Point of Care Cranial Ultrasound in a Hemicraniectomy Patient

Sarwal, Aarti; Elder, Natalie M.

doi:10.5811/cpcem.2018.7.39379

Cited by 9 publications

(3 citation statements)

References 2 publications

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“…POCUS is a non-invasive procedure, which is becoming an integral part in care and management of patients as it provides a real time information. It is also helpful in assessing progress of the disease and response to specific treatment (13). POCUS can be done bedside without mobilizing patient to minimize risk, reducing cost and monitoring complications.…”

Section: Discussionmentioning

confidence: 99%

“…Many authors have described several intracranial windows for ultrasound, but they are rarely performed (6). Transcranial POCUS in a hemicraniectomy patient provides a unique window for evaluating various pathologies which has been reported to identify important intracranial pathologies (13,17). Although, a B mode ultrasound can be done in patients with intact skull, the visibility becomes far better when the bone flap is removed.…”

Section: Discussionmentioning

confidence: 99%

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Systematic use of point of care ultrasound in neurosurgical intensive care unit: a practical approach

Pokhrel¹,

Thapa²

2023

Quant Imaging Med Surg

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Background: Point of care ultrasound (POCUS) is a cost-effective, non-invasive procedure with high diagnostic reliability and therapeutic utilities. For various reasons, it is not being used routinely in neurosurgical intensive care unit (ICU). We have introduced a systematic use of POCUS in critically ill patients in our neurosurgical ICU. We have studied the various indications and benefit of using this technique.Methods: This is a prospective, single center cohort observational study done in patients who were admitted in a tertiary neurosurgical ICU over 1 year (17 th September 2020 to 16 th September 2021).POCUS was used daily as per a standardized format for multiple purposes. A formal training to the operator was provided and standardized method of evaluation and intervention was used. Outcome was studied to understand the impact of the POCUS and difficulties encountered during its use.Results: POCUS was used in 240 patients, including all patients for primary and secondary surveys, 192 patients (80%) for optic nerve sheath diameter (ONSD) measurement, 14 myelomeningoceles for transfontanelle ultrasound study, 16 post operative cases of aneurysm clipping for transcranial Doppler (TCD) study, 86 patients for deep vein thrombosis (DVT) screening, 17 for evaluation of ventriculo-peritoneal (VP) shunt functionality, 30 for transcranial defect ultrasound, 45 for chest ultrasound, 4 for evaluation of hemodynamic shock and 67 patients who had difficult cannualtion or while insertion of central venous catheter placement. POCUS was also used for difficult cannulation, central catheter placement and e-FAST scan. Significant findings were reported 129 times, which led to immediate change in management in 62 patients (25.83%) as compared to 16 patients in whom significant findings were not reported using POCUS, but management was changed using other radiological modalities (P<0.01). There was initial lag in adopting the technique, however with practice, the team developed confidence. As a result, the accuracy and time taken to perform the procedure was reduced significantly.Conclusions: Routine systematic use of POCUS can be beneficial not only for the rapid diagnosis and prompt management of patients, but also helpful in monitoring and performing various procedures in neurosurgical ICU. Though not all modalities mentioned in standardized format was used in all patients, use of this format has helped improved training and maintain proper use of POCUS in our ICU.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systematic use of point of care ultrasound in neurosurgical intensive care unit: a practical approach

Pokhrel¹,

Thapa²

2023

Quant Imaging Med Surg

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“…Cranial ultrasound images were then obtained by trained investigators (AO and SK) blinded to patients’ CT scans and archived in QPath™ E (Telexy). Patients were excluded from the study if the patient, bedside family, or nursing staff declined an ultrasound scan, the patient had any penetrating head trauma or skull defects that could affect ultrasound insonation, 2 and if images could not be obtained within 24 hours of last or expected CT or MRI imaging to ensure corresponding acute pathology was imaged. Patients being evaluated for coronavirus disease 2019 (COVID‐19) or in contact precautions due to confirmed COVID‐19 were also excluded.…”

Section: Methodsmentioning

confidence: 99%

Brain topography on adult ultrasound images: Techniques, interpretation, and image library

Kapoor

Offnick

Allen

et al. 2022

Journal of Neuroimaging

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Background and Purpose Many studies have explored the possibility of using cranial ultrasound for discerning intracranial pathologies like tumors, hemorrhagic stroke, or subdural hemorrhage in clinical scenarios where computer tomography may not be accessible or feasible. The visualization of intracranial anatomy on B‐mode ultrasound is challenging due to the presence of the skull that limits insonation to a few segments on the temporal bone that are thin enough to allow transcranial transmission of sound. Several artifacts are produced by hyperechoic signals inherent in brain and skull anatomy when images are created using temporal windows. Methods While the literature has investigated the accuracy of diagnosis of intracranial pathology with ultrasound, we lack a reference source for images acquired on cranial topography on B‐mode ultrasound to illustrate the appearance of normal and abnormal structures of the brain and skull. Two investigators underwent hands‐on training in Cranial point‐of‐care ultrasound (c‐POCUS) and acquired multiple images from each patient to obtain the most in‐depth images of brain to investigate all visible anatomical structures and pathology within 24 hours of any CT/MRI imaging done. Results Most reproducible structures visible on c‐POCUS included bony parts and parenchymal structures. Transcranial and abdominal presets were equivalent in elucidating anatomical structures. Brain pathology like parenchymal hemorrhage, cerebral edema, and hydrocephalus were also visualized. Conclusions We present an illustrated anatomical atlas of cranial ultrasound B‐mode images acquired in various pathologies in a critical care environment and compare our findings with published literature by performing a scoping review of literature on the subject.

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Cranial Ultrasound

Sarwal

2022

Neurovascular Sonography

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Point of Care Cranial Ultrasound in a Hemicraniectomy Patient

Cited by 9 publications

References 2 publications

Systematic use of point of care ultrasound in neurosurgical intensive care unit: a practical approach

Systematic use of point of care ultrasound in neurosurgical intensive care unit: a practical approach

Brain topography on adult ultrasound images: Techniques, interpretation, and image library

Cranial Ultrasound

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