Table Of ContentA. Joseph Layon
Andrea Gabrielli
William A. Friedman
Editors
Textbook of
Neurointensive Care
Second Edition
123
T extbook of Neurointensive Care
A . Joseph L ayon • A ndrea G abrielli
W illiam A. F riedman
E ditors
T extbook of
Neurointensive Care
Second Edition
E ditors
A . Joseph L ayon, M D, FACP A ndrea G abrielli, M D, FCCM
C ritical Care Medicine D epartments of Anesthesiology and Surgery
Pulmonary and Critical Care Medicine U niversity of Florida College of Medicine
T he Geisinger Health System G ainesville
D anville F L
P A U SA
U SA
W illiam A. F riedman, M D
T emple University School of Medicine D epartment of Neurological Surgery
P hiladelphia U niversity of Florida College of Medicine
P A G ainesville
U SA F L
U SA
I SBN 978-1-4471-5225-5 ISBN 978-1-4471-5226-2 (eBook)
D OI 10.1007/978-1-4471-5226-2
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T o my family—Susana Picado, Maria Layon-Taylor, Nicolas Layon,
Daniel Layon—all in the service of our people and country. All of whom have
sacrifi ced.
T o those who are in search of a home, family, country: may you fi nd them.
T o those who struggle to become: may you be.
— A. Joseph Layon
T o my father Pietro and my mother Giuliana, now walking the family dog
between the clouds, for being my role models and the inspiration behind all
my efforts.
T o my brother and friend Marco, the real smart guy of the family.
T o my students, friends, and colleagues worldwide.
T o our patients, our inspiration for compassionate care, our reason to try
harder.
— Andrea Gabrielli
T o my many colleagues, friends, and patients who have taught me so much
about neurosurgery.
— William A. Friedman
F oreword to the Second Edition
D uring the 9 years since the publication of the fi rst edition of this Textbook of Neurointensive
Care, considerable developments have evolved in the critical care of the neurologically injured
patient. This second edition captures such advances presented by more than 100 leading
authorities, offering a clear and comprehensive update. It represents a collective accomplish-
ment of clinician scientists dedicated to providing such enormous material and thereby exten-
sive knowledge in the care of the brain injured from the emergency department to the ICU, to
the operating room, and through the postoperative period. This edition is the only textbook
providing such a comprehensive offering throughout the continuum of care.
S uch a continuum of critical care is exemplifi ed throughout this second edition in its exten-
sive chapters. A presentation of key concepts of brain physiology essential to the understand-
ing of intracranial hypertension is offered in the chapter on elevated intracranial hypertension.
Despite recent advances in the treatment, diagnosis, and management of aneurysms and cere-
bral vasospasm, morbidity and mortality remain high and are addressed in the chapter on treat-
ment of aneurysmal subarachnoid hemorrhage. The chapter on intracranial hemorrhage is an
essential presentation. Such hemorrhage remains formidable as patient outcome is still poor,
despite recent advances that have led to extensive research establishing evidence-based man-
agement. This chapter notes the disparate incidence of stroke in African-Americans and dis-
cusses possible risk factors in this population. Neuroradiologic imaging is discussed in a
substantial chapter, providing an understanding of how such images are created utilizing MRI
and CT modalities though technical presentation. The chapter on pharmacotherapy in the neu-
rosurgical ICU is a further example of the comprehensive approach to such care extended by
this second edition. Knowledge of pharmacokinetics and pharmacodynamics of neuroactive
drugs is provided for the optimal management of neuroinjured patients. In addition to these
chapters, all the contributions provide evidenced-based data and algorithms for decision mak-
ing and illustrate key points; multiple supporting references are provided for documentation
and reviews.
T his second edition is improved in its sectioning with the provision of an Introduction
(Part I ) which presents fundamentals of neurocritical care issues of organization, quality
improvement, and the emerging ICU subspecialty of Neurointensive Care Medicine. Part I I
addresses Neuroanatomy and Neurophysiology; Part I II covers Neuromonitoring; Part I V
addresses in detail the Neuroinjured Patient; Part V details Special Situations such as traumatic
brain injury in the adult and as well as in the pediatric population, the treatment of spinal cord
injury, and the treatment of seizures; Part V I provides Situations of Special Interest such as
intraoperative neuroanesthesia, neurorehabilitation, and brain death and the management of
potential organ donation. This section also reviews the ongoing concerns of ethical issues in
the neurointensive care unit.
I n 2003, the year prior to the publication of the fi rst edition of the Textbook of Neurocritical
Care, the Joint Commission (JC, formerly JCAHO) launched the Primary Stroke Center
Certifi cation Program. During the 9 years since the First Edition, more than 925 certifi ed pri-
mary stroke centers have been established in 48 states, with comprehensive stroke centers now
being certifi ed by JC in several states. The G et With The Guidelines- S troke National Quality
Improvement and Registry Program of the American Heart/American Stroke Association has
vii
viii Foreword to the Second Edition
grown rapidly over these 9 years. Over 1,400 hospitals are participating in this program. The
fi rst edition of this textbook and its editors and authors have contributed immensely to the
quality and outcomes of stroke care of these programs. Interim and current developments so
comprehensively provided now in this second edition will further enhance such care. It is a
pleasure and privilege to continue to work with such accomplished investigators. This second
edition is a tribute and an essential contribution to the care of the neurologically injured.
D anville, PA, USA Edgar J. Kenton III, MD, FAAN, FAHA
P reface to the Second Edition
W e claimed, in the Preface to the First Edition of Textbook of Neurointensive Care, that in the
near future our hospitals would be composed of EDs, ICUs, and operating rooms. Studies of
hospitals seem to have borne this out. And while we still are not sure of the precise dimensions
and shape it will take, health care (maybe better put, health i nsurance) reform will impact our
work and work environment signifi cantly. Even those of us who hoped for a reformed health
system when the First Edition went to press had no idea, even in our heart of hearts, that in
2013 we would see the beginnings—just that—of the reform of our health-care system.
I n this context, we have attempted to change and improve our T extbook of Neurointensive
Care. In this second edition, there is more emphasis on evidence-based medicine—our jump-
off point, not our end point—and best practice. We have improved chapters on the organization
of neurocritical care (Chap. 1 ) and quality improvement (Chap. 2 ) ; enhanced chapters on neu-
romonitoring (Chaps. 7 and 8 ) and on the prehospital care of the neurologically injured patient
(Chap. 9 ) ; and added chapters on neuroendocrine function (Chap. 1 5 ) , on hematological/
thrombotic issues (Chaps. 1 6 and 1 7) , and on acute kidney injury and the neurologically
injured patient (Chap. 1 9) . Additionally, there is an entire chapter (Chap. 3 6) on temperature
regulation. Finally, we have added a chapter on brain death and the management of the poten-
tial organ donor (Chap. 4 4) .
T he reader will note that we eliminated the section on “The Future of NeuroCritical Care.”
We are good, but not that good! We cannot see into the future any better than anyone else can!
W e thank our contributors for their hard work. We are in debt to them in a manner that will
never be paid. And the same goes for our editor and publisher, Elizabeth Corra and Grant
Weston: they have the patience of saints.
L et us know what you think of this second edition. As always, the errors in this book belong
to the three editors.
G ainesville, FL, USA A . Joseph Layon, MD, FACP
G ainesville, FL, USA A ndrea Gabrielli, MD, FCCM
G ainesville, FL, USA W illiam A. Friedman, MD
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