Neurocritical Care in Resource-limited Settings

Shrestha, Gentle S; Lamsal, Ritesh

doi:10.1097/ana.0000000000000720

Cited by 6 publications

(13 citation statements)

References 9 publications

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“…In the last 10-20 years, similar concepts were introduced for neurocritical care (Suarez, 2006). The birth of the concept of Neurocritical Care Unit was even more complicated than that of the Stroke Unit concept (Shrestha and Lamsal, 2020;Prust et al, 2022). Generally, neurocritical care was mainly for management of TBI, central nervous system infectious, and surgery patients, especially if in a serious clinical condition and with imminent risk to life.…”

Section: The Concepts Of Stroke Units and Neurocritical Care Unitsmentioning

confidence: 99%

“…Generally, neurocritical care was mainly for management of TBI, central nervous system infectious, and surgery patients, especially if in a serious clinical condition and with imminent risk to life. The establishment of neurocritical care units with acute phase neurointerventional treatments was associated with improved clinical outcomes compared with more traditional management (Varelas et al, 2004;Suarez, 2006;Kramer and Zygun, 2014;Shrestha and Lamsal, 2020). The possible reasons for better outcomes included: dedicated physicians and nurses, protocolized management, and stricter adherence to neurocritical care protocols (Shrestha and Lamsal, 2020).…”

Section: The Concepts Of Stroke Units and Neurocritical Care Unitsmentioning

confidence: 99%

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Stroke unit and Neurocritical Care Unit for acute neurological diseases in the USL Toscana Centro: a pilot model of Santo Stefano Hospital in Prato

Valenti,

Caruso,

Scotto Di Luzio

et al. 2023

Front. Stroke

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BackgroundAcute neurological diseases are leading causes of disability and death. The need for specialist neurocritical care skills for managing neurological emergencies has increased. Promising opportunities exist to improve outcomes in acute phases of neurological diseases, such as, for example, the concept of a stroke unit for stroke patients. A similar concept was introduced for a neurocritical care unit, which is associated with improved clinical outcomes compared with more traditional management. However, neurocritical care is often not recognized as a separate specialty. Significant progress in neurology has enabled better approaches for the critically ill neurologic patient, in particular those with stroke and hemorrhage, but also with epileptic seizures and epileptic status, traumatic brain injury (TBI), subdural/epidural hematoma, acute inflammatory polyradiculoneuritis, encephalitis, myasthenia gravis, acute myelitis, etc.Assessment of policy/guidelines options and implicationsExcept for cerebrovascular diseases, for other acute neurological diseases, there is no standardized model care service recognized. A good patient outcome can be obtained by the choice of neurology setting for acute patients including nursing and medical staff with specific training in neurocritical care. As we believe neurocritical care practices should be implemented, we suggest a pilot model on the basis of our experience. In this report, we show a model of the 2A setting of the Santo Stefano Hospital (Prato, USL Toscana Centro), where, as well as stroke units for cerebrovascular events, we have neurocritical care unit and acute-neurology experts for all acute neurological diseases.Actionable recommendations: our pilot experienceThe 2A setting of Stroke Unit/Neurocritical Care of the Santo Stefano Hospital includes 15 beds; 8 ± 2 beds are monitored by portable multi-parameter monitoring devices. Following acute treatment, diagnostic/etiologic work-up and automated monitoring of vital functions are performed in addition to adapted secondary prevention, early rehabilitation, and prevention of complications in all acute patients. We retrospectively assessed the diagnoses in the hospital discharge forms (HDF) of Stroke Unit/Neurocritical Care (2A) of 249 patients consecutively analyzed between 1 January 2022 and 30 June 2022. Out of the 249 patients affected by acute neurological diseases, 155 had cerebrovascular diseases (62.2%). In particular, 100 (64.5%) were diagnosed with ischemic stroke and 44 (28.4%) with hemorrhagic stroke. Thirty-two patients (12.8%) were hospitalized following a TBI. Sixteen patients (6.4%) had a new diagnosis of epilepsy and three (1.2%) of epileptic status. In our setting, the 3-month modified Rankin Scale (mRS) in the 36 stroke patients treated with recombinant-tissue plasminogen activator (r-TPA) was 0–2 (low disability) in 60% of cases. Additionally, 31% of 44 intracerebral haemorrhage (ICH) patients reported a moderate-severe degree of disability. Regarding TBI patients, the mRS ranged from 1 to 5, with significate difference between patients in Stroke Unit/Neurocritical Care (2A) in comparison with those in other departments (2–3 vs. 3–4, respectively). Globally, the setting discharge of the acute neurological patients were: rehabilitation (26%), intermediate care hospitals (44%), long-term care (5%), and home (25%). The 1-month mortality rate was 1.8%.DiscussionWe provide a brief description of the cases treated over a 6-month period to draw attention to the possibility of the existence of a ward dedicated exclusively and specifically to all acute neurological diseases. The sample of patients is very varied and interesting. More than 60% of patients had cerebrovascular diseases. The paucity of outcome data makes this report limited, but the diagnostic-therapeutic strategies, the presence of staff trained in specific neurocritical care, and the use of inpatient hospital-based registries are, in our opinion, strengths. Our pilot model of the setting of Stroke Unit/Neurocritical Care (2A) in the Santo Stefano Hospital (Prato, USL Toscana Centro) should be further implemented, also to verify systematically the associations with measurable outcome improvements in patients affected by strokes and other neurological acute diseases.

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Section: The Concepts Of Stroke Units and Neurocritical Care Unitsmentioning

confidence: 99%

Section: The Concepts Of Stroke Units and Neurocritical Care Unitsmentioning

confidence: 99%

Stroke unit and Neurocritical Care Unit for acute neurological diseases in the USL Toscana Centro: a pilot model of Santo Stefano Hospital in Prato

Valenti,

Caruso,

Scotto Di Luzio

et al. 2023

Front. Stroke

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“…Thus, in our circumstance, integrating neurocritical care into the current hospital workflow by collaboration between intensivists, neurologists, neurosurgeons, and other multidisciplinary care teams to take care of critically-ill neurologic patients at prevailing locations is more suitable than developing another specialized ICU because building a new NICU is costly, and needs new hospital staff recruitment and reorganization of the hospital system. As suggested in a previous article, the standard recommendations for the organization of NICUs are not feasible in resource-limited settings, and a multidisciplinary approach may be an acceptable alternative strategy to deliver neurocritical care to low- and middle-income countries ( 2 ).…”

Section: Current Situation Of Neurocritical Care In Thailandmentioning

confidence: 99%

“…Neurocritical care integrates critical care and neurological expertise to comprehensively manage patients with life-threatening brain injuries ( 1 , 2 ). With an advance in evidence-based knowledge and neuromonitoring technology, neurocritical care has become an essential part of the healthcare system in developed countries ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…With an advance in evidence-based knowledge and neuromonitoring technology, neurocritical care has become an essential part of the healthcare system in developed countries ( 3 ). However, despite a significant disease burden, neurointensive care units (NICU) and neurointensivists are rarely available in Thailand and other low and middle-income countries ( 2 , 4 , 5 ). Accordingly, an effort to deliver neurocritical care is essential to improve patient outcomes in Thailand.…”

Section: Introductionmentioning

confidence: 99%

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Implementation of neurocritical care in Thailand

Viarasilpa

2022

Front. Neurol.

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Dedicated neurointensive care units and neurointensivists are rarely available in Thailand, a developing country, despite the high burden of life-threatening neurologic illness, including strokes, post-cardiac arrest brain injury, status epilepticus, and cerebral edema from various etiologies. Therefore, the implementation of neurocritical care is essential to improve patient outcomes. With the resource-limited circumstances, the integration of neurocritical care service by collaboration between intensivists, neurologists, neurosurgeons, and other multidisciplinary care teams into the current institutional practice to take care of critically-ill neurologic patients is more suitable than building a new neurointensive care unit since this approach can promptly be made without reorganization of the hospital system. Providing neurocritical care knowledge to internal medicine and neurology residents and critical care fellows and developing a research system will lead to sustainable quality improvement in patient care. This review article will describe our current situation and strategies to implement neurocritical care in Thailand.

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