Textbook of Neurointensive Care: Volume 2: Perioperative Management, Monitoring, Pharmacotherapy

Foreword
Preface
Contents
Part I: Priorities in Perioperative Management
	1: Intraoperative Neuroanesthesia
		Introduction
		Anesthesia and Basic Neuropathophysiology
			Cerebral Oxygen Consumption
			Intracranial Pressure
			Cerebral Blood Flow and Its Influences
			Arterial Oxygen Content
			Fluid and Electrolyte Management
		Key Perioperative Events
			Intubation and Head Frame Placement
			Positioning
			Venous Air Embolism
			Extubation
			Postoperative Visual Loss
		Special Consideration for Specific Neurosurgical Procedures
			Mass Lesions
			Posterior Fossa Surgery
			Brainstem
			Transsphenoidal Hypophysectomy
		Vascular Neurosurgery
			Cerebral Aneurysms
			Arteriovenous Malformations
			Carotid Endarterectomy
			Endovascular Surgery
			Stroke Thrombectomy
			Spine Surgery
			Awake and Functional Operations
			Enhanced Recovery After Surgery (ERAS)
		Conclusion
		References
	2: Postoperative Care for the Neurosurgical Patient: Cranial Procedures
		Goals of Neurointensive Care Following Cranial Neurosurgical Procedures
		Who Goes to and Who Stays in the NICU?
		How Often and What Complications Occur?
		Common Complications
			Postoperative Hemorrhage
			Intracranial Hypertension/Cerebral Edema
			Hydrocephalus
			Infection
			Seizures
			Electrolyte or Metabolic Dysfunction
			Other Complications
		The Effects of Recovery from Anesthesia on Neurosurgical Patients
			Systemic Effects
			Cerebral Effects
		Effect of Anesthetic Agents on Neurosurgical Patients
		Management of Neurosurgical Recovery and Extubation
			Rapid-Awakening and Recovery
			Delayed Recovery
			Extubation
			Weaning Strategies and Extubation Failure
		Postoperative Pain
			Management of Post-craniotomy Pain
		Postoperative Nausea and Vomiting
		Basic Postoperative Neurosurgical Care
			Respiratory Care
				Airway Obstruction
				Hypoventilation
				Hypoxemia
				Neurogenic Pulmonary Edema
				Who Should Be Ventilated?
			Cardiovascular Management
				Hypotension
				Hypertension
			Fluid Management
				Fluid Status
				Fluid Therapy
				Choice of Fluids
		Postoperative Monitoring
			Neurological Exam
			Systemic Monitoring
			Intracranial Pressure Monitoring
			Other Monitors
			Imaging
		Conclusion
		References
	3: Complex Spine Surgery
		Introduction
		Complex Thoracic and Lumbar Surgical Approaches
			Anterior Approaches to the Thoracic Spine
			Anterior Approaches to the Lumbar Spine
			Lateral Approaches to the Lumbar Spine
			Posterior Approaches to the Ventral Thoracic and Thoraco-Lumbar Spine
		Spinal Instrumentation
			Posterior Instrumentation
			Anterior Instrumentation
			Sacro-Pelvic Instrumentation
		Clinical Applications of Complex Spine Surgery
			Spinal Trauma
				Atlanto-Axial Fractures
				Subaxial Cervical Facet Dislocation
				Thoracic and Lumbar Fractures
			Spinal Infections
				Posterior Approach
				Anterior Approach
				Single-Stage Anterior and Posterior Procedure
				Two-Staged Anterior–Posterior Procedure
				Lateral Approach
			Spinal Neoplasms
			Spinal Deformity
				Complications
		Conclusion
		References
Part II: Monitoring and Procedures
	4: Airway Management in the Neurointensive Care Unit
		Introduction
		Airway Management in Critically Ill Patients
		Airway Management in Neuro-Critically Ill Patients
		Airway Adverse Events in Critically Ill Patients
		Current Approach to Airway Management
			Evaluation of the Patient for Airway Management
			Monitoring During Airway Management
			Oxygenation Optimization
			Hemodynamic Optimization
			Pharmacologic Support
			Human Factors and Ergonomics of Airway Management in the Critical Care Setting
		Airway Management Techniques
			Patient Positioning
				Techniques for Perioperative Oxygenation
				Traditional O2 Delivery Methods
				Non-invasive Positive-Pressure Ventilation
				High-Flow Nasal Oxygen
				Face-Mask Ventilation
				Supraglottic Airway Devices
			Laryngoscopy
				Direct Laryngoscopy
					Stylets
					Tube Introducers (Bougies)
				Video Laryngoscopes
					Flexible Intubation Scopes (FIS)
					Awake Flexible Scope Intubation (AFSI)
			Invasive Airway Techniques
				Cricothyrotomy
		Extubation Techniques and Plans
			Phase I: Review Patient Information
			Phase II: Review Current Airway Issues
			Phase III: Establish Strategies to Decrease the Need for Reintubation
			Phase IV: Establish a Management Plan for Post-extubation Care and Reintubation if the Need Arises
		Airway Management in Neurosurgical-Neuro-Intensive Care Patients
			Airway Management in Acute Cervical Spine Injury
			Airway Management in Traumatic Brain Injury (TBI)
			Airway Management in Acute Stroke
			Airway Management in Status Epilepticus
			Airway Management in Patients with Neuro-Muscular Disorders
			Airway Management for Neuroradiology Procedures
		Conclusion
		References
	5: Critical Care Procedures
		Introduction
		Endotracheal Intubation
			Indications
			Contraindications
			Techniques
			Complications
		Tracheostomy
			Indications
			Contraindications
			Techniques
			Complications
		Flexible Bronchoscopy
			Indications
			Contraindications
			Techniques
			Complications
		Thoracentesis and Percutaneous Tube Thoracostomy
			Indications
			Contraindications
			Techniques
			Complications
		Open Tube Thoracostomy
			Indications
			Contraindications
			Techniques
			Complications
		Arterial Catheterization
			Indications
			Contraindications
			Techniques
			Complications
		Central Venous Catheterization
			Indications
			Contraindications
			Techniques
			Complications
		Pulmonary Artery Catheterization
			Indications
			Contraindications
			Techniques
			Complications
		Temporary Cardiac Pacing
			Indications
			Contraindications
			Techniques
			Complications
		Paracentesis
			Indications
			Contraindications
			Techniques
			Complications
		Conclusions
		References
	6: Echocardiography and Ultrasound Applications
		Introduction
		Brain Ultrasonography
		Evaluation for Ventriculomegaly and Hydrocephalus
		Noninvasive ICP Assessments
		Transcranial Doppler and ICP
		Optic Nerve Sheath Diameters and ICP
		Cerebral Vasospasm and Transcranial Doppler
		Point-of-Care Ultrasound (POCUS)
			Cardiac Ultrasound, Transthoracic, Point-of-Care, and Transesophageal Echocardiography
		Transesophageal Echocardiography (TEE)
			Indications, Contraindications, and Image Acquisition
			Clinical Applications
		References
	7: Invasive Neurological and Multimodality Monitoring in the Neuro-ICU
		Introduction
		Intracranial Pressure
		Pathophysiology
			The Monro-Kellie Doctrine and Compliance
			Autoregulation and Cerebral Perfusion Pressure
		The Rationale for an ICP Monitor
		Types of ICP Monitors
			Ventricular Catheter
			Intraparenchymal ICP Monitors
			A Combined Drain and Pressure Sensor
		Treatment of Increased ICP
			Duration of ICP Monitoring
			ICP Is More Than a Number
		Oxygenation in Brain
			Jugular Venous Oximetry
			Brain Tissue Oxygen (PbtO2) Monitoring
		Metabolic Monitoring: Cerebral Microdialysis
		Cerebral Blood Flow
			Cerebral Perfusion
			Laser Doppler Flowmetry
			Thermal Diffusion Flowmetry
			Invasive EEG
				SD Clinical Significance
		Bioinformatics and Making Sense of the Numbers in the Future
		References
	8: Noninvasive Neuromonitoring
		Introduction
		Neurological Ultrasonography
			Conventional Transcranial Doppler Ultrasonography
				Theory
				Physics of Transcranial Doppler Ultrasonography
				Technique
				Doppler Indices and Abnormal Hemodynamic Patterns in TCD Monitoring
				Transcranial Doppler Applications in Critical Neurological Illness
					Aneurysmal Subarachnoid Hemorrhage
					Acute Ischemic Stroke
					Traumatic Brain Injury
					Brain Death Determination
			Transcranial Color-Coded Duplex Sonography
				Theory
				Technique
				Transcranial Color-Coded Duplex Sonography Applications in Critical Neurological Illness
			Optic Nerve Sheath Diameter by Transorbital Ultrasound
				Theory
				Technique
				Transorbital Ultrasound Applications in Critical Neurological Illness
		Near-Infrared Spectroscopy
			Cerebral Oximetry
				Theory
				Technique
				Interpretation
				Limitations
				Cerebral Oximetry Applications in Critical Neurological Illness
					Reducing Risk of Perioperative Neurological Injury
					Primary Neurological Illness
			NIRS in Monitoring Cerebral Autoregulation
				Theory
				Technique
				Limitations
				Interpretation
				NIRS Autoregulation Monitoring Applications in Critical Neurological Illness
			Future Direction
		Evoked Potential Monitoring
			Theory
			Evoked Potential Monitoring Applications in Critical Neurological Illness
				Neuro-Prognostication
				Brain Death
				Intraoperative Monitoring
			Limitations
		Processed Electroencephalography
			Theory
			Technique
			Interpretation
			Processed EEG Applications in Critical Neurological Illness
			Limitations
		Point-of-Care Electroencephalography
			Theory
			Technique
				Headband EEG
				Stick-On Headpieces
				EEG Caps, Nets, and Templates
				Reduced EEG Electrode Montage
			Interpretation
			Future Direction
		Conclusion
		References
	9: Integrated Approaches to Multimodality Monitoring of Cerebral Physiology
		Introduction
		Optimizing Brain Tissue Perfusion as a Framework for Multimodality Monitoring
		ICP Monitoring Helps to Titrate Hemodynamic Goals After Brain Injury
		Cerebral Autoregulation Status Determines the Effects of Hemodynamic Manipulations
		Brain Tissue Oxygen Monitoring Identifies Cerebral Hypoxia Episodes
		Cerebral Microdialysis Provides a Nuanced Picture of Cerebral Metabolism
		Addition of Other Monitoring Modalities
		Putting It All Together
			Principle 1: Periodically Perform Bedside Physiological Challenges
			Principle 2: Look for Concordant/Predictable Changes Across Multiple Parameters
			Principle 3: Review Trends Rather than Single Snapshots in Time
			Principle 4: Identify Whether Abnormalities Are Actionable
			Principle 5: Assess the Effect of Treatment
		Future Directions
		References
	10: Neurological Applications of Hemodynamics and Pulmonary Monitoring
		Introduction
		Cardiovascular Interactions with Neuropathophysiologic Processes
			Neurological Information Derived from Hemodynamic Monitoring
			Pathophysiology of Neurogenic Hemodynamic Abnormalities
				Hypertension
				Bradycardia/Asystole
				Hypotension
				Cardiac Arrhythmias and EKG Morphologic Changes
				Ischemic and Nonischemic Cardiomyopathy
					Ischemic Cardiomyopathy
					Nonischemic Cardiomyopathy
			Specific Neurologic Syndromes Contributing to Hemodynamic Abnormalities
				Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage
				Subarachnoid Hemorrhage (SAH)
				Intracranial Hypertension, Brain Herniation, and Brain Death
				Seizures
				Traumatic Brain Injury
				Paroxysmal Sympathetic Hyperactivity: Autonomic Storming
				Autonomic Dysreflexia in Spinal Cord Injury (SCI)
				Post-ischemic Anoxic Encephalopathy
		Pulmonary Interactions with Neuro-Pathophysiologic Processes
			Impacts of Hypoxemia and CO2 Abnormalities
			Specific Neurogenic Pulmonary Syndromes
				Neurogenic Pulmonary Parenchymal Issues
				Localization of Respiratory Patterns
					Respiratory Dysrhythmias
						Central Hypoventilation Dysrhythmias: Apnea, Bradypnea, and Hypopnea
						Central Hyperventilation
						Cheyne-Stokes Ventilation
						Apneustic Breathing
						Biot’s Respirations
						Hiccups
				Neurogenic Airway Dysfunction and Respiratory Failure
					Upper Airway Dysfunction
					Spinal Cord Dysfunction
					Motor Neuron Disease and Neuropathies
					Neuromuscular Junction Disorders, Myopathies, and Diaphragmatic Dysfunction
		Conclusion
		References
Part III: Severe Neurological Complications of Critical Illness
	11: Systemic Illness and Multisystem Organ Failure
		Introduction
		Neurologic Disorders Acquired During Critical Illness
			Altered Mental Status
				Delirium
				Coma
			Seizures and Status Epilepticus
			Posterior Reversible Encephalopathy Syndrome
			Sleep Disorders and Sleep Deprivation
			Long-Term Cognitive Impairment Following Critical Illness
			ICU-Acquired Weakness
		Neurobiologic Effects of Medications Commonly Used in the ICU
			Sedatives
			Antibiotics
			Immune Suppressants
		Neurological Implications of Organ Dysfunction
			Cardiovascular
				Endocarditis
				Cardiac Arrest
				Hypertensive Crisis
				Altered Cerebral Autoregulation in Chronic Hypertension
			Respiratory Failure
				Hypoxia and Hypercapnia
				ALI/ARDS
					COVID-19
			Sickness Behavior Syndrome
			Sepsis-Associated Encephalopathy
			Liver Failure
				Acute Liver Failure
				Hepatic Encephalopathy
			Nutritional and Malabsorptive Disorders in the Critically Ill
				Wernicke’s Encephalopathy
			Encephalopathy of Renal Failure
				Uremic Encephalopathy
				Dialysis Disequilibrium Syndrome
			Encephalopathy Associated with Endocrine Disorders
			Metabolic Encephalopathy
		Summary
		References
	12: Environmental Injury: Toxins, Overdose, Drowning, Thermal Burns
		Introduction
		Toxins: Overdose
			Epidemiology
			Resuscitation
			Toxidromes
				Agitated/Excited
				Depressed
			Decontamination and Enhanced Elimination [6]
				Activated Charcoal
				Gastric Lavage
				Whole Bowel Irrigation
				Urinary Alkalinization
				Dialysis
				Plasma Exchange, Exchange Transfusion
			Antidotes
		Drowning
			Epidemiology
			Pathophysiology
			Clinical Features and Management
				Associated Conditions and Injuries
				Dysrhythmias
				Pulmonary Edema, ARDS, and Pneumonia
				Anoxic Brain Injury
		Thermal Injuries
			Resuscitation
				Assessment of Inhalation Injury
				Carbon Monoxide and Hydrogen Cyanide Poisoning
				Ventilator Management
				Resuscitation Fluids
			Wound Care
		Conclusion
		References
	13: Consultative Neurocritical Care
		Introduction
		Prerequisites for Neurological Examinations in the ICU
			Focused ICU Neurological Examination
			Common Neurological Consults in the ICU
		Why Is My Patient Not Waking Up and/or Confused?
			Altered Mental Status (AMS)
		What Are These Strange Movements?
			Acute Cerebral Structural Pathology Presenting as Movement Disorder
			Seizures
			Movement Disorders with Dysautonomia
			Hypokinetic Movement Disorders in the ICU
		Why Is My Patient Weak?
		What Do These Imaging Findings Mean?
		Can You Give Us Recommendations on What to Do with Antiplatelets/Anticoagulation?
			Considerations While Antithrombotic Therapy Is Interrupted for Urgent Surgery
				Indication for Antithrombotic Therapy
				Risk of Thromboembolism While Off Anticoagulation Therapy
				Risk of Bleeding if Anticoagulation Is Not Stopped
				Bridging
				Resumption of Anticoagulation
				Decision-Making in Patients on Antiplatelet Agents
				Considerations While Antithrombotic Therapy Is Interrupted for Acute Systemic or Cerebral Hemorrhage
				Neuraxial Bleeding/Large Ischemic Stroke
			Special Etiological Considerations
				Cerebral Microbleeds
				Infectious Endocarditis
				Ventricular Assist Devices
				Left Atrial Appendage (LAA) Closure
				Malignancy
		What Should We Do with This Patient’s Outpatient Medications?
			Strategies for Managing Chronic Medications Without Enteral Access
			Challenges Faced by Parkinson’s Patients in the ICU Who Lack Enteric Access
		My Patient Has COVID-19. Could COVID-19 Be Causing Neurological Issues?
		What Is the Prognosis for My Patient?
			Prognostication After CNS Insult
			General Principles for Neuroprognostication
				Excluding Potential Confounders
				Avoiding Therapeutic Nihilism
				Imaging and Neurophysiological Data
				Using Established Prognostic Disease-Specific Calculators
				Allowing Sufficient Time for Repeated and Longitudinal Observation
				Trial of Neurostimulants
				Seeking a Second Opinion
				Individualizing Outcome Prognostication
				Communicating Prognostic Impressions
		Summary
		References
Part IV: Pharmacotherapy
	14: Sedation, Analgesia and Muscle Relaxation in NICU
		Sedation and Analgesia
		Sedative and Analgesic Agents
			Propofol
			Benzodiazepines
			Barbiturates
			Opioids
			Non-Narcotics
		Neuromonitoring for Sedation and Analgesia
			Clinical Sedation Scales
			Clinical Analgesia Scales
			Instrumental Neuromonitoring
		Indications for Continuous Use of Sedative Agents
		Sedation Holds and Withdrawal
		Muscle Relaxation
			Neuromuscular Blocking Agents
		Specific Situations
			Treatment of Status Epilepticus
			Delirium
		References
	15: Anticoagulants and Reversal Agents
		Introduction
		Warfarin
			Pertinence to Neurocritical Care
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		Rivaroxaban
			Pertinence to Neurocritical Care
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		Apixaban
			Pertinence to Neurocritical Care
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		Edoxaban
			Pertinence to Neurocritical Care
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		Dabigatran
			Pertinence to Neurocritical Care
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		Heparin
			Pertinence to Neurocritical Care
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		Enoxaparin
			Pertinence to Neurocritical Care
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		Fondaparinux
			Pertinence to Neurocritical Care
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		Argatroban
			Pertinence to Neurocritical Care
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		Bivalirudin
			Pertinence to Neurocritical Care
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		References
			Key/Landmark References
	16: Antiplatelet Agents and Platelet Function Assays
		Introduction
			Rationale for Antiplatelet Use in Neuroendovascular Procedures
		Antiplatelet Agents
			Aspirin
				Clopidogrel
				Prasugrel
				Ticagrelor
				Cangrelor
			Glycoprotein IIb/IIIa Inhibitors
		Antiplatelet Testing
			Clinical Applications of Antiplatelet Testing
		Reversal Options
		Summary
		References
	17: Thrombolytics and Antifibrinolytics
		Introduction
		Thrombolytics
		Ischemic Stroke
		Treatment of Thrombolytic Hemorrhage
		Intraventricular Hemorrhage (IVH) and Intraventricular Thrombolytics
		Antifibrinolytics
		Antifibrinolytics in Trauma
		Antifibrinolytics for Subarachnoid Hemorrhage
		Conclusion
		References
	18: Osmotherapy
		Introduction
		Mannitol
			Pertinence to Neurocritical Care
			Dosing
			Monitoring
			Adverse Effects and Drug Interactions
		Hypertonic Saline
			Pertinence to Neurocritical Care
			Dosing
			Monitoring
			Adverse Effects and Drug Interactions
		Comparing Mannitol and Hypertonic Saline
		References
			Key/Landmark References
	19: Steroids and Immunomodulating Agents
		Introduction
		Corticosteroids
			Pertinence to Neurocritical Care
				Neuromyelitis Optica Spectrum Disorder
				Myasthenia Gravis
				Bacterial Meningitis
				Traumatic Brain Injury
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		Eculizumab (Soliris®)
			Pertinence to Neurocritical Care
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		Inebilizumab (Uplinza®)
			Pertinence to Neurocritical Care
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		Rituximab (Rituxan®)
			Pertinence to Neurocritical Care
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		Intravenous Immune Globulin (IVIG)
			Pertinence to Neurocritical Care
			Dosing and Monitoring
			Adverse Effects and Drug Interactions
		References
	20: Anticonvulsants
		Introduction
		First-Line Intravenous Anticonvulsants
			Benzodiazepines for Emergent Treatment
				Pertinence to Neurocritical Care
				Dosing and Monitoring
				Adverse Effects and Drug Interactions
			Phenytoin/Fosphenytoin
				Pertinence to Neurocritical Care
				Dosing and Monitoring
				Adverse Effects and Drug Interactions
			Valproic Acid
				Pertinence to Neurocritical Care
				Dosing and Monitoring
				Adverse Effects and Drug Interactions
			Levetiracetam
				Pertinence to Neurocritical Care
				Dosing and Monitoring
				Adverse Effects and Drug Interactions
		Anesthetic Agents
			Midazolam
				Pertinence to Neurocritical Care
				Dosing and Monitoring
				Adverse Effects and Drug Interactions
			Propofol
				Pertinence to Neurocritical Care
				Dosing and Monitoring
				Adverse Effects and Drug Interactions
			Pentobarbital
				Pertinence to Neurocritical Care
				Dosing and Monitoring
				Adverse Effects and Drug Interactions
			Ketamine
				Pertinence to Neurocritical Care
				Dosing and Monitoring
				Adverse Effects and Drug Interactions
		Other Anticonvulsants
			Phenobarbital
				Pertinence to Neurocritical Care
				Dosing and Monitoring
				Adverse Effects and Drug Interactions
			Lacosamide
				Pertinence to Neurocritical Care
				Dosing and Monitoring
				Adverse Effects and Drug Interactions
			Topiramate
				Pertinence to Neurocritical Care
				Dosing and Monitoring
				Adverse Effects and Drug Interactions
			Perampanel
				Pertinence to Neurocritical Care
				Dosing and Monitoring
				Adverse Effects and Drug Interactions
			Clobazam
				Pertinence to Neurocritical Care
				Dosing and Monitoring
				Adverse Effects and Drug Interactions
			Brivaracetam
				Pertinence to Neurocritical Care
				Dosing and Monitoring
				Adverse Effects and Drug Interactions
		References
			Key/Landmark References
			Highlighted References
	21: Neurostimulants
		Amantadine
		Bromocriptine
		Carbidopa-Levodopa
		Methylphenidate
		Modafinil
		Selective Serotonin Reuptake Inhibitors (SSRIs)
		Donepezil
		Zolpidem
		Conclusions
		References
Part V: Quality Improvement, Patient Safety and Systems Issues
	22: Quality Metrics and Performance Measures in Neurocritical Care
		Critical Care Quality Improvement
			Introduction to Critical Care Quality Improvement
			Introduction to Neurocritical Care Quality Improvement
		Fundamentals of Quality Metrics
			Definition of a Performance Measure
		Characteristics of a PM
			Types of PMs
		Neurocritical Care Performance Measures
			NCC-PMs by Neurological/Neurosurgical Emergency
				Acute Ischemic Stroke-Specific PMs
				Spontaneous Intracerebral Hemorrhage-Specific PMs
				Traumatic Brain Injury-Specific PMs
				American Academy of Neurology’s Acute Neurology PM Set
				Neurocritical Care Society’s PM set
				Awareness and Implementation of NCC-PMs
		Development and Testing of NCC-PMs
			Building a Case for NCC-PMs
			Defining the Numerator and Denominator
			Accumulating and Reviewing Necessary Evidence
			Finalizing a PM
			Beta-Testing PMs
			Benchmarking Healthcare Quality Metrics
		Implementation of Healthcare Quality Metrics in Clinical Practice
		Examples of Successful Use of PMs in General CC and NCC
		Unintended Consequences of Clinical Implementation of Quality Metrics
		Future of Neurocritical Care Quality Metrics
		Summary
		References
	23: Early Mobilization and Acute Rehabilitation in the NeuroICU
		Introduction
		Neurorehabilitation and Severe Acquired Brain Injury (sABI) with Disorders of Consciousness (DoC)
			Coma
			Vegetative State
			Minimally Conscious State (MCS)
		Holistic Neurological Evaluation of Patients with DoC and Clinical Predictive Factors
		Neurorehabilitation Protocols Post-sABI
		Special Consideration in Neurorehabilitation
			Pharmacotherapy in Acute Rehabilitation Post-ABI
		Neuropsychological Approach to the Patient with sABI
			Neuropsychological Treatment Post-sABI
		Special Consideration in Neurorehabilitation
			Caregiver
		Conclusions
		References
	24: Nutrition in the Neurocritically Ill Patient
		Introduction
		The Pathophysiology of Metabolism in Neurocritical Illnesses
			Catecholamines and the Hypothalamic-Pituitary-Adrenal (HPA) Axis
			The Inflammatory and Immune Response
		Substrate Utilization
		Evaluating Nutritional Requirements in the Neurocritically Ill Patient
			Indirect Calorimetry
			Energy Expenditure Equations (Table 24.1)
		Evaluating Nutrition Risk in Neurocritically Ill Patients
		General Nutritional Considerations in Neurocritical Care
			Dosing of Protein, Carbohydrates, and Fats
			Early Feeding and Enteral and Parental Nutrition
		Complications of Feeding
			Refeeding Syndrome
			Diarrhea
			Glutamine
			Arginine
			Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA)
		Conclusion
		References
	25: Global Neurocritical Care
		Introduction
		Advocacy and Training Models
			Global Surgery/Neurosurgery Movement
			Global Neurology Education
			Global Critical Care Movement
			HIC Training Opportunities: Perspective from the USA
			LMIC Training Opportunities
		Research
			Challenges
			Opportunities
		Global Perspectives from Africa, Asia, and Latin America
			Neurocritical Care in Africa
				Challenges of Neurocritical Care in Resource-Limited Countries
				Nigeria
				Ethiopia
			Neurocritical Care in Asia
				China
				India
				Cambodia
			Latin America and the Caribbean
				Haiti
				Peru
		COVID-19
		Conclusion
		References
	26: Ethical and Legal Considerations of Neurocritical Care
		Introduction
		Overview of Bioethics
		Overview of Neurocritical Care Ethics
		Surrogacy
		Clinician Decision-Making Responsibilities
		Discussing Prognoses and Certainty
		Brain Death Standards
		Dead Donor Rule
		Conclusion
		References
	27: Disaster Response
		Introduction
		What Is Disaster Preparedness?
		Orchestrating the Response
		Rules of Engagement
			Jurisdictional Authority
		Rules for Managing Disaster Response
		The National Incident Management System (NIMS)
		Incident Command Structure
			Operations Branch
			Planning Branch
			Finance Branch
			Logistics Branch
		Approach to Emergency Management
			Establish Communication with Areas Affected
			Secure the Area
			Search the Area
			Meet Basic Human Needs
			Restore Critical Infrastructure
			Open Schools and Local Business
			Begin the Recovery
		Emergency Support Functions
			The National Response Framework (NRF)
			NIMS Training Requirements
		Potential Hazards, Consequences, and Issues
			Consequences of the Hazard
			Disaster Behavioral Health
		Areas of Vulnerability
		Frequency of Occurrence
		Anticipated Consequences
			Communication with the Public
		Summary
		References
	28: Research Challenges in the ICU
		Introduction
		Neurointensive Care: A Challenging Environment for Research
			Patient Heterogeneity in Neurocritical Care
			Availability of Clinical Data in Neurocritical Care
			Study Design Considerations
			Requirement for Multi-centre Research
			Workforce Considerations
			Research Ethics and Consent in Unconscious Patients
			Intersection of General ICU-Related Pathology with NCCU-Specific Pathology
			Follow-Up and Long-Term Outcomes
		Specific Pathologies of Research Interest in the NCCU and Key Questions
			Traumatic Brain Injury
			Subarachnoid Hemorrhage
			Stroke
		Research Approaches in the NCCU
			Multimodality Monitoring
			Imaging
			Biomarker Research
			Genetics and Genomics
			Therapeutic Research
		Conclusions
		References
Index