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Chapter 18 - Prognostication in Palliative Care and Neurocritical Care

from Part II - Other Topics in Neuroprognostication

Published online by Cambridge University Press:  14 November 2024

By
Shannon Hextrum ,
Viren Patel  and
Edward M. Manno
Edited by
David M. Greer  and
Neha S. Dangayach
David M. Greer
Affiliation:
Boston University School of Medicine and Boston Medical Center
Neha S. Dangayach
Affiliation:
Icahn School of Medicine at Mount Sinai and Mount Sinai Health System
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Summary

Neuroprognostication, the focus of this book, is crucial toward the management of the highly complex patient in the neurological intensive care unit (Neuro ICU). It is of primary importance to understand the nature of the disease and the potential for recovery. Informed prognostication by neurologically trained physicians has been hypothesized to be a significant reason for the improved outcomes of neurological patients managed in a Neuro ICU versus general medical ICUs.[1]

Decisions surrounding withdrawal of life-sustaining therapies (WLST) are highly dependent on prognosis. In a retrospective study of Neuro ICU patients who were terminally extubated, family members surveyed most frequently cited quality of life, prognosis, and the patient’s previously known wishes as “very important” in their decision to remove life-sustaining therapy.[2]

Evidence-based prognostication in the Neuro ICU is difficult, and may be biased by the effect of WLST on patient mortality.

Type
Chapter
Information
Neuroprognostication in Critical Care , pp. 261 - 272
Publisher: Cambridge University Press
Print publication year: 2024

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