Critical care clinics
-
Neurologic conditions are often encountered in the general intensive care unit. This article will discuss some of the more common neurologic issues encountered and provide guidance in the assessment and management of these conditions.
-
Quality improvement is key to advancing outcomes for neurocritically ill patients. Variation in neurocritical care practice can lead to differences in health outcomes and contribute to health disparities. ⋯ Neurocritical care performance measures have recently been developed and may be used to target high priority areas for improvement. In addition, neurocritical care clinicians should be aware of the heavily weighted pay-for-performance and publicly reported performance measures that are directly relevant to neurocritical care practice.
-
The role of the neurointensivist as a subspecialist has been cemented in modern medicine globally. It was forged through the collaboration of neurologists, neurosurgeons, internists, anesthesiologists, general surgeons, emergency medicine physicians, and pediatricians. ⋯ Neurocritical care harnesses knowledge, technology, resources, and research opportunities to embrace a multisystem approach to care for the neurologically critically ill. Although recently formally recognized, its crucial role to serve patients with acute, life-threatening neurologic insults has been well established.
-
Patients with severe acute brain injury are left incapacitated, critically ill, and unable to make their own medical decisions. Surrogate decision-makers must make life-or-death decisions for patients and rely on clinicians' prognostication for guidance. No guidelines currently exist to guide clinicians in how to prognosticate; hence, neuroprognostication is still considered an "art" leaving room for high variability. This review examines the current literature on prognostication in neurocritical care, identifies ongoing challenges that exist in the field, and provides suggestions for future research with the goal to ameliorate variability and focus on scientific and patient-centered, rather than artistic approaches to prognostication.
-
Critical care clinics · Jan 2023
ReviewNeurocritical Care Research: Collaborations for Curing Coma.
One of the most common questions asked by family members of patients with brain injuries who are in a coma is "will my loved one wake up?". Despite substantial improvements in the care of patients with neurological diseases, the medical and scientific community struggles to answer this simple question. More importantly, the technology and treatment strategies to improve the trajectory of patients with impaired consciousness in the acute setting are limited. ⋯ Over the first few years of the group, several publications have focused on identifying the gaps in our knowledge to encourage research in the area. In this review, the current understanding of DoC is reviewed. The work of the Curing Coma Campaign to identify gaps in our knowledge is highlighted.