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The Evolution of Neurocritical Care in the Philippines

By Currents Editor posted 06-28-2018 15:11

By Joanne B. Robles, MD and Geraldine Siena L. Mariano, MD (pictured)

Geraldine_Mariano_Headshot.jpgIn the Philippines, cerebrovascular diseases rank as the second most common cause of mortality in the National Statistics Office epidemiological reports in 2017. Other neurological diseases that require intensive care management like status epilepticus and traumatic brain injury are unfortunately underreported leading to a lack of epidemiologic data. As technological advances moved us further into discovering more efficient and expedient means of preventing and protecting the injured brain from further insult and ensuring improved recovery and reduced mortality, the role of intensive neurologic management cannot be understated. This became the driving impetus for Filipino neurologists and other specialists to take an interest in the care of the critically ill patient with primary and secondary neurologic dysfunction. Neurocritical care has thus become an emerging subspecialty in the practice of neurology in the Philippines. The advances in the care of the neurocritically ill patient have paved the way for multidisciplinary specialists to improve outcomes of Filipino patients.

Over the past decade, tertiary high-volume hospitals in Metro Manila have begun to revolutionize the manner by which healthcare is delivered to patients with neurological diseases that require focused neurocritical care. Advancements in neuroimaging, neurosurgical techniques and thrombolysis in acute stroke care are now in local practice. Hospitals in Philippine urban cities now have Brain Attack Teams that ensure early recognition and management of acute ischemic stroke. Mechanical thrombectomy has likewise become a feasible option over the past few years.

However, the access to specialized healthcare is marginalized in the cities outside of metropolitan Manila, and these therapeutic advances still cannot be delivered to every neurologic patient. Recognizing these gaps in neurocritical care, a group of specialists gathered to formally discuss the founding of the Philippine Neurocritical Care Society (PNCS) on May 10, 2017. The meeting was held at St. Luke’s Medical Center in Quezon City, Philippines. The meeting was presided by Dr. Geraldine Siena Mariano and Dr. Abdias Aquino. The nonprofit organization is made up of experts and recognized leaders in various disciplines, such as neurocritical care, endovascular, neurosurgery, critical care, stroke, neuroradiology, clinical nutrition, rehabilitation medicine, nursing, clinical pharmacy and respiratory therapy from different institutions. The society is an affiliate of the NCS International Affiliates Program and it aims to reflect the mission statement of the Neurocritical Care Society.

The PNCS seeks to create local programs to educate and empower healthcare professionals in optimizing the delivery of neurocritical care especially in far-flung areas where there is limited access to care. Among the long-term goals of the organization is the development of local management guidelines that will allow standardization of care of the neurocritically ill patient even in hospitals with limited resources and the creation of hospital networks that will allow the expedient and coordinated transfer of patients to tertiary hospitals where optimal care can be provided.

(Image left:The NCCU team at St. Luke's Medical Center; Image right: The first Philippine Neurocritical Case Society (PNCS) meeting held in St. Luke’s Medical Center- Quezon City last May 10, 2017)

(Image right: Multidisciplinary rounds at St. Luke’s Medical Center, Quezon City, Philippines.)

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