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Wake Forest Neuro ICU: Impressions of a Visiting Professor

By Currents Editor posted 06-24-2017 23:00

  
Andrew_Cheng_Headshot.jpgBy Andrew Chang

Music and medicine have a unique synergy. While it may seem obvious that music is concerned primarily with the art of communication, it has taken me years of clinical practice to realize that one of the hallmarks of medicine is not only about the science of healing but also the art of communication. Communication — being able to reach out and touch someone’s life particularly at its most vulnerable — is perhaps what drew me most toward critical care medicine while I was training in neurosurgery in Sydney, Australia.

As I write this en route to attending the prestigious Van Cliburn International Piano Competition in Fort Worth, Texas (now in its 15th edition), and while listening to J.S. Bach’s Partitia No. 5, BWV829 being performed with masterful artistry by Igor Levitt, I reflect on my time spent visiting one of the newest neurocritical care units in the country.

The Wake Forest Baptist Hospital neuro ICU is a 24-bed, state-ofthe-art unit that treats patients not only with the highest fidelity but also takes patient care and safety very seriously. In addition to building a new unit several innovations in clinical workflow with the prime objective to achieve excellence in patient care have been instituted by the hospital, including what it calls a daily safety check-in. This is a multidisciplinary huddle, with staff representation from all departments, that meets in a central hub of the hospital for 20 minutes every morning, 365 days a year — an outstanding quality assurance initiative!

Wake Forest is also renowned for its history in ultrasound education and innovation including the neuromuscular, transcranial doppler (TCD) and ICU ultrasound courses. These courses attract scores of neurologists and critical care physicians from all across the globe every year. The neuromuscular ultrasound course, which I had the privilege of participating in as an honorary attendee, covers ultrasound applications of imaging neuromuscular structures in motor neuron disease, muscular dystrophy and chronic inflammatory demyelinating polyneuropathy (CIDP) for both diagnostic and prognostic purposes. A notable inclusion is a lecture on neuromuscular ultrasound for the evaluation of the diaphragm by Aarti Sarwal, MD, the medical director of the Wake Forest neuro ICU and a passionate educator abounding with energy and enthusiasm. While ultrasound is an established modality for imaging the heart and lung in the critical care setting, it is also a novel and emerging modality for assessing the structure and function of the diaphragm, particularly in the context of respiratory failure.

Learning to perform ultrasound can be considered an art, like learning to play the piano. It takes time, devotion and practice. However, it is accurate, reproducible and relatively easy to learn, says Sarwal. She is currently focussing her research on the potential utility of diaphragmatic ultrasound to predict weaning failure in critically ill patients on mechanical ventilation. Sound waves put to clinical use in the ICU. Where art meets science!

Andrew Cheng, MD, is a staff intensivist at St. George Hospital, the major teaching hospital in Sydney for the University of New South Wales, with clinical focus in neurocritical care. His research interests include temperature management in acute brain injury. Cheng and his colleagues are organizing the eighth International Hypothermia and Temperature Management Symposium to be held in Sydney on Aug. 28-30, 2018. 

Long ways from Sydney but close to my passion! Enjoying classical piano at the 15th Van Cliburn International Piano Competition in Fort Worth, Texas.
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Aarti Sarwal, MD, gave me the tour of the old neuro ICU at Wake Forest Baptist Health Center. Wake Forest became an enriching detour on my travels to the Cliburn festival.

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