Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University, Pathology Building, Room 627, 600 North Wolfe Street, Baltimore, MD 21287, USA.
Neurocrit Care. 2011 Dec;15(3):593-8. doi: 10.1007/s12028-011-9623-7.
Neurocritical illness heavily burdens the developing world. In spite of a lack of resources for population-based health in most developing countries, there is an increasing demand for resource-intense strategies for acute neurological care. Factors including rising individual incomes in emerging economies, need for neurointensive care in humanitarian emergencies, growth of private hospitals, the rising burden of noncommunicable disease, and the practice of neurocritical care by specialists outside of neurology are discussed. Possible steps to improve the global practice of neurocritical care include: (1) emphasis on prevention of neurocritical illness through traffic safety and adequate outpatient treatment; (2) standardization of training requirements and skill sets; (3) guidelines on cost-effective measures including medications, equipment, and devices; (4) strengthening of surveillance systems and registries for both noncommunicable and communicable neurological diseases; (5) expanded use of teleneurology; (6) educational exchanges of neurointensive health care workers; and (7) monitoring of neurological intensive care unit death rates due to nosocomial infections, neurological disease, and other causes. A summary of reported mortality rates among neurocritically ill patients in African countries in recent years is provided as an illustrative example.
神经危重症疾病在发展中国家负担沉重。尽管大多数发展中国家的人口健康资源匮乏，但对急性神经护理的资源密集型策略的需求却在不断增加。新兴经济体个人收入的增长、人道主义紧急情况下对神经重症监护的需求、私立医院的增长、非传染性疾病负担的增加以及神经科以外的专家进行神经重症监护等因素都在讨论之中。改善全球神经重症护理实践的可能步骤包括：（1）通过交通安全和充分的门诊治疗，强调预防神经危重症疾病；（2）标准化培训要求和技能组合；（3）制定关于药物、设备和装置等具有成本效益的措施的指南；（4）加强对非传染性和传染性神经疾病的监测系统和登记处；（5）扩大远程神经病学的使用；（6）神经重症医疗保健工作者的教育交流；以及（7）监测医院获得性感染、神经疾病和其他原因导致的神经重症监护病房死亡率。本文提供了近年来非洲国家神经危重症患者报告死亡率的摘要，作为说明性示例。
