Ultrasound-Guided Therapies in the Neuro ICU

Purpose of Review: The purpose of this paper is to provide an overview of the utility and indications of sonography in the Neuro ICU, with focus on recent studies and advances. Recent Findings: Emerging data continue to shed light on the benefit of critical care sonography with neurovascular ultrasound being of particular interest in the Neuro ICU. Recent development of safe and feasible robotic TCDs holds promise in allowing continuous bedside monitoring of cerebrovascular hemodynamics, especially in conjunction with the use of automated software such as ICM+. Although newer and feasible methods for non-invasive measures of intracranial fluid and hemodynamics are rapidly emerging, use of neurovascular ultrasound remains limited due to lack of clinical and technical expertise. Recently published consensus statement on the recommended skills and competence level required to perform brain ultrasonography in the critical care setting may serve as a helpful framework to guide further training and protocol development. Summary: Utilization of systemic sonography has grown as a diagnostic and procedural aid in the critical care setting, while the rising body of literature continues to demonstrate the value of routine use of neurovascular ultrasound. Standardization of protocols and training paradigms could promote integration of this valuable tool in guiding management of brain injury patients.