Brain Point-of-Care Ultrasound (BrainPOCUS) in Adult Critical Care: An Introduction to Methods

Brain point-of-care ultrasound (BrainPOCUS) is a relatively recent addition to the critical care clinicians' POCUS armamentarium. Whilst the transcranial ultrasound techniques employed have origins dating back to the 1950s, it is only more recently that the potential role of a POCUS brain examination in critical care settings has gained more widespread general interest and recognition. The information BrainPOCUS can provide in critically ill sedated or comatose patients is unique and informs about pathophysiology typically undecipherable from physical examination alone. BrainPOCUS in critical care is an evolving technique, finding its place somewhere between a basic bedside physical examination and a classical comprehensive neurosonology investigation. This article aims to provide the BrainPOCUS novice with a step-by-step guide to practical aspects of B-mode imaging, the transcranial colour-coded duplex (TCCD) technique, and the transcranial colour-coded triplex (TCCT) technique. Intended as a methodological introduction for an intensivist. Thus, further study, practical training, data synthesis and understanding, and formal accreditation pathway completion are required.