Study guide
Sepsis, Endocarditis & Antimicrobial Principles
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
Sepsis, Endocarditis & Antimicrobial Principles
Key Takeaways Explain This Topic AI
The 2026 Surviving Sepsis Campaign distinguishes probable or definite sepsis from possible infection without shock when setting antibiotic timing.
Fluid resuscitation requires ongoing reassessment; TBI changes the usual balanced-crystalloid preference toward 0.9% saline.
Infective endocarditis may produce embolic infarction, infected aneurysm, abscess, or intracranial hemorrhage.
Antimicrobial selection depends on source, host, local susceptibility, CNS penetration, organ clearance, and source control.
Last updated: October 2026
Identify Infection Without Missing Its Mimics
Sepsis is life-threatening organ dysfunction associated with a dysregulated response to infection. In the neuro-ICU, altered consciousness, fever, tachycardia, leukocytosis, or hypotension may also arise from seizures, central fever, drug withdrawal, pulmonary embolism, endocrine crises, or sympathetic hyperactivity. A positive culture can represent contamination or colonization. Use the clinical syndrome and likely source, while beginning emergency stabilization promptly when sepsis is probable.
Assess airway, oxygenation, perfusion, lactate trends, urine output, skin findings, devices, and potential infection sources. Obtain appropriate cultures before antibiotics when this does not cause an important treatment delay. A normal lactate does not exclude sepsis, and an elevated lactate can reflect adrenergic stimulation or impaired clearance in addition to hypoperfusion. Repeated assessment is more useful than interpreting a single number in isolation.
Current Timing and Circulatory Guidance
The 2026 Surviving Sepsis Campaign recommends immediate antimicrobial therapy, ideally within one hour of recognition, for probable or definite sepsis, including shock. For possible sepsis without shock, it supports rapid, time-limited investigation and treatment within three hours if concern persists. A low likelihood of infection without shock permits close monitoring while further evaluation proceeds. This framework avoids treating every unexplained fever as proven sepsis while preserving urgency when serious infection is likely.
For sepsis-induced hypoperfusion or shock, the guideline suggests at least 30 mL/kg of IV crystalloid within three hours, with explicit consideration of individual context and frequent reassessment. Do not mechanically administer additional fluid despite pulmonary edema or evidence of poor fluid tolerance. Unstable shock may warrant concurrent vasopressors and fluid. Norepinephrine is a principal first-line pressor; temporary peripheral administration through an appropriate monitored site can avoid delay while central access is arranged.
A usual initial MAP target around 65 mm Hg may need modification when intracranial pressure or another neurologic condition requires a higher perfusion pressure. The guideline generally favors balanced crystalloids but specifically suggests 0.9% saline in sepsis with TBI. Avoid supplemental albumin in TBI. These distinctions are important because a general ICU recommendation cannot be transferred automatically to every neurologically injured patient.
Choose Antibiotics for the Actual Infection
Factor Practical implication
Source Pneumonia, urinary infection, abdominal infection, line infection, and meningitis need different coverage and source control
Exposure and local resistance Recent hospitalization, antimicrobial exposure, devices, and local susceptibility guide resistant-organism coverage
- Host Neutropenia, transplant drugs, HIV, and cellular therapies change likely pathogens
- Site penetration Suspected CNS infection requires an appropriate CNS-active regimen
Clearance and toxicity Adjust maintenance dosing for renal or hepatic dysfunction and renal replacement; monitor selected drug levels
A loading dose and a maintenance dose answer different pharmacokinetic questions. Do not automatically reduce an urgently needed loading dose simply because renal function is impaired. Subsequent dosing must account for clearance, volume of distribution, dialysis, and organism susceptibility. Prolonged beta-lactam infusion can improve time-dependent exposure in selected settings, but compatibility and delivery must be reliable.
Reassess daily, narrow therapy when microbiology and the clinical course permit, and discontinue treatment when an alternative diagnosis is established. Procalcitonin is an adjunct in selected decisions rather than a substitute for clinical assessment. Antibiotics alone may fail when infected hardware, an obstructed urinary tract, an undrained abscess, or another source remains uncontrolled.
Endocarditis and Neurologic Complications
Infective endocarditis should be considered when bacteremia, embolic infarcts in multiple territories, new valve findings, persistent fever, or a relevant device or exposure is present. Obtain blood cultures and echocardiographic evaluation. TEE may be required when TTE is nondiagnostic and suspicion remains, especially with prosthetic valves or devices. Lack of a loud murmur does not exclude infection.
Neurologic events include septic embolic infarction, hemorrhagic transformation, infected intracranial aneurysm, meningitis, and abscess. A thunderclap headache or new hemorrhage may require vascular imaging. IV thrombolysis for stroke associated with infective endocarditis is hazardous because hemorrhagic complications can occur; selected mechanical interventions require specialist assessment. Valve-surgery timing after a neurologic complication balances uncontrolled infection or cardiac failure against hemorrhage and operative risks.
Encephalopathy in the Immunocompromised Host
Immunosuppressed patients may have infection without robust fever or CSF inflammation. Consider the immune defect, time since transplant or treatment, prophylaxis, exposures, and imaging pattern. Opportunistic infections and treatment toxicity can coexist. Broad coverage may be needed initially, but each additional drug creates interaction and toxicity risks, including calcineurin-inhibitor interactions, beta-lactam neurotoxicity, and marrow suppression. Consult infectious diseases and pharmacy rather than treating all post-transplant encephalopathy with one generic regimen.
Sources checked October 17, 2026: 2026 adult Surviving Sepsis Campaign and IDSA healthcare-associated CNS infection guideline .