Neurocritical care
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Alterations in regional brain microcirculation have not been well studied in patients with sepsis. Regional brain microcirculation can be studied using contrast-enhanced brain ultrasound (CEUS) with microbubble administration. ⋯ Alterations in regional brain microcirculation are present in critically ill patients with sepsis and are associated with poor outcome. Trial registration Registered retrospectively on December 19, 2019.
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Transcranial color Doppler (TCD) is currently the only noninvasive bedside tool capable of providing real-time information on cerebral hemodynamics. However, being operator dependent, TCD monitoring is not feasible in many institutions. Robotic assisted TCD (ra-TCD) was recently developed to overcome these constraints. The aim of this study was to evaluate the safety and feasibility of cerebral monitoring with a novel ra-TCD in acute neurovascular care. ⋯ This novel ra-TCD showed an excellent safety and feasibility and proved to be as reliable as manual TCD in detecting blood flow velocities. These findings support its wider use for cerebral hemodynamics monitoring in acute neurovascular care. However, further technical improvements are needed to expand the range of applicable settings.
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The apnea test (AT) plays a vital role in diagnosing brain death by evaluating the absence of spontaneous respiratory activity. It entails disconnecting the patient from mechanical ventilation to raise the CO2 partial pressure and lower the pH. Occasionally, the AT is aborted because of safety concerns, such as hypoxemia and hemodynamic instability, to prevent worsening conditions. However, the exact oxygen partial pressure level needed before commencing AT, indicating an inability to tolerate the test, is still uncertain. This study seeks to determine pre-AT oxygen levels linked with a heightened risk of test failure. ⋯ PaO2 values at the conclusion of the AT are closely associated with PaO2 values at the beginning of the test. Establishing a cutoff value of approximately 300 mmHg PaO2 at the onset of AT may assist in avoiding saturation drops below 90%.