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General Principles of Neurocritical Care

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Textbook of Neuroanesthesia and Neurocritical Care

Abstract

Neurocritical care (NCC) refers to the care and examination of the comatose patient; treatment of raised intracranial pressure (ICP) and neuromuscular respiratory failure; use of therapies specific for acute stroke, ICH, SAH, TBI, and status epilepticus, among other conditions; and treatment of medical complications typical for acute neurologic illness. The pivotal aspect of NCC involves providing intensive monitoring to critically ill neurological patients and thus requires the support of specially trained personnel with skills to identify subtle neurologic changes which remain the best markers for worsening injury. The neurointensivist plays a central role, directing medical care, triaging patients, and managing ICU resources. In addition, the critical care provider team also consists of residents, fellows, and/or physician extenders. Ideally such a team should be available 24 h a day to provide continuous monitoring and care. Like any other critically ill patient, management of the neurocritically ill patient begins with ensuring a secured airway, adequate ventilation, and circulation. This is followed by a rapid neurological assessment to grade the level of consciousness and elucidate the cause and severity of injury in order to identify immediate interventions such as ICP control. Once stable, appropriate radiological studies are obtained to confirm the suspected diagnosis followed by specific therapies including neurosurgical interventions. In this chapter, we review the principles of NCC, current neuromonitoring approaches, and the best treatment maneuvers available.

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Author information

Authors and Affiliations

  1. Division of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Vishank Shah

  2. Department of Anesthesiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jose I. Suarez

  3. Department of Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jose I. Suarez

Authors
  1. Vishank Shah
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  2. Jose I. Suarez
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Correspondence to Jose I. Suarez .

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Editors and Affiliations

  1. Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India

    Hemanshu Prabhakar

  2. Division of Neuroanesthesiology, Department of Anesthesiology, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India

    Zulfiqar Ali

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Shah, V., Suarez, J.I. (2019). General Principles of Neurocritical Care. In: Prabhakar, H., Ali, Z. (eds) Textbook of Neuroanesthesia and Neurocritical Care. Springer, Singapore. https://doi.org/10.1007/978-981-13-3390-3_1

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  • DOI: https://doi.org/10.1007/978-981-13-3390-3_1

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  • Publisher Name: Springer, Singapore

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  • Online ISBN: 978-981-13-3390-3

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