Critical care clinics
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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.
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Critical care clinics · Jan 2023
ReviewArtificial Intelligence and Big Data Science in Neurocritical Care.
In recent years, the volume of digitalized web-based information utilizing modern computer-based technology for data storage, processing, and analysis has grown rapidly. Humans can process a limited number of variables at any given time. ⋯ Innovations in machine learning technology with the development of deep neural networks and efficient, cost-effective data archival systems have provided the infrastructure to apply artificial intelligence on big data for determination of clinical events and outcomes. Here, we introduce a few computer-based technologies that have been tested across these domains.
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Neurocritical care is a relatively young subspecialty that is rapidly coming into its own. As the neurocritical care community has expanded, the process of training and credentialing physicians in this growing field has undergone a rapid evolution. This article will review the history and current state of neurocritical care training and education, physician certification, and program accreditation in the United States within the larger context of critical care training across subspecialties.
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Critical care clinics · Jan 2023
ReviewPhysiological Monitoring in Patients with Acute Brain Injury: A Multimodal Approach.
Neurocritical care management of acute brain injury (ABI) is focused on identification, prevention, and management of secondary brain injury (SBI). Physiologic monitoring of the brain and other organ systems has a role to predict patient recovery or deterioration, guide individualized therapeutic interventions, and measure response to treatment, with the goal of improving patient outcomes. In this review, we detail how specific physiologic markers of brain injury and neuromonitoring tools are integrated and used in ABI patients to develop therapeutic approaches to prevent SBI.
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Although intracranial pressure (ICP) monitoring has been the mainstay of traumatic brain injury (TBI) management for decades, new understanding of TBI physiopathology calls for paradigm shifts. The complexity of TBI management precludes ICP being taken as an isolated value with a specific threshold. Multimodality monitoring is crucial to expanding our comprehension of individualized pathophysiology, allowing for a precise and tailored treatment approach. This article will review keys concepts to interpret and apply published ICP management guidelines and statements.