Neuro Resus

A case based discussion on the different types of shock encountered in ICU and how shock is diagnosed

A summary of my experiences at the second and third days of the ESICM.

Links include:

Here is the IMPACT calculator for prognosticating in traumatic brain injury

For the Brain Tissue Oxygen Monitoring in Traumatic Brain Injury (BOOST 2) go here

For Simon Finfer's talk on the DECRA study click here

The Girault paper: Noninvasive Ventilation and Weaning in Patients with Chronic Hypercapnic Respiratory Failure

For lung ultrasound, you should look at both the Bouhamed paper and the Sartori paper, both here in fulltext for free.

There are a few lung ultrasound videos out there too, like this one

The BLUE protocol is here

Brain trauma foundation guidelines are here

Free fulltext of ECASS III is here

Martin Smith on intracerebral haemorrhage is all summarised here

A good summary of treating refractory status epilepticus is here

Some good neuro papers from the last year:

• Cerebral tissue oxygenation measured by two different probes: challenges and interpretation
• For the paper on measuring brain temperature with MRI spectroscopy, go here
• Ultrasound of the optic nerve sheath to estimate ICP is here
• Invasive and noninvasive assessment of cerebral oxygenation in patients with severe traumatic brain injury
• This is probably a more useful paper on the risk factors for delirium after cardiac surgery
• The bispectral index and suppression ratio are very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest
• Also see our presentation on this topic here

Top haemodynamic papers:

• Here is an older paper on using IVC diameter for volume responsiveness, and here is the paper Alex Mebezza referred to
• Comparing two different arginine vasopressin doses in advanced vasodilatory shock: a randomized, controlled, open-label trial
• Effects of fluids on microvascular perfusion in patients with severe sepsis

Top Mechanical ventilation papers:

• Non-invasive ventilation in postoperative patients: a systematic review
• Comparison of patient–ventilator interfaces based on their computerized effective dead space
• Predictors of prolonged weaning and survival during ventilator weaning in a respiratory ICU
• Post-traumatic stress disorder after weaning from prolonged mechanical ventilation

Top ICU infection/micro papers from the last year:

• Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection
• Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: A systematic review and meta-analysis
• Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study
• Intrapleural use of tissue plasminogen activator and DNase in pleural infection

Best of metabolic and sepsis articles last year:

• Impact of hypoxic hepatitis on mortality in the intensive care unit
• Assessing adrenal insufficiency of corticosteroid secretion using free versus total cortisol levels in critical illness

• Initial experiences with point-of-care rapid thrombelastography for management of life-threatening postinjury coagulopathy
• A Cochrane review is here

A description of some of the presentations I attended on the first day of this year's ESICM conference in Berlin.

Here are links to some of the material discussed in this Podcast:

• For the WHO Malaria Guidelines, look here

• For an article on paroxysmal sympathetic hyperactivity, go here

• For more about VAP, there's this, and for prevention, look here.

• Here is the JAMA paper on hydrocortisone in multi-trauma patients

• For review on NAVA look here.

• Here is the key Subarachnoid Haemorrhage paper: Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage: Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference

An interview with Professor Richard Lee discussing the role of intensive care specialsits now and in the future.

A podcast on the acute management of spinal cord injury from an Australian Emergency Department and intensive Care perspective.

A brief podcast on strategies to help wean a patient from mechanical ventilation.

A case-based podcast on the acute management of intra-cerebral haemorrhage by Oliver Flower, an intensive care specialist from Sydney. It accompanies a recent review article:

Flower O, Smith M.

The acute management of intracerebral hemorrhage.

Curr Opin Crit Care. 2011 Apr;17(2):106-14.