Letter to the Editor
Bias in the interpretation of the transcranial color-coded duplex sonography register
Factores de confusión en el análisis del registro de ecografía dúplex transcraneal codificado color
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Rocchetti, J.J. Egea-Guerrero" "autores" => array:2 [ 0 => array:4 [ "nombre" => "N.S." "apellidos" => "Rocchetti" "email" => array:1 [ 0 => "nicolasrocchetti@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.J." "apellidos" => "Egea-Guerrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos, Hospital Eva Perón, Granadero Baigorria, Santa Fe, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Neurocríticos, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores de confusión en el análisis del registro de ecografía dúplex transcraneal codificado color" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Arroyo Diez et al. presented an interesting clinical case on a female patient admitted to hospital due to brain hemorrhage with findings of iatrogenic pneumothorax secondary to the catheterization of the central vascular access. The color-coded duplex sonography register (CCDSR) confirmed the lack of diastolic wave, which would be later normalized after the insertion of thoracic drainage.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> However, we should bear in mind that even though the CCDSR is a valuable ultrasound imaging modality that allows real-time simultaneous 2D study of the brain at bedside, the color visualization of basal arterial and venous vessels, and the doppler spectrum analysis of these vessels, if we want to interpret it correctly it is essential to know the hemodynamic characteristics of the patient.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Unfortunately, this piece of information that we think is inevitable is not mentioned anywhere in the manuscript which conditions the CCDSR register in such a way that it cannot be interpreted in isolation without knowing the patient's hemodynamic situation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Regardless of the method used by the authors – CCDSR – another valid option would have been to use the transcranial doppler ultrasonography. However, this is a more complex imaging modality because it requires appropriate training to be able to obtain the register and its interpretation. As any other flow imaging modality, it is as limited as the CCDSR, and it requires the patient's hemodynamic stabilization and clinical data such as the patient's fever, anemia, CO<span class="elsevierStyleInf">2</span> levels, among others, to be able to interpret the register obtained correctly.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We think the following should have been reported as they are important pieces of information while conducting a general physical examination: heart and respiratory rates, oxygen saturation, and the presence of decreased vesicular breath sounds during respiratory auscultation. And, in this case, they are particularly relevant data since they are altered in a great number of patients with tension pneumothorax at presentation.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In sum, although the CCDSR image of the case presented here is interesting, we believe it lacks the minimal information required, so we have to be cautious when it comes to interpreting its results. However, we agree with the authors’ message on the need to develop non-invasive imaging modalities, to be used at bedside by intensivists, to have more information on the physiopathological processes that critically ill patients actually go through.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rocchetti NS, Egea-Guerrero JJ. Factores de confusión en el análisis del registro de ecografía dúplex transcraneal codificado color. Med Intensiva. 2019;43:255.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disappearance of cerebral diastolic flow after an unexpected complication" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Arroyo Diez" 1 => "A. Zabalegui Perez" 2 => "G. 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|---|---|---|---|
| 2024 November | 7 | 7 | 14 |
| 2024 October | 34 | 31 | 65 |
| 2024 September | 36 | 32 | 68 |
| 2024 August | 40 | 29 | 69 |
| 2024 July | 33 | 32 | 65 |
| 2024 June | 44 | 38 | 82 |
| 2024 May | 31 | 40 | 71 |
| 2024 April | 39 | 37 | 76 |
| 2024 March | 33 | 37 | 70 |
| 2024 February | 30 | 39 | 69 |
| 2024 January | 32 | 28 | 60 |
| 2023 December | 27 | 39 | 66 |
| 2023 November | 34 | 43 | 77 |
| 2023 October | 23 | 30 | 53 |
| 2023 September | 27 | 43 | 70 |
| 2023 August | 20 | 28 | 48 |
| 2023 July | 30 | 25 | 55 |
| 2023 June | 27 | 22 | 49 |
| 2023 May | 36 | 32 | 68 |
| 2023 April | 27 | 24 | 51 |
| 2023 March | 41 | 28 | 69 |
| 2023 February | 65 | 35 | 100 |
| 2023 January | 32 | 17 | 49 |
| 2022 December | 47 | 26 | 73 |
| 2022 November | 39 | 28 | 67 |
| 2022 October | 54 | 35 | 89 |
| 2022 September | 33 | 27 | 60 |
| 2022 August | 35 | 40 | 75 |
| 2022 July | 29 | 37 | 66 |
| 2022 June | 26 | 19 | 45 |
| 2022 May | 36 | 35 | 71 |
| 2022 April | 37 | 37 | 74 |
| 2022 March | 54 | 51 | 105 |
| 2022 February | 36 | 29 | 65 |
| 2022 January | 38 | 39 | 77 |
| 2021 December | 35 | 43 | 78 |
| 2021 November | 44 | 33 | 77 |
| 2021 October | 66 | 77 | 143 |
| 2021 September | 30 | 29 | 59 |
| 2021 August | 26 | 36 | 62 |
| 2021 July | 20 | 23 | 43 |
| 2021 June | 39 | 18 | 57 |
| 2021 May | 41 | 43 | 84 |
| 2021 April | 68 | 91 | 159 |
| 2021 March | 88 | 23 | 111 |
| 2021 February | 43 | 26 | 69 |
| 2021 January | 31 | 22 | 53 |
| 2020 December | 36 | 22 | 58 |
| 2020 November | 27 | 18 | 45 |
| 2020 October | 30 | 29 | 59 |
| 2020 September | 83 | 15 | 98 |
| 2020 August | 77 | 22 | 99 |
| 2020 July | 58 | 20 | 78 |
| 2020 June | 23 | 14 | 37 |
| 2020 May | 23 | 12 | 35 |
| 2020 April | 25 | 9 | 34 |
| 2020 March | 40 | 8 | 48 |
| 2020 February | 81 | 36 | 117 |
| 2020 January | 45 | 20 | 65 |
| 2019 December | 49 | 16 | 65 |
| 2019 November | 23 | 20 | 43 |
| 2019 October | 32 | 12 | 44 |
| 2019 August | 0 | 0 | 0 |
| 2019 May | 0 | 5 | 5 |
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