Evidence-Based Review of Clinical Trials in Neurocritical Care

Repercussions of the Emergency neurological life support on scientific literature: a bibliometric study

BACKGROUND

 In 2012, the Neurocritical Care Society launched a compilation of protocols regarding the core issues that should be addressed within the first hours of neurological emergencies - the Emergency neurological life support (ENLS).

OBJECTIVE

 We aim to evaluate this repercussion through a bibliometric analysis.

METHODS

 We searched Scopus on October 2022 for articles mentioning ENLS. The following variables were obtained: number of citations; number of citations per year; number of publications per year; year of publication; research type; research subtype; country of corresponding author and its income category and world region; journal of publication and its 5-year impact factor (IF); and section where ENLS appeared.

RESULTS

 After applying eligibility criteria, we retrieved 421 articles, published from 2012 to 2022. The mean number of citations per article was 17.46 (95% Confidence Interval (CI) = 8.20-26.72), while the mean number of citations per year per article was 4.05 (95% CI = 2.50-5.61). The mean destiny journal 5-year IF was 5.141 (95% CI = 4.189-6.093). The majority of articles were secondary research (57.48%; n = 242/421) of which most were narrative reviews (71.90%; n = 174/242). High-Income countries were the most prominent (80.05%; n = 337/421 articles). There were no papers from low-income countries. There were no trials or systematic reviews from middle-income countries.

CONCLUSION

 Although still low, the number of publications mentioning ENLS is increasing. Articles were mainly published in journals of intensive care medicine, neurology, neurosurgery, and emergency medicine. Most articles were published by authors from high-income countries. The majority of papers were secondary research, with narrative review as the most frequent subtype.

Prevention, Treatment, and Monitoring of Seizures in the Intensive Care Unit

The diagnosis and management of seizures in the critically ill patient can sometimes present a unique challenge for practitioners due to lack of exposure and complex patient comorbidities. The reported incidence varies between 8% and 34% of critically ill patients, with many patients often showing no overt clinical signs of seizures. Outcomes in patients with unidentified seizure activity tend to be poor, and mortality significantly increases in those who have seizure activity longer than 30 min. Prompt diagnosis and provision of medical therapy are crucial in order to attain successful seizure termination and prevent poor outcomes. In this article, we review the epidemiology and pathophysiology of seizures in the critically ill, various seizure monitoring modalities, and recommended medical therapy.

Transitions of Care for Patients with Neurologic Diagnoses Transition from the Intensive Care Unit to the Floor

Transition of care from the intensive care unit to acute care units after critical neurologic injury includes the consideration of a variety of factors to ensure safe and effective care, and promote ongoing neurologic recovery. Assessment of effectiveness of deescalation techniques, agitation management, and risk factor mitigation are important strategies to enhance the success of transitions. Clear and consistent interdisciplinary communication between teams during hand-off between units is imperative to decrease the risk of complications and errors, and to streamline discharge processes.