Kaleem Safa, Harris William T, Oh Stephanie, Ch'ang Judy H
Department of Neurology, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA.
Department of Neurology, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA.
World Neurosurg. 2025 Jan;193:285-295. doi: 10.1016/j.wneu.2024.09.117. Epub 2024 Dec 17.
Neurocritical care as a field aims to treat patients who are neurologically critically ill due to a variety of pathologies. As a recently developed subspecialty, the field faces challenges, several of which are outlined in this review. The authors discuss aneurysmal subarachnoid hemorrhage, status epilepticus, and traumatic brain injury as specific disease processes with opportunities for growth in diagnosis, management, and treatment, as well as disorders of consciousness that can arise as a result of many neurological injuries. They also address logistical challenges, such as the need for specialized resources needed to successfully run a neurosciences intensive care unit (neuro-ICU), the variations in training of those who staff neuro-ICUs, and different interdisciplinary team structures. Although an immense amount of data is collected in the neuro-ICU, leveraging the data for clinical research is an area with room for further innovation. Additionally, developing accurate basic science models for these disease processes is an ongoing area of exploration. Finally, the authors explore psychosocial challenges present in the care of neurologically critically ill patients, including limitations in prognostication and religious and cultural perceptions of brain death.
神经重症监护作为一个领域，旨在治疗因各种病理状况而处于神经重症状态的患者。作为一个最近发展起来的亚专业领域，该领域面临着诸多挑战，本综述将概述其中的几个挑战。作者们讨论了动脉瘤性蛛网膜下腔出血、癫痫持续状态和创伤性脑损伤等特定疾病过程，这些疾病在诊断、管理和治疗方面有增长机会，以及许多神经损伤可能导致的意识障碍。他们还探讨了后勤方面的挑战，比如成功运营一个神经科学重症监护病房（神经重症监护病房）所需的专门资源、神经重症监护病房工作人员培训的差异以及不同的跨学科团队结构。尽管神经重症监护病房收集了大量数据，但利用这些数据进行临床研究是一个仍有进一步创新空间的领域。此外，为这些疾病过程开发准确的基础科学模型是一个正在探索的领域。最后，作者们探讨了神经重症患者护理中存在的社会心理挑战，包括预后判断的局限性以及对脑死亡的宗教和文化观念。
