roles for TCD in pediatrics include as a point of care ultrasound (POCUS) or as a neuromonitoring strategy in the pediatric intensive care unit (PICU). We will therefore also review the literature for the applications of TCD in critically ill children with traumatic brain injury (TBI), cerebral vasospasm, brain death, and those undergoing support with extracorporeal membrane oxygenation (ECMO). Based on the limited available evidence for these topics, TCD data in these populations should be treated as hypothesis-generating. TCD may serve as a precursor or adjunct to definitive imaging or invasive techniques. In order to put TCD into routine practice in the pediatric intensive care unit (PICU), collaboration and research is needed to determine the appropriate clinical indications and quantify the impact of use on clinical care and outcomes.