Preface

Shraddha Mainali, MD, FNCS

Kevin Sheth, MD

Neurocritical care is a dynamic field focused on the evaluation and management of potentially life-threatening neurological and neurosurgical conditions. These conditions demand rapid and coordinated interventions to optimize outcomes. Improving outcomes for patients with critical nervous system injury requires progress in clinical science, diagnostic and monitoring strategies and the identification and implementation of safe, effective interventions. This special issue of Seminars in Neurology offers a synthesis of the latest updates across various domains of neurocritical care, reflecting recent developments and the ongoing integration of new research findings into clinical practice. At the core of all of these developments is an interdisciplinary approach to helping patients and families. In this issue, we invite leaders in critical care neurology to share with you the current state of the art in this exciting discipline.

Dr. Ariane Lewis provides a comprehensive summary of the World Brain Death Project (WBDP), underscoring the critical need to integrate the WBDP's standards for brain death and neurologic criteria into national guidelines. This review not only highlights emerging research questions but also stresses the importance of considering the social and legal implications of these standards.

The management strategies for severe myasthenia gravis and Guillain–Barré syndrome, discussed by Maximiliano A. Hawkes et al, focuses on the timing of interventions and respiratory management. This is an area where there has been significant evidence generation in recent years that can inform clinical practice.

Nicolas Lejeune et al review the use of advanced imaging and electrophysiology to study cognitive motor dissociation (CMD) in disorders of consciousness. These advanced tools are instrumental in uncovering covert consciousness, thereby informing both prognosis and treatment approaches. Authors highlight the need for ongoing research to enhance our comprehension of CMD.

Recent advances in the management of large hemispheric infarcts are presented by Charlene J. Ong et al, highlighting new therapeutic strategies that address complications and enhance recovery processes.

Lourdes Carhuapoma et al advocate for re-evaluating recovery timelines in intracerebral hemorrhage, emphasizing the potential for recovery beyond the typical 90-day assessments. This review synthesizes existing literature on outcome trajectories across functional and nonfunctional domains.

Temperature management in acute brain injuries is critically reviewed by Victor Lin et al, who note the inconsistent effectiveness of therapeutic hypothermia in various types of severe acute brain injury (SABI). While fever prevention is universally recognized as beneficial, the application and success of hypothermic temperature control vary, highlighting the need for additional research to develop optimal temperature management practices for different types of SABI.

The updated management of status epilepticus by Sulaiman Almohaish et al highlights how treatment strategies vary based on the timing and stage of the condition, emphasizing their importance in managing this acute neurological emergency and significantly affecting patient outcomes.

Yilun Chen et al discuss the improvement in the prediction of posttraumatic epilepsy, focusing on the integration of biomarkers and clinical data to inform personalized care strategies and enhance long-term neurological recovery.

Artificial intelligence and machine learning's transformative role in diagnosis, treatment planning, and prognostic assessments in neurocritical care is extensively reviewed by Dr. Vitt and colleague. The authors discuss the integration of these tools as essential components of the field, addressing both their scientific promise and associated challenges, including ethical implications and the need for extensive validation in diverse clinical settings.

Sarah Livesay highlights the significant contributions of nursing interventions to patient management and outcome optimization in neurocritical care. This review provides insights into the nursing process and ongoing research needs to further enhance nursing practices.

Virginie Plante et al present updates in pediatric neurocritical care, focusing on unique requirements and multidisciplinary approaches necessary for managing critically ill children. This review covers the latest developments and best practices in the field, addressing commonly encountered clinical scenarios such as abnormal movements, weakness and paralysis, and strategies for neuromonitoring and neuroprotection.

Keri S. Kim and colleagues detail “An Update on Curing Coma Campaign,” providing a progress update on the Neurocritical Care Society's efforts to fill knowledge and research gaps in coma and disorders of consciousness. This initiative is crucial for prioritizing future educational and research endeavors, enhancing patient care and clinical outcomes.

Lastly, Neha S. Dangayach et al discuss the broader impacts of post-intensive care syndrome in neurocritical care settings, emphasizing the importance of comprehensive care strategies that consider both patient and family well-being.

This collection of articles aims to arm clinicians, researchers, and other stakeholders with cutting-edge insights and developments, supporting more informed and effective practices within the ever-evolving field of neurocritical care.

Publication History

Article published online:
19 June 2024