Neurocritical Care Resource Utilization in Pandemics: A Statement by the Neurocritical Care Society

Moheet, Asma M.; Shapshak, Angela Hays; Brissie, Megan A.; Abulhasan, Yasser B.; Brophy, Gretchen M.; Frontera, Jennifer A.; Hall, Wiley R.; John, Sayona; Kalanuria, Atul; Kumar, Abhay; Lele, Abhijit V.; Mainali, Shraddha; May, Casey C.; Mayer, Stephan A.; McCredie, Victoria; Silva, Gisele Sampaio; Singh, Jeffrey M.; Steinberg, Alexis; Sung, Gene; Tesoro, Eljim P.; Yakhkind, Aleksandra

doi:10.1007/s12028-020-01001-6

Cited by 5 publications

(12 citation statements)

References 40 publications

(32 reference statements)

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“…1 With up to 38% of COVID-19 patients requiring admission to an intensive care unit (ICU), and 75% to 88% of critically ill COVID-19 patients requiring mechanical ventilation, [2][3][4][5][6][7] the pandemic has necessitated changes to the structure and function of critical care services in hospitals and health care systems worldwide. The delivery of care to patients requiring neurological/neurosurgical critical care (hereby referred to as NCC patients) may be disrupted as scarce neurocritical care resources were reallocated due to shifting priorities 8,9 in preparation for managing projected surges of patients with COVID-19 disease. 10 NCC patients may be admitted to a dedicated neurocritical care unit (NCCU) or a mixed-general intensive care unit (gen-ICU).…”

Section: Discussionmentioning

confidence: 99%

“…A 176-question survey available in English, Spanish, and Brazilian Portuguese was developed using the Institute of Translational Health Sciences’ REDCap database management system. Survey items covered the Neurocritical Care Society’s recommendations on neurocritical care resource utilization in a pandemic 9. The full questionnaire is available in the supplementary material (Supplemental Digital Content [SDC] 1: Survey questionnaire, http://links.lww.com/JNA/A461).…”

Section: Methodsmentioning

confidence: 99%

“…[40][41][42][43] Early in the pandemic, critical care capacity for NCC patients was preserved by a temporary suspension of elective non-neurological and neurological surgeries, including elective endovascular, cranioplasty, and open cerebrovascular procedures. 44,45 Strategies to generate additional staffing for ICU teams included: (a) reallocation or redeployment of existing ICU clinicians by specialty and subspecialty training; (b) utilization of non-ICU based clinicians, such as registered certified nurse anesthetists, to participate in routine critical care delivery; (c) return to work of retired physicians and nurses, 9 and; (d) recruitment of traveler nurses or per diem personnel. Medication shortages were reported by more than two-thirds of respondents' that had experienced a first surge of COVID-19 patients; the reported pharmaceutical practices confirmed shortages and strategies to mitigate shortages as previously published.…”

Section: Impact Of the Covid-19 Pandemic On Neurocritical Care Delive...mentioning

confidence: 99%

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Perceptions Regarding the SARS-CoV-2 Pandemic’s Impact on Neurocritical Care Delivery: Results From a Global Survey

Lele

Wahlster²,

Alunpipachathai³

et al. 2021

Journal of Neurosurgical Anesthesiology

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Background: The SARS-CoV-2 (COVID-19) pandemic has impacted many facets of critical care delivery. Methods: An electronic survey was distributed to explore the pandemic’s perceived impact on neurocritical care delivery between June 2020 and March 2021. Variables were stratified by World Bank country income level, presence of a dedicated neurocritical care unit (NCCU) and experiencing a COVID-19 patient surge. Results: Respondents from 253 hospitals (78.3% response rate) from 47 countries (45.5% low/middle income countries; 54.5% with a dedicated NCCU; 78.6% experienced a first surge) participated in the study. Independent of country income level, NCCU and surge status, participants reported reductions in NCCU admissions (67%), critical care drug shortages (69%), reduction in ancillary services (43%) and routine diagnostic testing (61%), and temporary cancellation of didactic teaching (44%) and clinical/basic science research (70%). Respondents from low/middle income countries were more likely to report lack of surge preparedness (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.8-5.8) and struggling to return to prepandemic standards of care (OR, 12.2; 95% CI, 4.4-34) compared with respondents from high-income countries. Respondents experiencing a surge were more likely to report conversion of NCCUs and general-mixed intensive care units (ICUs) to a COVID-ICU (OR 3.7; 95% CI, 1.9-7.3), conversion of non-ICU beds to ICU beds (OR, 3.4; 95% CI, 1.8-6.5), and deviations in critical care and pharmaceutical practices (OR, 4.2; 95% CI 2.1-8.2). Respondents from hospitals with a dedicated NCCU were less likely to report conversion to a COVID-ICU (OR, 0.5; 95% CI, 0.3-0.9) or conversion of non-ICU to ICU beds (OR, 0.5; 95% CI, 0.3-0.9). Conclusion: This study reports the perceived impact of the COVID-19 pandemic on global neurocritical care delivery, and highlights shortcomings of health care infrastructures and the importance of pandemic preparedness.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Impact Of the Covid-19 Pandemic On Neurocritical Care Delive...mentioning

confidence: 99%

See 1 more Smart Citation

Perceptions Regarding the SARS-CoV-2 Pandemic’s Impact on Neurocritical Care Delivery: Results From a Global Survey

Lele

Wahlster²,

Alunpipachathai³

et al. 2021

Journal of Neurosurgical Anesthesiology

Self Cite

View full text Add to dashboard Cite

show abstract

“…The reasons for this trend need further exploration but may due to reduced ICU bed availability leading to patients, that would ordinarily have been cared for in the ICU, being managed in non-critical care settings and by providers that lack specific expertise. Critically ill neurologic patients have been shown to have better outcomes when managed by specially trained neurocritical care personnel in dedicated neurocritical care units ( Moheet et al., 2020 ) and during the pandemic this care may not have been available or patients may have been admitted to medical ICUs due to simultaneous COVID-19 infections. These hypotheses need further study as this data was not available in TriNetX.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, as the pandemic continues to evolve, there may be a delayed collateral impact on critically ill neurologic patients. Guidelines to ensure adequate care for NCC patients during the pandemic ( Moheet et al., 2020 ) should be adopted widely.…”

Section: Discussionmentioning

confidence: 99%