Background Cardiac output (CO) measurement in the intensive care unit (ICU) requires invasive devices such as the pulmonary artery (PA) catheter or arterial waveform pulse contour analysis (PCA). This study tests the accuracy and feasibility of point of care ultrasound (POCUS) of the common carotid artery to estimate the CO non-invasively and compare it to existing invasive CO measurement modalities. Methods Patients admitted to the surgical and cardiothoracic ICU in a tertiary university-affiliated academic center during a 4-month period, with invasive hemodynamic monitoring devices for management, were included in this cohort study. Common carotid artery POCUS was performed to measure the CO and the results were compared to an invasive device. Results Intensivists and ICU fellows, using ultrasound of the common carotid artery, obtained the CO measurements. Images of the Doppler flow and volume were obtained at the level of the thyroid gland. Concurrent CO measured via invasive devices was recorded. The patient cohort comprised 36 patients; 52 % were females. The average age was 59 ± 13 years, and 66 % were monitored via PCA device and 33 % via PA catheter. Intraclass correlation coefficient (ICC) analysis demonstrated almost perfect correlation (0.8152) between measurements of CO via ultrasound vs. invasive modalities. The ICC between PO-CUS and the invasive measurement via PCA was 0.84 and via PA catheter 0.74, showing substantial agreement between the ultrasound and both invasive modalities. Conclusions Common carotid artery POCUS offers a non-invasive method of measuring the CO in the critically ill population.Keywords Cardiac output Á Ultrasound Á Carotid doppler Á Pulmonary artery catheter Á Pulse contour analysis Á Point of care ultrasound Abstract Background La misurazione della gittata cardiaca (CO) in Unità di Terapia Intensiva (ICU) richiede dispositivi invasivi come il cateterismo dell'arteria polmonare (PA) o l'analisi dell'onda dell'impulso arterioso (PCA). Questo studio si propone di valutare l'accuratezza e la fattibilità dell'ecografia (POCUS) della carotide comune per stimare la CO in modo non invasivo e confrontarla con le modalità esistenti di misurazione della CO effettuate in maniera invasiva. Metodi I pazienti ricoverati in terapia intensiva chirurgica e cardiotoracica in un centro accademico, affiliato con l'università, nel corso di un periodo di quattro mesi, sottoposti a dispositivi di monitoraggio emodinamico invasivo sono stati inclusi in questo studio. E' stata eseguita l'ecografia dell'arteria carotide comune per misurare la CO ed i risultati sono stati confrontati con una tecnica invasiva. Risultati Medici di terapia intensiva e borsisti, utilizzando l'ecografia della carotide comune, hanno ottenuto le misurazioni della CO. Immagini del flusso Doppler e di volume sono state ottenute a livello della ghiandola tiroidea. Contemporaneamente è è stata registrata la CO mediante dispositivi invasivi. Il gruppo era costituito da 36 Ultrasound (2015) 18:127-133 DOI 10.1007 pazien...

IJV and IVC collapsibility correlated during spontaneous breathing but there was no statistically significant correlation during increased thoracic or intra-abdominal pressure. Increased intra-abdominal pressure was associated with a significant smaller maximal IVC diameter and cautions the reliability of IVC diameter in clinical settings that are associated with intra-abdominal hypertension or abdominal compartment syndrome.

Background. Lung injury prediction score (LIPS) is valuable for early recognition of ventilated patients at high risk for developing acute respiratory distress syndrome (ARDS). This study analyzes the value of LIPS in predicting ARDS and mortality among ventilated surgical patients. Methods. IRB approved, prospective observational study including all ventilated patients admitted to the surgical intensive care unit at a single tertiary center over 6 months. ARDS was defined using the Berlin criteria. LIPS were calculated for all patients and analyzed. Logistic regression models evaluated the ability of LIPS to predict development of ARDS and mortality. A receiver operator characteristic (ROC) curve demonstrated the optimal LIPS value to statistically predict development of ARDS. Results. 268 ventilated patients were observed; 141 developed ARDS and 127 did not. The average LIPS for patients who developed ARDS was 8.8 ± 2.8 versus 5.4 ± 2.8 for those who did not (p < 0.001). An ROC area under the curve of 0.79 demonstrates LIPS is statistically powerful for predicting ARDS development. Furthermore, for every 1-unit increase in LIPS, the odds of developing ARDS increase by 1.50 (p < 0.001) and odds of ICU mortality increase by 1.22 (p < 0.001). Conclusion. LIPS is reliable for predicting development of ARDS and predicting mortality in critically ill surgical patients.

In the longest comparative study to date using a standard assessment modality, HPA axis recovery was more frequent in acromegaly compared to NFA patients, independent of tumor size, cavernous sinus invasion (CSI), and body mass index (BMI). HPA axis integrity must be carefully and periodically monitored in acromegaly patients during short- and long-term follow-up to prevent overtreatment with glucocorticoids.

A 57-year-old male sustained a blunt head injury after discharging a mortar firework off the vertex of his head. Physical examination revealed a stellate scalp lesion and pure bilateral leg paraplegia. Initial spinal computed tomography and magnetic resonance imaging were negative for pathology. Initial head computed tomography revealed open, nondisplaced, frontal, and parietal skull fractures with underlying subdural and subarachnoid hemorrhage. Follow-up magnetic resonance imaging one week later showed bilateral precentral gyri frontal lobe contusions involving the lower extremity motor cortices and subcortical white matter extending anteriorly into the region of the supplementary motor areas. The patient's complete paraplegia informed the subsequent hospital rehabilitation. However, motor recovery was more rapid than anticipated, with the patient regaining ambulatory function before inpatient rehabilitation discharge after 27 days of hospitalization. He continued to have issues with spasticity after discharge. We discuss the current literature surrounding paraplegia secondary to head trauma and the recovery that follows. Firework misuse is a known cause of head injury but has not been recorded as a cause of isolated bilateral paraplegia. Isolated precentral gyri contusion must be considered in patients presenting with paraplegia following trauma to the vertex of the head and normal spinal imaging. We show the importance of repeat imaging to follow the evolving nature of traumatic head injuries presenting with paraplegia. We also illustrate the variability in rehabilitation planning and the need for adjustment in rehabilitation planning for paraplegic patients following head trauma.

African American patients with septic shock were treated with higher doses of NE and required longer duration of NE administration compared with white patients.

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However, CEA, when performed, provides better protection against late CE compared with CAS. Further identification of clinical risk factors and plaque characteristics for CE will help improve efficiency of STB in stroke prevention and avoid unnecessary procedures.