Hemodynamic and neuro-monitoring for neurocritically ill patients: An international survey of intensivists.
To investigate multimodality systemic and neuro-monitoring practices in acute brain injury (ABI) and to analyze differences among "neurointensivists" (NI; clinical practice comprised >1/3 by neurocritical care), and other intensivists (OI).



Anonymous 22-question Web-based survey among physician members of SCCM and ESICM.



Six hundred fifty-five responded (66% completion rate); 422 (65%) were OI, and 226 (35%) were NI. More NI follow hemodynamic protocols for TBI (44.5% vs 33%, P=.007) and SAH (38% vs 21%, P<.001). For CPP optimization, NI use more arterial-waveform-analysis (AWA) (45% vs 35%, P=.019), and ultrasound (37.5% vs 28%, P=.023); NI use more PbtO2(28% vs 10%, P<.001). In the case scenario of raised ICP/low PbtO2, most employ analgesia and/or sedation (47%) and osmotherapy (38%). More NI use pressure reactivity (vasopressor use OI 23% vs NI 34.5%, P=.014). For DCI, more NI target cardiac index (CI) (35% vs 21%, P<.001), and fluid responsiveness (62.5% vs 53%, P=.03). Also, NI use more angiography (57% vs 43.5%, P=.004), TCD (56.5% vs 38%, P<.001), CTP (32% vs16%, P<.001), and PbtO2(18% vs 7.5%, P=.001).



Intensivists with exposure to ABI patients employ more neuro- and hemodynamic monitoring. We found large heterogeneity and low overall use of advanced brain-physiology parameters.
Department of Neurology/Neurocritical Care, Baylor College of Medicine, Houston, TX, USA.
Sanjeev
S
Sivakumar
Department of Intensive Care, Erasmus Hospital, Brussels, Belgium.
Fabio S
FS
Taccone
Department of Neurology/Neurocritical Care, Henry Ford Hospital, Detroit, MI, USA.
Mohammed
M
Rehman
Department of Neurology/Neurocritical Care, Oregon Health and Science University, Portland, OR, USA.
Holly
H
Hinson
Neurocritical Care, Baptist Medical Center, Jacksonville, FL, USA.
Neeraj
N
Naval
Department of Neurology/Neurocritical Care, Baylor College of Medicine, Houston, TX, USA. Electronic address: lazaridi@bcm.edu.
Christos
C
Lazaridis
D000328:Adult; D001930:Brain Injuries / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
Brain injuries; Hemodynamics; Monitoring, neuromonitoring; Physiologic; Survey