Fleming Victoria, Muehlschlegel Susanne
Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Avenue North, S-5, Worcester, MA 01655, USA.
Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Avenue North, S-5, Worcester, MA 01655, USA; Department of Anesthesiology/Critical Care, University of Massachusetts Chan Medical School, 55 Lake Avenue North, S-5, Worcester, MA 01655, USA; Department of Surgery, University of Massachusetts Chan Medical School, 55 Lake Avenue North, S-5, Worcester, MA 01655, USA.
Crit Care Clin. 2023 Jan;39(1):139-152. doi: 10.1016/j.ccc.2022.06.005. Epub 2022 Oct 13.
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.
患有严重急性脑损伤的患者会丧失行为能力，病情危急，无法自行做出医疗决策。替代决策者必须为患者做出生死抉择，并依靠临床医生的预后判断提供指导。目前尚无指导临床医生进行预后判断的指南；因此，神经预后判断仍被视为一门“艺术”，存在很大的变异性。本综述审视了神经重症监护中有关预后判断的当前文献，确定了该领域存在的持续挑战，并为未来研究提供建议，目标是减少变异性，专注于以科学和患者为中心而非凭经验的预后判断方法。
