Procedures and Protocols in the Neurocritical Care Unit

Foreword
Preface
Acknowledgements
Contents
Contributors
Part I: Procedures
Vascular Access
1 Peripheral Vascular Catheters
1.1 Introduction
1.2 Method of Insertion [6]
1.3 Technique [6, 13]
1.4 Pitfalls
2 Central Vascular Catheters
2.1 Introduction
2.2 Indications
2.2.1 Non-tunneled CVCs (Fig. 5)
2.2.2 Tunneled CVCs
2.3 Technique of Insertion for Non-tunneled Catheters [6, 13] (Fig. 6)
2.4 Pitfalls
3 Specialty Catheters
3.1 Hemodialysis Catheters: (Fig. 7)
3.2 Introducer Sheaths: (Fig. 8)
3.3 Technique
3.3.1 Hemodialysis Catheter
3.3.2 Introducer Sheath [36]
References
Pulmonary Artery Catheters
1 Introduction
2 Indications
3 Technique/Methods
4 Types of Kits Available
5 Pitfalls and Troubleshooting
References
Arterial Catheters
1 Introduction
2 Indications
3 Technique/Methods
4 Types of Kits Available
5 Pitfalls and Troubleshooting
Airway Access
Introduction
Airway Anatomy
1 Supraglottic Devices
1.1 Oropharyngeal and Nasopharyngeal Airways
1.2 Laryngeal Mask Airway (LMA)
2 Infraglottic Devices
2.1 Direct Laryngoscopy
2.2 Video Laryngoscopy
3 Surgical Airway
4 Percutaneous Dilatation Tracheostomy (PDT)
5 Bronchoscopy
6 Summary
Bibliography
Thoracocentesis
1 Introduction
2 Indications
3 Technique/Methods
3.1 Prepare the Patient
3.2 Prepare Equipment and Yourself
3.3 Procedure Walkthrough
4 Pitfalls/Troubleshooting
References
Chest Tube Thoracostomy
1 Introduction
2 Indications
3 Technique/Methods
3.1 Prepare the Patient
3.2 Prepare Equipment and Yourself
3.3 Procedure Walkthrough
4 Pitfalls/Troubleshooting
References
Pericardiocentesis
1 Introduction
2 Indications
3 Equipment
4 Technique/Methods
5 Management After Pericardiocentesis
6 Complications
7 Tips to Avoid Complications
References
Paracentesis
1 Introduction
2 Indications for Abdominal Paracentesis
3 Contraindications
4 Steps Involved in Performing Abdominal Paracentesis
5 Analyzing Peritoneal Fluid
6 Complications
7 Types of Kits Available
8 Pitfalls of Paracentesis
References
Lumbar Puncture and Intrathecal Drug Administration
1 Introduction
2 Indications
3 Contraindications
4 Anatomy, Positioning, and Needle Location
4.1 Anatomy
4.2 Position Techniques
4.3 Spine Level Location
5 Needle Variants
5.1 Needle Type
5.2 Needle Gauge
6 Imaging Guided
6.1 Ultrasound Guidance
6.2 Fluoroscopy Guidance (Fig. 2)
6.3 CT Guidance
7 Complications
7.1 Intrathecal Lidocaine
7.2 Epidural Hematoma
7.3 Infection
7.4 Post Lumbar Puncture Headache
7.5 Needle Deformation
8 Conclusion
References
Intracranial Access
1 Introduction
2 Intracranial Pressure Monitoring
2.1 External Ventricular Drain Placement
2.2 Fiberoptic Intracranial Pressure Monitor (Camino, or “bolt”)
2.3 Brain Oxygenation Monitoring (Licox®, Integra; San Diego, CA, USA)
3 Subdural Drainage
3.1 Subdural Drain
3.2 Subdural Evacuating Port System (SEPS) Placement
References
Point of Care Ultrasound
1 Introduction
2 Basics of Ultrasonography
2.1 Echogenicity
2.2 Probe Selection
2.3 Positioning and Probe Control
3 Vascular Ultrasound
3.1 Vascular Access
3.2 Deep Venous Thromboembolism Screening and Diagnosis
3.3 Two-Point DVT Screen
4 Lung Ultrasound
4.1 Normal Lung Ultrasound Patterns
4.1.1 Lung Sliding
4.1.2 A-Lines
4.2 Abnormal Lung Ultrasound Patterns
4.2.1 Pneumothorax
4.2.2 B-Lines
4.2.3 Pleural Effusions
4.2.4 Consolidation
4.2.5 BLUE Protocol
5 Cardiac Ultrasound
5.1 Transthoracic Views
5.1.1 Parasternal Long-Axis View
5.1.2 Parasternal Short-Axis View
5.1.3 Apical Four-Chamber View
5.1.4 Subcostal Long-Axis View
5.1.5 Inferior Vena Cava Longitudinal View
5.2 Utility of Cardiac POCUS
5.2.1 Left Ventricular Systolic Function
5.2.2 Fluid Responsiveness
5.2.3 Tamponade
5.3 Right Ventricular Function and Pulmonary Embolism
6 Focused Assessment Sonography in Trauma (FAST)
7 Conclusion
References
Transcranial Doppler Ultrasound
1 Introduction
2 Doppler Ultrasound Concepts
3 TCD Equipment and the Technique
3.1 Comparison of TCD to TCCD
4 Technique
5 Clinical Applications of TCD
5.1 Vasospasm
5.2 Stenosis
5.3 Acute Ischemic Stroke
5.4 Traumatic Brain Injury
5.5 Brain Death Evaluation
5.6 Sickle Cell Disease
6 Conclusion
References
Cervical Traction
1 Introduction
2 Indications, Contraindications, and Caveats
3 Procedure: Cervical Traction/Closed Reduction with Garner-Wells Tongs
4 Post-procedural Care
5 Case Presentation
References
Part II: Protocols
Sedation and Analgesia Management
1 Introduction
2 Indications
3 Drug Selection
4 Pharmacological Agents for Sedation and Analgesia
5 Tools for Objective Measuring of Sedation and Analgesia
6 Sedation Interruptions
7 Pitfalls
8 Summary
References
Intracranial Hypertension in Intensive Care Unit
1 Introduction
1.1 Pathophysiology of Raised ICP
1.2 Etiology of Elevated ICP: [8–12]
1.3 Clinical Features: Table 2 [13–15]
1.4 ICP Monitoring: [1, 2, 8, 13, 16]
1.5 Indications for ICP Monitoring Devices [3]
1.6 Role of Fundoscopy: [17–22]
1.7 Management: [3, 23–28]
1.8 Surgery [30–32]
1.9 Mannitol [33–35]
1.10 Sedation: [16, 27, 39]
1.11 Temperature Modulation
2 Lumbar Drain (LD)
2.1 Future Directions
References
Sepsis and Fever in the Neuro-Critical Care Unit (NCCU)
1 Introduction
1.1 Definitions
2 Measurement of Body Temperature [9, 10]
3 Causes of Fever in Intensive Care Unit (ICU)
4 Infectious Causes of Fever (Table 3)
5 Management of Bacterial Meningitis
6 AMP-C Group of Organisms
7 Non-infectious Causes of Fever in NCCU
8 Protocol for Fever Management in NCCU
References
Status Epilepticus
1 Introduction
2 Treatment Algorithm for Management of Convulsive Status Epilepticus
3 Drugs Used for Treatment of Status Epilepticus
4 Current Evidence
5 Future Directions
References
Targeted Temperature Management
1 Introduction
2 Indications and Contraindications (Table 1)
3 Techniques for Targeted Temperature Management
4 Conventional Methods
5 Surface Cooling (SFC)
6 Endovascular Cooling
7 Other Methods
8 Protocol
8.1 Induction
8.2 Maintenance
8.3 Rewarming
9 Shivering (Fig. 4)
References
Original Bibliography
Mechanical Ventilation and Weaning In ICU
1 Introduction
2 Airway Assessment
3 Predictors of Difficult Ventilation
4 Predictors of Difficult Intubation – Table 1
5 Modes of Ventilation
References
Tracheostomy Care
1 Introduction
2 Tracheostomy Care
3 Post-placement Care
4 Tracheostomy Weaning to Decannulation
4.1 Downsizing
4.2 Passy-Muir Valve or Speaking Valve
4.3 Capping Trials
4.4 Decannulation
Bibliography
Hemodynamic Monitoring
1 Introduction
2 Basic Principles of Fluid Resuscitation
2.1 Frank-Starling Curve
2.2 Diastolic Volume-Pressure Curve (Fig. 1)
2.3 Contractility (Fig. 1)
2.4 Mean Systemic Filling Pressure (Pms)
2.5 Venous Return
3 Hemodynamic Profiles of Shock
3.1 Methods of Assessment
4 Role of Ultrasound in Hemodynamic Assessment
4.1 Method
4.2 Basic Principles of Lung Ultrasound and Image Acquisition
4.3 Method
5 Artifacts
6 Real Images
6.1 Utility in Neuro-Science Intensive Care Unit
7 Future Directions
8 Application
References
Endotracheal Intubation via Direct Laryngoscopy
1 Introduction
2 Indications and Contraindications
3 Medications
4 Choosing the Medications for ETI in a Neurocritical Patient
5 Anatomy
6 Preparation
7 Technique
8 Confirming Proper Placement of Endotracheal Tube
9 Protocol for ETI (Fig. 2)
References
Vasospasm
1 Introduction
1.1 Incidence and Pathophysiology
1.2 Diagnostic Modalities
2 Prevention of Vasospasm
3 Treatment of Vasospasm (Table 5)
4 Pharmacological Treatment
5 Endovascular Therapy
6 Protocol for Vasospasm Management
7 Future Directions
References
Phenobarbital for Alcohol Withdrawal Syndrome
1 Introduction
2 Management of Alcohol Withdrawal
3 Pharmacotherapy
4 Literature Review
References
Diabetic Ketoacidosis and Hyperglycemia
1 Introduction
2 Glucose Homeostasis in the Brain
3 Hyperglycemia and Hypoglycemia in the Neurocritical Care Unit (NCCU)
4 Management of Hyperglycemia in the NCCU
References
Electrolyte Management
1 Introduction
2 Calcium Management
3 Magnesium Management
4 Phosphorus Management
5 Potassium Management
6 Sodium Management
7 Summary
References
Plasmapheresis
1 Introduction
2 Basic Nomenclature
3 Indications of Therapeutic Plasma Exchange (Table 1)
3.1 Principles
3.2 Mechanisms of Action
4 Technique (Fig. 1)
4.1 Vascular Access for Therapeutic Plasma Exchange
4.2 Anticoagulation
4.3 Replacement Fluids
5 Prescription of Therapeutic Plasma Exchange
6 Summary of Recommendations for Use of TPE in Neurology Intensive Care
7 Complications and Monitoring
8 Contraindications
9 Conclusion
References
Intravenous Immunoglobulin
1 Introduction
2 Composition
3 Mechanism of Action
4 Immunoglobulin in Neurological Diseases
4.1 Neurological Dose of IVIG
4.2 Neurological Disorders Treated with IVIG
5 Adverse Effect and Management
6 Conclusion and Future Directions
References
Brain Death
1 Introduction
2 Procedure for Declaration of Death by Neurological Criteria
3 Current Evidence and Guidelines
4 Special Case Scenarios
5 Future Prospects
References
Continuous Renal Replacement Therapy
1 Introduction
2 Risk Factors for Renal Injury in the ICU
3 Diagnosing Acute Kidney Injury in Critically-Ill Patients (Table 1)
4 Indications of Renal Replacement Therapy (Table 2)
5 Timing of RRT- Is Early Initiation of RRT Beneficial?
6 Renal Replacement Therapies in NCCU
7 Types of Renal Replacement Therapy (RRT) (Table 3)
8 CRRT
8.1 Principles of CRRT
8.2 Modes of CRRT
9 Is CRRT Superior Than Other Modalities?
10 CRRT Dosing
11 Dialysis Access
12 Anticoagulation
13 Types of Anticoagulation for CRRT [17]
13.1 Regional Anticoagulation (Table 6)
13.2 Systemic Anticoagulation (Table 7)
14 Special Considerations for CRRT Prescription in Neurocritical Care Patients
15 Prevention of AKI
16 Novel Approaches
17 Conclusion
References
Delirium
1 Introduction
2 Epidemiology
3 Risk Factors
4 Diagnosis
4.1 Clinical Presentation
5 Prevention
6 Management
7 Outcomes
References
Index