The Present State of Neurointensivist Training in the United States: A Comparison to Other Critical Care Training Programs

Marcolini, Evie G.; Seder, David B.; Bonomo, Jordan; Bleck, Thomas P.; Hemphill, J. Claude; Shutter, Lori; Rincón, Fred; Timmons, Shelly D.; Nyquist, Paulmdmph

doi:10.1097/ccm.0000000000002876

Cited by 15 publications

(6 citation statements)

References 25 publications

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“…Social awareness about patient safety has also increased the awareness about high-quality neurocritical care among patients and neurologists. Having a neurointensivist staff member and organizing the intensive care unit (ICU) infrastructure are crucially important for providing adequate care to neurocritically ill patients 78. However, there is currently a lack of full-time neurointensivists in Korean hospitals despite the presence of neurological, neurosurgical, or general ICUs in most general hospitals 9.…”

Section: Introductionmentioning

confidence: 99%

“…Having a neurointensivist staff member and organizing the intensive care unit (ICU) infrastructure are crucially important for providing adequate care to neurocritically ill patients. 7,8 However, there is currently a lack of full-time neurointensivists in Korean hospitals despite the presence of neurological, neurosurgical, or general ICUs in most general hospitals. 9 To our knowledge, the effects of full-time neurointensivist staffing in a dedicated neurological intensive care unit (NRICU)-which may comprise a different patient population than a neurosurgical ICU, a combined neurological and neuro-JCN surgical ICU, or a general ICU-on the quality of care and outcomes of neurocritically ill patients have not been described previously.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Appointing a Full-Time Neurointensivist to Run a Closed-Type Neurological Intensive Care Unit

Lee

Kim

et al. 2019

J Clin Neurol

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Background and Purpose To investigate whether appointing a full-time neurointensivist to manage a closed-type neurological intensive care unit (NRICU) improves the quality of critical care and patient outcomes. Methods This study included patients admitted to the NRICU at a university hospital in Seoul, Korea. Two time periods were defined according to the presence of a neurointensivist in the preexisting open-type NRICU: the before and after periods. Hospital medical records were queried and compared between these two time periods, as were the biannual satisfaction survey results for the families of patients. Results Of the 15,210 patients in the neurology department, 2,199 were admitted to the NRICU ( n =995 and 1,204 during the before and after periods, respectively; p <0.001). The length of stay was shorter during the after than during the before period in both the NRICU (3 vs. 4 days; p <0.001) and the hospital overall (12.5 vs. 14.0 days; p <0.001). Neurological consultations (2,070 vs. 3,097; p <0.001) and intrahospital transfers from general intensive care units to the NRICU (21 vs. 40; p =0.111) increased from the before to after the period. The mean satisfaction scores of the families of the patients also increased, from 78.3 to 89.7. In a Cox proportional hazards model, appointing a neurointensivist did not result in a statistically significant change in 6-month mortality (hazard ratio, 0.82; 95% confidence interval, 0.652–1.031; p =0.089). Conclusions Appointing a full-time neurointensivist to manage a closed-type NRICU had beneficial effects on quality indicators and patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of Appointing a Full-Time Neurointensivist to Run a Closed-Type Neurological Intensive Care Unit

Lee

Kim

et al. 2019

J Clin Neurol

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“…One hundred five studies of 657 articles (16%) identified by date and keywords criteria search met inclusion criteria for analysis (Fig. 1) (2, 13–116) and were published in 55 different journals ( Supplemental Table 4 , http://links.lww.com/CCM/H371). Notably, 70 (67%) of the included studies were published in only four journals ( Critical Care Medicine , Journal of Critical Care , Journal of Intensive Care , and Neurocritical Care ).…”

Section: Resultsmentioning

confidence: 99%

Defining Intensivists: A Retrospective Analysis of the Published Studies in the United States, 2010–2020*

Halpern,

Tan,

Bothwell

et al. 2024

Critical Care Medicine

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OBJECTIVES: The Society of Critical Care Medicine last published an intensivist definition in 1992. Subsequently, there have been many publications relating to intensivists. Our purpose is to assess how contemporary studies define intensivist physicians. DESIGN: Systematic search of PubMed, Embase, and Web of Science (2010–2020) for publication titles with the terms intensivist, and critical care or intensive care physician, specialist, or consultant. We included studies focusing on adult U.S. intensivists and excluded non–data-driven reports, non-U.S. publications, and pediatric or neonatal ICU reports. We aggregated the study title intensivist nomenclatures and parsed Introduction and Method sections to discern the text used to define intensivists. Fourteen parameters were found and grouped into five definitional categories: A) No definition, B) Background training and certification, C) Works in ICU, D) Staffing, and E) Database related. Each study was re-evaluated against these parameters and grouped into three definitional classes (single, multiple, or no definition). The prevalence of each parameter is compared between groups using Fisher exact test. SETTING: U.S. adult ICUs and databases. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 657 studies, 105 (16%) met inclusion criteria. Within the study titles, 17 phrases were used to describe an intensivist; these were categorized as intensivist in 61 titles (58%), specialty intensivist in 30 titles (29%), and ICU/critical care physician in 14 titles (13%). Thirty-one studies (30%) used a single parameter (B–E) as their definition, 63 studies (60%) used more than one parameter (B–E) as their definition, and 11 studies (10%) had no definition (A). The most common parameter “Works in ICU” (C) in 52 studies (50%) was more likely to be used in conjunction with other parameters rather than as a standalone parameter (multiple parameters vs single-parameter studies; 73% vs 17%; p < 0.0001). CONCLUSIONS: There was no consistency of intensivist nomenclature or definitions in contemporary adult intensivist studies in the United States.

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“…Despite the rapid modernization and development of specialized neurocritical care units and staffed by a subspecialty trained population of neurointensivists and staff [207][208][209], the medical management of cerebral edema developed within this clinical practice is independent of targeting the underlying cellular and molecular mechanisms that drive it [7]. As a result, the nontargeted therapies that are employed in-practice remain the standard of clinical practice [60] and focus on the downstream effects of cerebral edema formation without modulation of the neuroinflammatory cascade that is paramount in all neuronal injury [29,210,211].…”

Section: Discussionmentioning

confidence: 99%

The Medical Management of Cerebral Edema: Past, Present, and Future Therapies

Halstead

Geocadin

2019

Neurotherapeutics

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Cerebral edema is commonly associated with cerebral pathology, and the clinical manifestation is largely related to the underlying lesioned tissue. Brain edema usually amplifies the dysfunction of the lesioned tissue and the burden of cerebral edema correlates with increased morbidity and mortality across diseases. Our modern-day approach to the medical management of cerebral edema has largely revolved around, an increasingly artificial distinction between cytotoxic and vasogenic cerebral edema. These nontargeted interventions such as hyperosmolar agents and sedation have been the mainstay in clinical practice and offer noneloquent solutions to a dire problem. Our current understanding of the underlying molecular mechanisms driving cerebral edema is becoming much more advanced, with differences being identified across diseases and populations. As our understanding of the underlying molecular mechanisms in neuronal injury continues to expand, so too is the list of targeted therapies in the pipeline. Here we present a brief review of the molecular mechanisms driving cerebral edema and a current overview of our understanding of the molecular targets being investigated.

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The Present State of Neurointensivist Training in the United States: A Comparison to Other Critical Care Training Programs

Cited by 15 publications

References 25 publications

Effects of Appointing a Full-Time Neurointensivist to Run a Closed-Type Neurological Intensive Care Unit

Effects of Appointing a Full-Time Neurointensivist to Run a Closed-Type Neurological Intensive Care Unit

Defining Intensivists: A Retrospective Analysis of the Published Studies in the United States, 2010–2020*

The Medical Management of Cerebral Edema: Past, Present, and Future Therapies

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