Simonetto Marialaura, Stieg Philip E, Segal Alan Z, Ch'ang Judy H
Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.
Department of Neurological Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York, USA.
World Neurosurg. 2025 Jan;193:330-337. doi: 10.1016/j.wneu.2024.09.118. Epub 2024 Dec 17.
Providing specialized care to critically ill neurology patients has improved outcomes for patients with neurological emergencies; however, there are still some gaps in neurocritical care (NCC) that offer opportunities for improvement. Among these gaps, improving education of the multidisciplinary NCC team, targeting individualized treatments for neurologically critically ill patients, and reducing disparities for undeserved patients as well as disadvantaged areas are priorities to advance the field. This review focuses on the current challenges neurointensivists face, including difficulties in neuroprognostication, ethical challenges in end-of-life care, and neuropalliative care. Challenges also involve providing specific NCC education for the multidisciplinary NCC team, as well as advancing research to provide treatments for critically ill neurological patients. Finally, the authors describe future directions that can take NCC to the next level.
为重症神经病学患者提供专科护理已改善了神经急症患者的治疗结果；然而，神经重症监护（NCC）仍存在一些差距，这为改进提供了机会。在这些差距中，改善多学科NCC团队的教育、针对神经重症患者进行个体化治疗，以及减少未得到充分服务的患者和弱势地区的差异，是推动该领域发展的优先事项。本综述重点关注神经重症医生目前面临的挑战，包括神经预后评估的困难、临终关怀中的伦理挑战以及神经姑息治疗。挑战还包括为多学科NCC团队提供特定的NCC教育，以及推进研究以为重症神经病学患者提供治疗。最后，作者描述了可将NCC提升到新水平的未来方向。
