Study guide
Obstructive Lung Disease, Pulmonary Hypertension & Bronchoscopy
ABPN Neurocritical Care Study Guide Exam
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1 Chapter 1: Neurologic Examination & Coma Assessment in the ICU
Current Examination, Blueprint & Preparation Neurologic Examination in Critically Ill Patients Coma Evaluation & Consciousness Alterations Delirium & Toxic-Metabolic Encephalopathy in the ICU
2 Chapter 2: Cerebral Physiology & Intracranial Dynamics
Cerebral Blood Flow, Metabolism & Autoregulation Intracranial Pressure & Compliance Cerebral Edema & Herniation Syndromes
3 Chapter 3: Intracranial Hypertension & Cerebral Perfusion Management
Tiered ICP Management Protocols Hyperosmolar Therapy & Fluid Management Advanced & Refractory ICP Interventions
4 Chapter 4: Airway, Mechanical Ventilation & Pulmonary ICU Management
Emergency Airway Management & Neuro-Intubation Mechanical Ventilation Strategies in Acute Brain Injury Tracheostomy & Ventilator Weaning in Neurocritical Care Pulmonary Complications in the Neuro-ICU Obstructive Lung Disease, Pulmonary Hypertension & Bronchoscopy
5 Chapter 5: Hemodynamics, Shock & Cardiovascular Management
Hemodynamic Monitoring & Blood Pressure Targets Vasoactive Agents: Inotropes, Vasopressors & Antihypertensives Cardiac Complications of Brain Injury
6 Chapter 6: Neuropharmacology, Analgesia & Sedation
ICU Sedation & Analgesia Neuromuscular Blockade & Monitoring Propofol Infusion Syndrome & Drug Toxicities Antiseizure Drug Pharmacology in the ICU
7 Bleeding, Thrombosis & Hematologic Emergencies
Warfarin & Heparin Reversal Direct Oral Anticoagulant (DOAC) Reversal Antiplatelet Management & Platelet Dysfunction Venous Thromboembolism Prophylaxis & Management Transfusion, Coagulopathy, TMA & Cellular-Therapy Neurotoxicity
8 Chapter 8: Systemic ICU Care, Fluids, Electrolytes & Endocrine
Hyponatremia & Osmoregulation: SIADH vs Cerebral Salt Wasting Diabetes Insipidus, Hypernatremia & Endocrine Crises Critical Care Prophylaxis, Nutrition & Infection Prevention
9 Systemic Trauma & Environmental Injury
Polytrauma, Chest Injury & Abdominal Hemorrhage Burns, Electrical Injury & Hanging
10 Cardiac Emergencies & Mechanical Support
IABP, Ventricular Devices & ECMO Acute Coronary, Valvular, Rhythm & Aortic Emergencies
11 Kidney Injury, Acid–Base & Renal Replacement
Acute Kidney Injury & Renal Drug Clearance Acid–Base Disorders, Electrolytes & Renal Replacement
12 Systemic Infection & Endocrine Emergencies
Sepsis, Endocarditis & Antimicrobial Principles Thyroid, Adrenal & Dysglycemic Emergencies
13 Gastrointestinal & Hepatic Emergencies
Acute Abdomen, GI Bleeding & Abdominal Compartment Syndrome Acute Liver Failure, Cirrhosis & Hepatic Drug Effects
14 Chapter 9: Neuroimaging in the Neuro-ICU
Non-Contrast CT & CT Angiography CT Perfusion & Advanced Perfusion Imaging Magnetic Resonance Imaging in Critical Illness
15 Chapter 10: Electrophysiology & Neuromonitoring
Continuous EEG & ACNS Standardized Critical Care Terminology Invasive Neuromonitoring: ICP & External Ventricular Drains Multimodal Monitoring: PbtO2, Microdialysis & Transcranial Doppler
16 Angiography, Electrodiagnosis & CSF Analysis
Conventional Angiography & Cranial–Spinal Shunts EMG, Nerve Conduction & Acute Muscle Disease CSF Analysis: Infection, Inflammation & Hemorrhage
17 Chapter 11: Bedside Procedures, Ultrasound & Death by Neurologic Criteria
Critical Care Procedural Skills Critical Care Ultrasound & Echocardiography Determination of Death by Neurologic Criteria
18 Chapter 12: Acute Ischemic Stroke & Reperfusion Therapies
Acute Ischemic Stroke Management & Thrombolysis Endovascular Thrombectomy & Large Vessel Occlusion Malignant Hemispheric & Cerebellar Infarction
19 Chapter 13: Spontaneous Intracerebral Hemorrhage & Intraventricular Hemorrhage
Acute Intraparenchymal Hemorrhage Management Intraventricular Hemorrhage & Hydrocephalus Surgical Evacuation & Minimally Invasive Surgery in ICH
20 Chapter 14: Aneurysmal Subarachnoid Hemorrhage & Delayed Cerebral Ischemia
Aneurysmal Subarachnoid Hemorrhage: Acute Resuscitation & Securing Delayed Cerebral Ischemia & Cerebral Vasospasm Non-Aneurysmal Subarachnoid Hemorrhage & Vascular Malformations
21 Venous, Spinal & Traumatic Vascular Disease
Cerebral Venous Thrombosis & Spinal Cord Infarction Traumatic Dissection, Carotid–Cavernous Fistula & Penetrating Injury
22 Chapter 15: Traumatic Brain & Spinal Cord Injury
Severe Traumatic Brain Injury & Contusions Acute Traumatic Spinal Cord Injury & Neurogenic Shock Spine Trauma, Fractures & Cord Syndromes
23 Chapter 16: Status Epilepticus, Seizures & Neuromuscular Emergencies
Status Epilepticus: Convulsive & Non-Convulsive Refractory & Super-Refractory Status Epilepticus Acute Neuromuscular Respiratory Failure
24 Chapter 17: Post-Cardiac Arrest Care, CNS Infections & Encephalitis
Targeted Temperature Management & Post-Cardiac Arrest Care Post-Cardiac Arrest Neuroprognostication Acute CNS Infections, Encephalitis & Inflammatory Emergencies
25 Neuroinflammation & Neurooncology
Fulminant Demyelination & Autoimmune Encephalitis Brain, Spinal & Leptomeningeal Cancer Emergencies
26 Pregnancy, Transplantation & Pediatric Care
Pregnancy, Postpartum & Post-Transplant Neurologic Care Pediatric Neurocritical Care
27 Chapter 18: Neurosurgical & Perioperative Emergencies
Postoperative Neurosurgical Complications Device Complications: EVDs, Shunts & ICP Monitors Cerebral Hyperperfusion Syndrome & Post-Interventional Emergencies
28 Chapter 19: Ethics, Palliative Care & Organ Donation in the Neuro-ICU
Communication, Surrogate Decision-Making & Conflict Resolution Neuroprognostication Ethics, Withdrawal of Life Support & Palliative Care Organ Donation & Management of the Deceased Donor
Obstructive Lung Disease, Pulmonary Hypertension & Bronchoscopy
Key Takeaways Explain This Topic AI
Expiratory flow that fails to return to baseline suggests incomplete exhalation and intrinsic PEEP.
In severe obstruction, reducing respiratory rate and allowing longer expiration can improve circulation despite a lower minute ventilation.
Pulmonary hypertension makes the right ventricle vulnerable to hypoxemia, acidemia, excessive airway pressure, and abrupt loss of systemic pressure.
Bronchoscopy can diagnose or relieve selected airway problems but can worsen oxygenation, airway pressures, and ICP.
Last updated: October 2026
Connect the Ventilator to the Circulation
The outline includes COPD exacerbation, asthma, pulmonary arterial hypertension, pulmonary physiology, and bronchoscopy. These subjects test whether the clinician recognizes that an airway pressure or blood gas is a physiologic clue rather than an isolated target. Airflow obstruction lengthens the time required to exhale. Starting another breath before emptying is complete traps gas and raises end-expiratory alveolar pressure. This intrinsic PEEP , or auto-PEEP, can impair venous return, overload the right ventricle, lower cardiac output, and reduce cerebral perfusion.
Inspect the expiratory flow waveform: failure to return to zero before the next inspiration suggests incomplete exhalation. An expiratory hold can estimate total PEEP in a passive patient, but spontaneous effort and regional airway closure complicate interpretation. Compare peak and plateau pressures. A high peak with a much lower plateau suggests increased airway resistance from bronchospasm, secretions, or a narrow or obstructed tube; elevation of both raises concern for reduced compliance, gas trapping, or other parenchymal or chest-wall problems.
Treat Asthma and COPD While Protecting the Brain
Treat the exacerbation's cause and use inhaled bronchodilators, appropriate systemic corticosteroids, and other indicated therapy. Steroids used for an obstructive lung exacerbation are a separate indication from treating traumatic brain edema ; the latter is harmful. Consider infection and aspiration where appropriate rather than assuming every wheeze requires antibiotics.
In severe obstruction, a lower set respiratory rate, an appropriately limited tidal volume, and higher inspiratory flow can lengthen expiratory time. Monitor plateau pressure, total PEEP, blood gases, and perfusion. Increasing respiratory rate reflexively to normalize CO2 can worsen air trapping and shock. A patient who deteriorates after this adjustment may improve when expiratory time is restored.
Permissive hypercapnia may be accepted in some pulmonary patients, but intracranial hypertension changes the balance because CO2 can increase cerebral blood volume. Coordinate ventilation with ICP, CPP, arterial pH, and oxygenation. Neither unlimited tidal volume to force normocapnia nor unmonitored acceptance of major hypercapnia is a safe universal solution. In a chronic CO2 retainer, baseline physiology also matters; rapid overventilation can cause marked alkalemia.
Noninvasive ventilation benefits selected COPD patients who can protect their airway, cooperate, and clear secretions. Profound coma, active vomiting, inability to handle secretions, or immediate intubation needs usually preclude it. A reassuring mask oxygen saturation does not establish airway protection or exclude worsening hypercapnia.
Finding Leading concern Response to assess
Wheeze, high peak pressure, relatively preserved plateau Increased resistance Tube patency, bronchodilation, secretion management
Expiratory flow persists at next inspiration Dynamic hyperinflation Longer expiration and reassessment of total PEEP
Hypotension after increasing rate Air trapping and reduced venous return Immediate ventilator and hemodynamic reassessment
- Somnolence with rising CO2 Ventilatory failure Airway protection and escalation of support
- Pulmonary Hypertension and Right Ventricular Failure
The thin-walled right ventricle tolerates acute increases in afterload poorly. Hypoxemia, hypercapnia, acidemia, pulmonary embolism, and excessive lung distension can increase pulmonary vascular resistance. Severe systemic hypotension also reduces right coronary perfusion, worsening RV contractility. Assess echocardiographic RV size and function, septal position, volume status, and systemic perfusion; a dilated RV is not specific for an acute PE.
Avoid both indiscriminate fluid loading and severe underfilling. Excess fluid can dilate the RV further, shift the septum toward the LV, and reduce left-sided filling. Maintain systemic pressure and oxygenation, treat the precipitating cause, and coordinate inotropes or pulmonary vasodilators with specialists when indicated. Abrupt interruption of a chronic continuous pulmonary vasodilator infusion can cause dangerous rebound physiology. Verify medication delivery during transport and procedures.
Intubation is particularly hazardous in decompensated pulmonary hypertension: sedation, vasodilation, and positive pressure can combine to cause cardiovascular collapse. Prepare an expert airway and circulatory plan rather than treating intubation as a routine technical step.
What Bronchoscopy Can and Cannot Do
Flexible bronchoscopy may evaluate a suspected mucus plug, airway obstruction, hemoptysis, selected infections, or inhalation injury. It is not required routinely for every infiltrate or every episode of VAP. Scope insertion narrows the effective endotracheal tube lumen and can increase resistance, intrinsic PEEP, CO2, and ICP; suction and lavage can worsen oxygenation transiently.
Before the procedure, review oxygenation reserve, ventilation, hemodynamics, coagulation, and intracranial stability. Use appropriate preoxygenation, sedation, monitoring, and an agreed stopping plan. A patient with new lobar collapse may benefit from removal of an obstructing plug, while a patient with refractory hypoxemia and unstable ICP may require stabilization before diagnostic lavage. Interpret cultures with clinical findings because airway colonization alone does not prove pneumonia.
Sources checked October 17, 2026: GOLD COPD reports , GINA asthma guidance , and ESICM acute brain injury ventilation consensus .