NEUROCRITICAL CARE COVID-19
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It’s here. Time to learn. Please see the COVID19 Section on TamingtheNeuroICU menu here:
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TAMING THE NEURO ICU
TTM and ECMO – How low should you go?
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In 2002, two landmark clinical trials published back-to-back in the New England Journal of Medicine (Bernard and HACA), building upon animal models that showed a neuroprotective benefit to hypothermia after cardiac arrest, set the bar for post-cardiac arrest care in the new millennium. Practice patterns changed rapidly as intensivists and hospital systems attempted to replicate their results, with greater than 50% of their patients in the 33C hypothermia arm of each trial achieving a good neurological outcome.
Read MoreCVC Confirmation using POCUS
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Central venous catheters (CVCs) are widely used in the resuscitation and treatment of critically ill and injured patients. Standard practice necessitates verification of line placement when inserted above the diaphragm. This has traditionally been accomplished in most institutions by use of post-insertion chest radiography, which will both identify the tip of the catheter at the cavoatrial junction and rule out pneumothorax ipsilateral to the insertion site.
Read MoreRetained Hemothorax: An Unusual Case
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Traumatic hemothorax occurs frequently, with up to 300,000 cases occurring yearly in the United States.1 In cases of polytrauma, head and chest injuries frequently occur together,2 and thus it is important for all neurointensivists who see TBI to understand management of common traumatic chest injuries, including hemothorax. While some small hemothoraces (<300cc’s) can be monitored clinically,3 standard of care for most large traumatic hemothoraces is rapid tube thoracostomy.
Read MoreOptions for non-invasive ICP monitoring in patients with fulminant hepatic failure
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Elevated intracranial pressure (ICP) is an important cause of death following acute liver failure (ALF). While invasive ICP monitoring (IICPM) is most accurate, the presence of coagulopathy increases bleeding risk in ALF. Our objective was to evaluate the accuracy of three noninvasive ultrasound-based measures for the detection of concurrent ICP elevation in ALF—optic nerve sheath diameter (ONSD) using optic nerve ultrasound (ONUS); middle cerebral artery pulsatility index (PI) on transcranial Doppler (TCD); and ICP calculated from TCD flow velocities (ICPtcd) using the estimated cerebral perfusion pressure (CPPe) technique .
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