Building a Pediatric Neurocritical Care Program: A Multidisciplinary Approach to Clinical Practice and Education from the Intensive Care Unit to the Outpatient Clinic

Abstract

We describe our 10-year experience developing the Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program at Northwestern University Feinberg School of Medicine. The neurocritical care team includes intensivists, neurologists, and an advanced practice nurse who have expertise in critical care neurology and who continue care in long-term follow-up of intensive care unit patients in a dedicated neurocritical care outpatient clinic. Brain-directed critical care requires collaboration between intensivists and neurologists with specific expertise in neurocritical care, using protocol-directed consistent care, and physiological measures to protect brain function. The heterogeneity of neurologic disorders in the pediatric intensive care unit requires a background in the relevant basic science and pathophysiology that is beyond the scope of standard neurology or critical care fellowships. To address this need, we also created a fellowship in neurocritical care for intensivists, neurologists, and advanced practice nurses. Last, we discuss the implications for pediatric neurocritical care from the experience of management of pediatric stroke and the development of stroke centers.

Retrospective Analysis and Family Feedback of Patients Who Underwent Tracheostomy in Pediatric Intensive Care Unit: Single Center, 10 Years of Experience

“…In our study, we found in line with the literature that neurological system diseases were the most common disease group in which tracheostomy was performed (7). This is because these children are in the higher risk group in terms of mechanical ventilator duration, ventilator-related pneumonia incidence and mortality rates than other children in intensive care unit (8)(9)(10). In 93% of our patients, the reason for admission to our service was respiratory distress.…”

International Survey of Critically Ill Children With Acute Neurologic Insults: The Prevalence of Acute Critical Neurological Disease in Children: A Global Epidemiological Assessment Study*

“…32 Data are needed to elucidate the optimal configuration and integration of neurocritical care services that affect outcomes. 29,30,33,34 Few centers reported having ICU follow-up clinics, an innovative multidisciplinary effort to address recovery from critical illness. 35 …”

A Multidisciplinary Approach to the Assessment and Management of Pre-school Age Neuro-developmental Disorders: A Local Experience

“…Advantages of inter-disciplinary cooperation among multi-professional teams have been well documented in several pediatric, medical and surgical conditions, including reduced length of hospital admission and improved quality of life [31][32][33]. Multidisciplinary regular early intervention among Down syndrome children have been shown to signi icantly improve rates of school attendance compared to others not receiving regular early interventions [34].…”

“…Neurodevelopment ASD Diagnosis and management [42,38,37] Learning and behavioural problems [43] Language-impairment [44] Cerebral Palsy [45,46] Developmental Surveillance [47] Respiratory Asthma [48] infants with chronic lung disease [49] Neurology Spinal Muscular Atropy (SMA) [50] Traumatic brain injury [51] Epilepsy [52] Neurocritical care [32] Nutritional Obesity [53,54] Health Services Transitioning [55] Minimizing drug errors [55] Genetic Beckwith-Wiedeman syndrome [57] Haemophilia [58] Mental Health Eating disorders in children and adolescents.…”