Leading Insights

Gabrielle Horstman, MD/PhD This month we would like to highlight one of the new programs launched this year by the Inclusion in Neurocritical Care (INCC)  Committee– The INCC Virtual Book Club! This program was created in response to multiple requests from members like you during the 2020 Annual meeting. Fully embracing the virtual nature of the meeting, the idea for a book club stemmed from a very active chat discussion during the Women In Neurocritical Care (WINCC) keynote address given by Dr. Chere Chase-Gregory where she illustrated her personal ...

Richard Leston,  APP Supervisor, Department of Neurosurgery, Clinical Preceptor of APP Neurosurgery Clerkship With: Alexis Catania, PA & Krista O’Leary PA-S South Shore University Hospital was preparing to open its brand-new Neuro ICU in March of 2020, eager to become a major neuroscience center in Suffolk County, New York. This effort involved a rapid expansion of the neurosurgery department, adding a team of neurointensivists, and quadrupling the APP staff over the course of one year.  Unfortunately, COVID-19 delayed the launch of our ICU while we ...

Zachary Threlkeld, MD, Ahmad Riad Ramadan, MD, Sara Hefton, MD, Starane Shepherd, MD, H.E. Hinson, MD INCC Sexual and Gender Minority Subcommittee As part of broader diversity, equity, and inclusion efforts within NCS, the Sexual and Gender Minority (SGM) subcommittee of the Inclusion in Neurocritical Care Committee (INCC) aspires to raise awareness about and mitigate health disparities in SGM individuals, support development of culturally sensitive neurocritical care, and promote the recruitment and retention of SGM individuals who are historically ...

Jon Rosenberg, MD, Weill Cornell Medicine/New York-Presbyterian Hospital Laura Chen, DO, Weill Cornell Medicine/New York-Presbyterian Hospital Judy Ch’ang, MD, Weill Cornell Medicine/New York-Presbyterian Hospital A 34-year-old man presented with a high-grade traumatic brain injury (TBI) after being struck by a motor vehicle. In the emergency department he had a GCS of 3 and was intubated for airway protection. His initial CT showed bilateral frontal subarachnoid hemorrhage, left subdural hematoma and temporal contusion with effacement ...

Bryan Boling, DNP, University of Kentucky Jennifer Mears, PA, Weill Cornell Medicine/New York-Presbyterian Hospital Aarti Sarwal, MD, Wake Forest Baptist Health Judy Ch’ang, MD, Weill Cornell Medicine/New York-Presbyterian Hospital Point-of-care-ultrasound (POCUS) is an indispensable tool used in the diagnosis, screening, procedural guidance, and management of critically ill patients across the world. Unlike other imaging modalities, POCUS is performed and interpreted by the intensivist at the bedside, enabling real-time management ...

Peter J. Papadakos MD, FCCM, FCCP, FAARC, FNIV Over the last decade, many unregulated drugs have appeared on the marketplace and have adversely affected our patients. We are all familiar with artificial marijuana which were sold in thousands of convenience stores throughout the country. These synthetic cannabinoids sold with catchy names such as K2, Spice, Scooby, Bizzaro or Snzx. The FDA acted rapidly to educate the public and make them illegal. They impacted our ICU’s with seizures, unconscious, delirium, aggressive and combative behavior, and the ...

Shweta Goswami, MD, University of Florida Sasha Yakhkind, MD, University of Pennsylvania Every year, neurology residents combine the wisdom of their mentors, their experience, their passion, and their personalities to guide them in the decision of sub-specialization. In 2017, 90% of neurology residents planned to complete fellowship before going into practice (1), and the process of application into subspecialty training is nuanced and evolving. Neurocritical care fellowship is part of the United Council for Neurologic Specialties (UCNS), and the ...

Luis Rafael Moscote-Salazar, MD Critical Care Unit, Bogotá, Colombia Centro Policlínico del Olaya I ván David Lozada-Martínez, MS University of Cartagena Cartagena, Colombia View Blog in English Las enfermedades neurológicas y neuroquirúrgicas son una de las principales causas de morbilidad y mortalidad en todo el mundo, y América Latina no es una excepción [1-3]. La incorporación de la atención neurocrítica ha representado un cambio de paradigma en el manejo de estas enfermedades [4]. Sin embargo, el advenimiento de la reciente ...

Luis Rafael Moscote-Salazar, MD Critical Care Unit, Bogotá, Colombia Centro Policlínico del Olaya I ván David Lozada-Martínez, MS University of Cartagena Cartagena, Colombia Blog en Español Neurological and neurosurgical diseases are a major cause of morbidity and mortality worldwide, and Latin America is no exception [1-3]. The incorporation of neurocritical care has represented a paradigm shift in the management of these diseases [4]. However, the advent of the recent pandemic represented a series of challenges for neurocritical ...

Shivani Ghoshal, MD Currents is excited to launch a new Arts Corner to recognize visual, performing, and creative artworks pertaining to neurocritical care, as well as makers within our own community. The practice of neurocritical care is as humbling as it is rewarding, and requires mindfulness both of oneself and one’s peers. We hope this corner will be a step toward recognizing creative outlets for NCS members and bringing our community closer together even while we are apart.  For its debut, we’d like to introduce Shivani Ghoshal, a neuro-intensivist ...

By Yingying Su, MD, Neuro ICU Professor, Xuanwu Hospital, Capital Medical University In 1998, when the neuro ICU of Xuanwu Hospital of Capital Medical University was established, we initiated a research project with the Beijing Municipal Science and Technology Commission—a study of bedside brain injury monitoring, evaluation, and brain protection treatment. Since then, with the support of nine scientific research projects, we have carried out studies of neuro-electrophysiology (EEG, EPs and ERPs), neuro-biochemical markers (S-100 and NSE), cerebral ...

Richard Choi, DO Please note this opinion piece reflects the views of the author and does not necessarily reflect the position of ChristianaCare.   The recent wave of increased social and racial injustice awareness as well as the significant increase in anti-Asian hate crimes 1 have had me reflecting on my life-long cultural and racial experiences.  As a Chinese-Korean American child growing up in Spain in the 80s and 90s, I unfortunately became accustomed to experiencing racist behaviors and slurs such as people holding their eyes in a slanted-eye ...

Ryan Hakimi, DO, MS, NVS, RPNI, CPB, FNCS This series will be a running feature highlighting billing, coding, practice management, and other business aspects of neurocritical care.  Although all of us received extensive education and training in the care of neurocritical care patients, few if any of us received any training on the non-patient care aspects of our daily jobs. The goal of this series will be to increase your value as a neurocritical care provider to your organization while improving regulatory compliance and hospital-based metrics. ...

J. Spencer Dingman, PharmD, BCCCP Neurocritical Care Pharmacy Specialist Wesley Medical Center, Wichita, KS James.dingman@wesleymc.com Brian W. Gilbert, PharmD, BCCCP, BCPS Emergency Medicine Pharmacy Specialist Wesley Medical Center, Wichita, KS Brian.gilbert@wesleymc.com With Sean Di Paola, PA-C, MPAS Emergency Medicine Physician Assistant Wesley Medical Center, Wichita, KS Sean.dipaola@carepointhc.com Christopher D. Cassidy, MD Emergency Medicine Physician Wesley Medical Center, Wichita, KS Christopher.cassidy@carepointhc.com ...

Dyan Fleming, PharmD, BCPS, BCCCPS Treating neurocritical care patients in Alaska, land of the midnight sun, comes with unique geographical, environmental, and seasonal challenges. Navigating these challenges requires careful planning coupled with complex coordination of medical care to minimize delays and optimize patient outcomes as much as possible through all transitions and levels of care.  Alaskans are resilient when it comes to dealing with crises in the harsh elements and sometimes “wild” remoteness.  Can you imagine for a minute- it’s ...

Bindi Parikh, MD, Neurology Resident, University of Minnesota Christine Yeager, MD, Assistant Professor of Neurology, University of Minnesota     Section Editor Lauren Koffman, DO, MS One Thursday, amidst the peak of the COVID-19 pandemic, Naema had been working from home as a student advisor and was carrying out her usual activities. Though she did not feel quite herself, she drove herself to take care of errands and later went outside for a run. She recalls, “I was feeling off, my appetite was off. I didn’t know at the time that ...

By Sana Alkhawaja, MD, CABEM; Nehad Al Shirawi, MD, MRCP; Hasan Mohammed Naser, MBBS, Najat S. Hameed Naser, RN; Asrar A. Majeed Al Asheeri, RN; Redha Abdulla Al Hammam, RN; Amina Maki Husain, RN  The Kingdom of Bahrain, home of the ancient Dilmun civilization, is a Middle Eastern island situated in the Arabian Gulf. Bahrain is made up of an archipelago of 33 natural islands. The capital city of Manama lies in the heart of the island, the most densely populated area, with over two thirds of Bahrain’s 1.7 million people residing there. The total land ...

By Peter J Papadakos, MD, FCCM, FCCP, FAARC, FNIV During the worldwide COVID-19 pandemic, critical care practitioners throughout the United States and the world were instructed by health agencies, government leaders and hospital administration to ban family members from visiting critically ill patients.  The question I ask, along with many of my critical care peers, is - did we do more harm than good to our patients and their families?  How did the rush to deal with this pandemic and flatten the curve affect our bedside care?  Did what these leaders ...

By Kia Ghiassi, Department of Neurology, Missouri University, Columbia Missouri;  Jesyree Veitia, Universidad Central de Venezuela, Caracas, Venezuela; and Francisco Gomez, Department of Neurology, Missouri University, Columbia Missouri Adequate cerebral blood flow (CBF) is a key component in ensuring optimal oxygen delivery to brain parenchyma, considered a biomarker of tisular health and function with clinical utility. CBF when combined with MAP allows for inference of cerebral autoregulation, as a measure recommended by the NCS and European Society ...

By Michael Diringer, MD The financial infrastructure for scientific publishing is being completely transformed by a desire to ensure that scientific knowledge is freely accessible to all.  The power behind this transformation resides with those who fund research; they are insisting that reports of work they fund be freely and immediately available.  In the past, scientists published their research in journals at no cost, and publishers made money by charging individuals, universities, and other institutions for subscriptions.  The new concept, referred ...

By Jamie Nicole LaBuzetta, MD, MSc, MPhil, Division of Neurocritical Care,Department of Neurosciences, UC San Diego Health In the early 1990s, most physicians were Republicans.  Three decades later, the demographic composition of the medical workforce has shifted 1, 2 , and so has the overall political alignment of physicians. Now, physicians are roughly split between the two major political parties, though data suggest that some specialties have political tendencies; for instance, practitioners in fields such as surgery lean Republican, whereas those ...

By Tommy T. Thomas, MD, PhD; Ebonye Green MNSc, ACNPC-AC, CNRN, SCRN, APRN; Deepa Malaiyandi, MD and Hana Nobleza, MD Some of us watched the videos. A doctor’s cry for help from the very medical establishment to which she belongs. A CEO expresses contrition by saying that there were “good people” on both sides. A man cries out for his mother as he was robbed of breath. We ask the question, “How we can avoid this situation?” The answers lie far beyond this isolated incident. They are buried in the awareness and analysis of a long history of ...

By Starane Shepherd, MD, Assistant Professor of Neurology, Rush University Medical Center, Chicago, IL Over the last year of this pandemic, I have taken care of a large number of patients with COVID-19 infections in our neurocritical care unit. At the height of the surge in Chicago, our unit became one of the COVID-19 ICU surge units and battled the health crisis sweeping through my city, Chicago, the United States and the world. While taking care of these patients, struggling for their every breath, one factor stood out to me: their race. Most of ...

By Matilda Dervisevic 1 , Chetan Sateesh Nayak 2  and Francisco Gomez 3 1 Univeristy of Missouri Medical School 2 Department of Neurology, University of Missouri 3 Department of Neurology, University of Missouri Refractory status epilepticus (RSE) is a condition in which there is continuing seizure activity despite the administration of two first-line agents. Super-refractory status epilepticus (SRSE) is described as continual RSE for 24 hours, or with recrudescence upon withdrawal of anesthetic agents. As a neurological emergency, RSE confers ...

By Stephen A. Trevick, MD, Northwest Neurology, IL  The emotional impact of the COVID-19 pandemic will be felt throughout society for months and years to come.  This impact will come in many guises and patterns throughout medicine and certainly in the acute care of neurocritical care patients.  Resources will continue to be limited and healthcare providers may be reassigned between specialties and units.  Our neurological patients will have concerns, often justifiably, that their care is suffering. Each human being has a hierarchy of needs.  It is ...

By Lucie Pelunkova, MSc, Critical Care Nursing, Nurse Educational Specialist, Neurologic Critical Care Unit, Cleveland Clinic Abu Dhabi; Nouran Salem, PharmD, BCCCP, MBA, Critical Care Pharmacotherapy Specialist, Cleveland Clinic Abu Dhabi; Seby John, MD, Consultant Neurologist, Vascular Neurology and Neurointerventional Surgery, Neurological Institute, Cleveland Clinic Abu Dhabi; Fadi Hamed, MD, Consultant Intensivist, Section Head, Medical and Surgical Critical Care Unit, Critical Care Institute, Cleveland Clinic Abu Dhabi; and Jamil R. Dibu, MD, Consultant ...

By Yingying Su, MD, PhD The 11th National Conference of Neurocritical Care Committee of the Chinese Society of Neurology (NCC/CSN) was held on Aug. 23-29 2020. We would like to thank Prof. Jose, the director of Neurocritical Care, and Prof. Gene and Brophy, the former director of Neurocritical Care, for their emails and videos to wish the conference a success. May the COVID-19 epidemic end soon, and the neurointensivists of Neurocritical Care Society (NCS) around the world will meet again.  The whole conference was held online for the first time. ...

By Thomas D. Bernier, PharmD; and Michael Schontz, PharmD, BCPS, BCCCP Aneurysmal subarachnoid hemorrhage (aSAH) accounts for 5% of all strokes, and due to a multitude of complications, patients are at exceptional risk of mortality and morbidity. 1 The incidence of aSAH is geographically diverse varying between 2 and 16.5 per 100,000 hospitalized adults globally. 2 Patients are at risk of multifactorial mortality and morbidity in aSAH, as patients can experience rebleeding, hydrocephalus, seizures, infections and notably delayed cerebral ischemia ...

By Ahmad Abdussalam, MD, MRCP UK, neuro intensivist, UCNS Certified; Dana Bakdach, BSC, PharmD, clinical pharmacist; Sundus Sardar, MBBS, medical resident; Nadir Kharma, pulmonary critical care and sleep medicine; Ali Ait Hssain, MD, DESAR, ECMO consultant; Adel Royce Mangodato, senior RN; and Ashraf Molokhia, MD, consultant intensivist and anesthetist In Qatar, the first case of COVID-19 was confirmed on Feb. 27, 2020. While the global death toll continues to climb, Qatar stands out with a low mortality rate of 0.14%, and 150 deaths to date. 1 ...

By Padmaraj Duvvuri, MD; Editor Lauren Koffman, DO, MS Over the past two years, there has been an ongoing effort to establish a Midwest Chapter within the Society of Critical Care Medicine (SCCM). I have tried to become an active member of the chapter and will be speaking at the upcoming inaugural conference on Aug. 29, 2020. During the COVID-19 pandemic I believe most of us have developed a renewed sense of comradery amongst all specialties and support staff. Now more than ever, we should work together to facilitate education across various aspects ...

By Anthony Jaworski, PharmD, BCCCP  A reported 6% of new onset seizures and 9% of status epilepticus cases are attributed to drug neurotoxicity. 1,2   Over the years, there has been a decline in cases of seizures from cocaine, theophylline and tricyclic antidepressant (TCA) toxicity. There are increasing reports of seizures from newer antidepressants, such as bupropion in the United States and citalopram in Switzerland. In Iran and Australia, the trend in tramadol poisonings are increasing, and seizure is a common complication.  In developing countries, ...

By Brian R. Schuler, PharmD, senior pharmacist;   Kaylee K. Marino, PharmD, BCCCP, BCPS, clinical pharmacy specialist; and   Michael Reznik, MD As pharmacists and clinicians working in the neurosciences intensive care unit (ICU), we understand the importance of agitation and delirium management and acknowledge the lack of evidence related specifically to the neurocritical care population. Although we do use propofol and antipsychotic medications in many cases, and prefer quetiapine or olanzapine because of less potent antidopaminergic effects, ...

By Telmo E. Fernandez-Cadena, Intensive Care, Guyaquil, Ecuador; Manuel Jibaja, director, Intensive Care Unit, Hospital Eugenio Espejo, Quito, Ecuador; Nelson Maldonado, MD, Neurocritical Care, Universidad San Francisco de Quito (USFQ); Miguel Andrade, MD Perspectives from Guayaquil, Ecuador On Feb. 29, 2020, the first case of SARS-CoV-2 in Ecuador was announced in Guayaquil. What we saw as a distant problem in Wuhan and New York had finally arrived. A city hospital was enabled with 24 intensive care beds for COVID-19, and the opening of ...