Renwick Christian M, Curley Jonathan
Anesthesiology and Critical Care, University of Virginia, Charlottesville, USA.
Cureus. 2023 Jul 31;15(7):e42719. doi: 10.7759/cureus.42719. eCollection 2023 Jul.
We present a 52-year-old male patient with cardiogenic shock who was placed on veno-arterial extracorporeal membrane oxygenation (ECMO) as a bridge to an orthotopic heart transplant. While on ECMO, the patient developed an acute intracranial bleed confirmed on computerized tomography (CT). However, his clinical status deteriorated and he was unstable for transport to evaluate for worsening hemorrhage. Instead, optic nerve sheath (ONS) ultrasonography was utilized to confirm increased intracranial pressure, which guided the goals of care until he stabilized enough to transport for advanced imaging. Repeat CT confirmed the worsening of his cerebellar bleed with obstructing hydrocephalus and brainstem compression. This case demonstrates how ONS ultrasound can be utilized in a cardiothoracic intensive care unit to evaluate sedated patients for new or worsening intracranial hemorrhage. In ECMO patients, who are often unstable with the risks of transportation for CT outweighing potential benefits, ONS ultrasonography can provide the care team with meaningful data on a patient's neurologic status.
我们介绍了一名52岁的心源休克男性患者，其接受了静脉-动脉体外膜肺氧合（ECMO）作为原位心脏移植的过渡治疗。在接受ECMO治疗期间，患者经计算机断层扫描（CT）证实发生急性颅内出血。然而，其临床状况恶化，因病情不稳定无法转运以评估出血是否加重。于是，采用视神经鞘（ONS）超声检查来确认颅内压升高，以此指导护理目标，直至患者病情稳定到足以转运进行进一步影像学检查。重复CT检查证实其小脑出血恶化，伴有梗阻性脑积水和脑干受压。该病例展示了在心胸重症监护病房中，ONS超声检查可用于评估镇静患者是否发生新的或加重的颅内出血。对于经常病情不稳定、CT检查的转运风险超过潜在益处的ECMO患者，ONS超声检查可为医护团队提供有关患者神经状态的有意义数据。
