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Neurointensivists Role in Neurosurgical Care and Training PowerPoint Presentation

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This medical PowerPoint presentation discusses how neurointensivists play a crucial role in the care of patients undergoing neurosurgical procedures. They specialize in the management of critically ill patients with neurologic disorders, such as traumatic brain injury, subarachnoid hemorrhage, and stroke, among others. Their expertise in managing complex patients in the intensive care unit (ICU) helps to optimize outcomes and reduce complications.

Neurointensivists work closely with neurosurgeons to manage patients before, during, and after surgery. They are responsible for ensuring that the patients condition is stable enough to undergo surgery, managing the patients blood pressure, oxygenation, and other vital signs during the procedure, and closely monitoring the patients recovery in the ICU. They also work closely with other members of the care team, including nurses, respiratory therapists, and physical therapists, to coordinate care and ensure that the patient receives the best possible care.

In terms of training, neurointensivists typically have completed a residency in neurology or neurosurgery, followed by a fellowship in neurocritical care. This specialized training equips them with the knowledge and skills needed to manage critically ill patients with neurologic disorders. They also work closely with neurosurgeons during their training to gain practical experience in the management of neurosurgical patients.

In summary, neurointensivists play a critical role in the care of neurosurgical patients by providing expert management of complex neurologic disorders in the ICU. They work closely with neurosurgeons to optimize patient outcomes and reduce complications, and they receive specialized training in neurocritical care to prepare them for this important role.

Tags : neurointensivists, neurosurgical procedures, neurologic disorders, traumatic brain injury, subarachnoid hemorrhage, stroke, critical care medicine, critical care medicine PowerPoint presentation

Published on : Mar 31, 2023 | Views : 972 | Downloads : 0

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Slide 1-

Neurointensivist’s Role in Neurosurgical Care & Training Lori A. Shutter, MD Director, NSICU/Neurocritical Program Assoc. Professor of Neurosurgery, Neurology & PMR University of Cincinnati Medical Center
Slide 2-

Objectives Describe the specialty of neurocritical care. Review the requirements for certification in neurocritical care. Discuss the role of a neurointensivist in neurosurgical residency training.
Slide 3-

Modern Intensive Care “Intensive-care medicine has become the art of managing extreme complexity—and a test of whether such complexity can, in fact, be humanly mastered.” Atul Gawande, The New Yorker, 1/6/08 Bundles; Check lists; Time Outs Protocols; Guidelines; Evidence-based Care Multidisciplinary; Collaborative JACHO; CMS
Slide 4-

What is a Neuro-intensivist? A physician devoted to comprehensive multisystem care of the critically ill neurological patient. Assumes a primary care role for patients in the ICU, coordinating both neurological & medical management. Has a unique concern with the interface between the brain and other organ systems in the setting of critical illness. Takes on responsibility for various elements of ICU care that might otherwise be provided by multiple subspecialists (i.e. cardiology, endocrinology, infectious diseases, pulmonary medicine, and neurology). Proficiency with standard ICU monitoring, as well as specialized neuro-monitoring and interventions.
Slide 5-

Are Neurointensivists Needed? Disclosure: I am biased on this topic Advances in the treatment of neurological conditions Advances in critical care Uniqueness of the neurological patient Increased patient / family awareness Collaboration for professional & academic growth Multi-disciplinary team care
Slide 6-

History of NCC Neurological Intensive Care AAN course ’80 – 87 Gap from ’88 – 99, restarted in 2000 Subspecialty development: late ’80s – early 90s MGH: Allan Ropper Columbia: Matt Fink Hopkins: Dan Hanley and Cecil Borel UVa: Tom Bleck Growth through Neurology departments, or other intensivists in units with high neurosurgical volumes Focus changed to Neurocritical Care, NOT specialized stroke units
Slide 7-

Organized NCC Organized NCC has made major strides in last decade AAN CCEN Section* Neurocritical Care Society* SNACC* AANS/CNS Joint Section on Neurotrauma & Critical Care German Neurocritical Care Working Group Neurocritical Care Society 2007 saw the 5th Annual Meeting 651 physician members (105 residents); 774 total members NCC recognized as a subspecialty by UCNS* in 2006
Slide 8-

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Slide 9-

Neurocritical Care Dedicated Neuro-ICUs with fellowship trained neuro-intensivists in the US = 50* 29 states; 39 cities & DC NCC Program Models Division of Neurology vs Neurosurgery vs Anesthesiology Department of Critical Care – Multidisciplinary Neuro-ICU models Closed vs ‘Semi-closed’ vs Open Primary providers vs Co-attendings vs Consultants
Slide 10-

Neurocritical Care Certification First certification exam in NCC in 12/07 Eligibility for exam: fellowship or practice tracts. Fellowship tract: documentation of training in an accredited NCC fellowship program Practice tract available until 2012 Exam components Neurological – 48% General medical critical care – 47% Procedural – 5% Current diplomates in NCC = 91. Next examination – 12/08
Slide 11-

Neurocritical Care Training Fellowship Training Programs 39 in the US (in 18 states) < 25 currently active 2 year training curriculum developed based on UCNS / ACGME guidelines Program accreditation through UCNS starting in 2007. 11 programs submitted applications. Specialties eligible for training in NCC: neurology, neurosurgery, emergency medicine, anesthesia, internal medicine, pediatrics
Slide 12-

NCC Training Requirements Duration of training 12 months of ICU experience > 50% focusing on primarily neurological & neurosurgical conditions Recommend 18 – 24 months to provide adequate elective & off-service time Additional qualifications Provider / instructor in ACLS, ATLS, PALS, FCCS Faculty Provide direct supervision in ICU Demonstrate adequate training / experience in NCC Minimum of 25% of time dedicated to NCC
Slide 13-

Neurological Conditions Cerebrovascular Neurotrauma Seizures Neuromuscular diseases Neuro-oncology Infections Toxic-metabolic Inflammation / demyelination Encephalopathies Movement disorders Neuroendocrine Clinical syndromes Peri-operative neurosurgical care Neurorehabilitation Pharmacotherapeutics
Slide 14-

ET Tube Feeding Tube ICP monitor CVL EEG leads EEG box PbtO2
Slide 15-

Monitor Ventilator EEG PbtO2 IV Pumps Tube feed pump
Slide 16-

General Medical Conditions Cardiovascular Shock / resuscitation Coronary Ischemia Neurogenic Cardiac Abnormalities Cardiac Arrhythmias Hypertensive Crisis Pulmonary edema: cardiogenic & non-cardiogenic Pulmonary embolism Acute aortic / peripheral vascular disorders Advanced cardiovascular monitoring & derived parameters
Slide 17-

General Medical Conditions Pulmonary Respiratory failure Pneumonitis / pneumonia Adult Respiratory Distress Syndrome Upper airway obstruction COPD / asthma Neurogenic breathing patterns Mechanical ventilation: modes, weaning, monitoring Pleural diseases: empyema, effusion Pulmonary hemorrhage / hemoptysis Sleep apnea
Slide 18-

General Medical Conditions Renal Fluids / electrolytes Acute Renal Failure Drug dosing Acid-base disorders Hemodialysis Rhabdomyolysis UTI / Urosepsis GI GI bleed GI perforation Ileus Obstruction Hepatic failure Pancreatitis
Slide 19-

General Medical Conditions Metabolic/ Endocrine Nutrition Thyroid function Adrenal crisis Diabetes Pheochromocytoma Systemic Inflammatory Response Syndrome Fever/thermoregulation Infectious Antibiotics Drug resistance Hospital acquired infections AIDS Central fever
Slide 20-

General Medical Conditions Hematologic Hemostasis defects & therapy Blood component rx Hemolytic disorders Hypercoagulable states DVT prophylaxis Anticoagulation Transfusion reactions Immunology Transplantation General Trauma Burn management ICU Agitation Monitoring Prognostication
Slide 21-

Procedural Competencies Arterial catheters Central venous catheters Pulmonary artery catheters Management of vasoactive medications Airway Management Non-intubated Direct laryngoscopy Endotracheal intubation Mechanical ventilation CPAP/BiPAP ventilation Interpretation of bedside pulmonary function CPR/ACLS (with certification)
Slide 22-

Procedural Competencies Lumbar puncture; Shunt / ventricular drain tap Conscious sedation & barbiturate anesthesia Neuro-monitoring ICP, CPP, PbtO2, SjvO2 management Management of EVDs TCDs EEGs Management of plasmapheresis & IVIG IV & intraventricular thrombolysis Interpretation of neuroimaging studies Moderate hypothermia
Slide 23-

Training Residents in NCC Work hour restrictions have damaged the ICU experience for residents Attitude change – from physicians to shift workers They are less involved and many are less happy Frequent transfers to other services rather than managing the problems Attendings aren’t reading sleep deprivation literature because we are doing the resident’s work! PGY-1s (neurosurgery, neurology, others) have been added to the ICU rotation BUT – even the best ones have trouble being alone in an ICU that early
Slide 24-

Training Residents in NCC Neurotrauma / Critical Care Fellowships Is this adequate critical care training? It will not meet criteria for NCC Certification Does that matter? That Depends Are you managing anything other than trauma? Do you want to? Does it provide adequate exposure to medical critical care? What are you going to focus on for your career? Do you want extra certifications?
Slide 25-

Training Residents in NCC I don’t have the answer Exposure to the specialty Division of Neurosurgery Collaboration Interwoven in didactic / conference sessions Dedicated ICU time Not just 30 minutes on am rounds! PGY-1 year As part of neurology requirement Advanced training / Enfolded ‘fellowship’
Slide 26-

What to do? Develop connections with NCC organizations Work with NCS leadership to address issues specific to neurosurgical training Decide if NCC should be a focus of your program Develop a curriculum with your neurointensivist Based on fellowship training requirements
Slide 27-

Thank You