Continuous Optical Monitoring Of Cerebral Hemodynamics During Head-of-bed Manipulation In Brain-injured Adults

Introduction: Head-of-bed manipulation is commonly performed in the neurocritical care unit to optimize cerebral blood flow (CBF), but its effects on CBF are rarely measured. This pilot study employs a novel, non-invasive instrument combining two techniques, diffuse correlation spectroscopy (DCS) for measurement of CBF and near-infrared spectroscopy (NIRS) for measurement of cerebral oxy- and deoxy-hemoglobin concentrations, to monitor patients during head-of-bed lowering. Methods: Ten brain-injured patients and ten control subjects were monitored continuously with DCS and NIRS while the head-of-bed was positioned first at 30° and then at 0°. Relative CBF (rCBF) and concurrent changes in oxy- (ΔHbO2), deoxy- (ΔHb), and total-hemoglobin concentrations (ΔTHC) from left/right frontal cortices were monitored for 5 min at each position. Patient and control response differences were assessed. Results: rCBF, ΔHbO2, and ΔTHC responses to head lowering differed significantly between brain-injured patients and healthy controls (P < 0.02). For patients, rCBF changes were heterogeneous, with no net change observed in the group average (0.3 ± 28.2 %, P = 0.938). rCBF increased in controls (18.6 ± 9.4 %, P < 0.001). ΔHbO2, ΔHb, and ΔTHC increased with head lowering in both groups, but to a larger degree in brain-injured patients. rCBF correlated moderately with changes in cerebral perfusion pressure (R = 0.40, P < 0.001), but not intracranial pressure. Conclusion: DCS/NIRS detected differences in CBF and oxygenation responses of brain-injured patients versus controls during head-of-bed manipulation. 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The changing nature of rectus sheath haematoma: Case series and literature review

AbstractBackgroundRectus sheath haematoma (RSH) is classically described as a rare condition, following a relatively benign course. Notable in its' diagnostic difficulty, RSH may mimic a wide range of other more serious pathologies. With the advent of computed tomography (CT) scanning misdiagnosis is now less common. However, a number of recent case reports suggest the frequency and severity of cases is increasing. This case series examines our experience of RSH, and reviews the changing presentation and management of this condition.MethodsRetrospective review of a prospectively maintained patient database, including all patients with discharge diagnosis of RSH over 30-month period. An additional two cases were noted prospectively. Clinical notes were reviewed and linked to radiological imaging.ResultsSeven patients were identified (3 female, 4 male; median age 76, range 27–89) during the review period. Two patients were haemodynamically compromised at presentation, with significant tachycardia in two others. One patient had an unknown bleeding diathesis, whilst the remainder were all prescribed anticoagulant medication. Three patients required fluid resuscitation and blood transfusion. The correct diagnosis was only made in two patients prior to imaging. All patients underwent confirmatory CT scanning.ConclusionThis case series indicates the increasing prevalence and severity of rectus sheath haematoma, largely due to increased use of anticoagulant medication in an aging population. Our findings emphasise the changing nature of the condition, together with the variable clinical courses it may take. Clinicians must treat this condition expectantly and be aware of complications that may ensue