Abstract
In the beginning, cerebral ultrasound (US) was not considered feasible because the intact skull was a seemingly impenetrable obstacle. For this reason, obtaining a clear image resolution had been a challenge since the first use of neuroultrasound (NUS) for the assessment of small deep brain structures. However, the improvements in transducer technologies and advances in signal processing have refined the image resolution, and the role of NUS has evolved as an imaging modality for the brain parenchyma within multiple pathologies. This article summarizes ten crucial applications of cerebral ultrasonography for the evaluation and management of neurocritical patients, whose transfer from and to intensive care units poses a real problem to medical care staff. This also encompasses ease of use, low cost, wide acceptance by patients, no radiation risk, and relative independence from movement artifacts. Bedsides, availability and reliability raised the interest of critical care intensivists in using it with increasing frequency. In this mini-review, the usefulness and the advantages of US in the neurocritical care setting are discussed regarding ten aspects to encourage the intensivist physician to practice this important tool.
Highlights
Ultrasound (US) has gained a prominent role in critical care clinical practice
We propose the performance of NUS that comprises US measurement of the optic nerve sheath diameter (ONSD), transcranial Doppler (TCD) evaluation by the “conventional” or “blind” method, and transcranial color-coded duplex (TCCD)
This study presents 10 reasons why NUS should be part of the current clinical practice dealing with intensive care unit (ICU) patients, considering different clinical contexts of patients admitted to a mixed general-neuro ICU
Summary
Ultrasound (US) has gained a prominent role in critical care clinical practice. Cerebral US does not replace advanced and precise static imaging exams, it adds dynamic cerebrovascular information of a non-invasive test at the bedside, that does not displace the patient from the intensive care unit (ICU), does not expose them to radiation, and allows for prompt re-evaluation after some intervention or clinical change [1, 2]. Transcranial color-coded duplex and TCD are methods based on cerebral blood flow (CBF) velocity that are related to cerebral perfusion pressure (CPP). A recent study has demonstrated that TCD values combined with ONSD measurement increased the accuracy [0.91 (0.84–0.97)] of non-invasive methods to detect IH [9].
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