Oct 29th, 2019 Archives

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Non-Invasive Multiparametric Monitoring through Measurement of the Optic Nerve Sheath Diameter and Transcranial Doppler Ultrasound as an Approach to Cerebral Hemodynamics

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Among a group of monitoring techniques that estimate ICP non-invasively, the measurement of the optic nerve sheath diameter (ONSD) seems to be the most promising. The prediction threshold to correlate with a high ICP (> 20 mmHg) has been proposed by some authors between 5.7 and 5.9 mm but there is no uniform cut-off point in the literature. Objective: to determine the utility of the ONSD measurement as an estimate of non-invasive ICP; correlating it with invasive measurements and cerebral hemodynamic patterns by transcranial Doppler. Method: the sample consisted of a series of five neurocritical cases admitted to the intensive care unit of the Centro de Investigaciones Médico Quirúrgicas, to which an intraventricular catheter was placed to measure ICP by air bag using the Spiegelberg monitor. Each patient underwent simultaneous measurements of ICP, transcranial Doppler ultrasound and retrobulbar ultrasound to measure OND. In total, 16 measurements were made that integrated the data for statistical analysis. Results: the value of ONSD over which there was ICP ≥ 20 mmHg was 6.50 mm, constituting the cut-off point. The correlation between mvMCA and ONSD was moderate and inverse, with statistical significance (r = -0.532, p = 0.034). Conclusions: non-invasive multiparametric monitoring as part of critical ultrasound shows promise in neurocritical patients.

Anselmo A. Abdo-Cuza, Roberto Castellanos-Gutierrez, Juan A. Gutiérrez-Martínez, Juliette Suárez-López, et. al. Measurement of the Optic Nerve Sheath Diameter and Transcranial Doppler Ultrasound as an Approach to Cerebral Hemodynamics. Archives of Emergency Medicine and Intensive Care. 2019; 2(1): 22-29   

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Point-of-care ultrasound in the critically-ill pregnant-postpartum patient: What every intensivist should know

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ICMPregnant and postpartum women account for a low, although not negligible, rate of admissions to the intensive care unit (ICU), being hypertensive disorders of pregnancy and obstetric hemorrhage, the leading causes requiring critical care. Given the widespread use of point-of-care ultrasound (POCUS) in the ICU, most of these complications can be detected and monitored using this method. For using POCUS appropriately, normal changes of pregnancy-puerperium should be well-known by the intensivists for avoiding confusion with pathology. This review summarizes the normal findings of pregnancy and puerperium and its correlation with POCUS, as well as main pathologies observed in this period, both grouped according to POCUS applications: cardiac, lung, abdomen-pelvis, vascular and brain ultrasound.

Intensive Care Med. 2019 Aug;45(8):1123-1126. doi: 10.1007/s00134-019-05682-2.

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Filed under Doppler transcraneal, Fallo hepático agudo, Monitorización hemodinámica, ultrasonido_emergencia by on . Comment. #

Ecografía clínica en enfermos críticos en países en desarrollo de Latinoamérica

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MedwaveAnselmo Abdo-Cuza, Pablo Blanco (Cuba, Argentina). Medwave 2019;19(9):e7709

En los últimos años, la ecografía clínica ha revolucionado el cuidado de los enfermos críticos y puede considerarse hoy en día una herramienta de trabajo imprescindible para los profesionales. Si bien su uso atraviesa una etapa in crescendo en los países en desarrollo de Latinoamérica, aún es infrautilizada, por diversos motivos. Describimos en este artículo el estado actual de la ecografía en el enfermo crítico en varios países en vías de desarrollo de Latinoamérica, los problemas y barreras que atentan contra su implementación, y proponemos algunas estrategias para la diseminación del método.

Medwave 2019;19(9):e7709 doi: 10.5867/medwave.2019.09.7709

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