Pediatric neurocritical care is a field dedicated to providing specialized assessment and care of critically-ill children with neurologic disease or at risk of neurologic compromise. Fellowship programs for providers interested in specializing in pediatric neurocritical care are growing and developing to meet the needs of trainees and the patient populations that they serve. Fetal and neonatal neurocritical care fellowship remains a separate opportunity for training; however, inclusion of fetal and neonatal neurology education into pediatric neurocritical care broadens understanding of normal and pathologic anatomy and physiology, diagnostic interpretation of the developing brain, targeted management interventions, family counseling and prognostication, and long-term optimization of outcomes. For instance, the care of neurologic injury in congenital heart disease emphasizes the incorporation of medical education across the lifespan. Additionally, neonates requiring NICU admission and care are more likely to require future PICU care and be served by neurocritical care providers. Furthermore, neonates with neurologic injury or at risk for neurologic injury are not exclusively admitted to neonatal units. Education across the age-spectrum inclusive of fetal and neonatal neurology is valuable for trainees in understanding underlying disease processes, management, and sequelae and promotes the growth of the field of pediatric neurocritical care.
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http://dx.doi.org/10.1016/j.siny.2024.101552 | DOI Listing |
Background: Paroxysmal sympathetic hyperactivity (PSH) occurs with high prevalence among critically ill patients with traumatic brain injury (TBI) and is associated with worse outcomes. The PSH-Assessment Measure (PSH-AM) consists of a Clinical Features Scale and a diagnosis likelihood tool (DLT) intended to quantify the severity of sympathetically mediated symptoms and the likelihood that they are due to PSH, respectively, on a daily basis. Here, we aim to identify and explore the value of dynamic trends in the evolution of sympathetic hyperactivity following acute TBI using elements of the PSH-AM.
View Article and Find Full Text PDFNeurocrit Care
January 2025
Neurocritical Care Services, Saint Marys Hospital Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Neurotherapeutics
January 2025
Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address:
A wide range of acute brain injuries, including both traumatic and non-traumatic causes, can result in elevated intracranial pressure (ICP), which in turn can cause further secondary injury to the brain, initiating a vicious cascade of propagating injury. Elevated ICP is therefore a neurological injury that requires intensive monitoring and time-sensitive interventions. Patients at high risk for developing elevated ICP undergo placement of invasive ICP monitors including external ventricular drains, intraparenchymal ICP monitors, and lumbar drains.
View Article and Find Full Text PDFJ Neurosurg Anesthesiol
January 2025
Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Background: An anesthesia information management system (AIMS) can be used to assess operating room utilization. The aim of this study was to assess neurosurgery OR utilization patterns using an AIMS.
Methods: This retrospective audit was performed at a tertiary neurosciences university hospital over a 1-year period.
J Neurosurg Anesthesiol
January 2025
Neurological Surgery.
Background: We implemented a quality improvement project to transition from routine cerebrospinal fluid (CSF) sampling to indication-based sampling in aneurysmal subarachnoid hemorrhage (aSAH) patients with an external ventricular drain (EVD).
Methods: Forty-seven patients were assessed across 2 epochs: routine (n=22) and indication-based (n=25) CSF sampling. The primary outcome was the number of CSF samples, and secondary outcomes included cost reductions and ventriculostomy-associated infections.
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