A Perspective from the Neurocritical Care Society and the Society of Critical Care Medicine: Team-Based Care for Neurological Critical Illness.

Women as a Growing Force in Critical Care Medicine-the Journal, Profession, and Society.

Fifty Years of Critical Care Medicine: The Editors' Perspective.

As early as August 1974, "organ failure resuscitation ward" for critically ill patients with cardiac, respiratory or renal failure had appeared as independent medical units in China. In 1980s, the discipline of critical care medicine had experienced a rapid development, shown its superiority in both daily health care and public health emergency, also its status in the academy of medicine. On September 4th, 1989, the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) accepted the Chinese Association of Integrative Medicine, Society of Critical Care Medicine (TCMWMCSCCM) as an official member. In November 1989, the former State Scientific and Technological Commission approved the establishment of Critical Care Medicine in Tianjin, the first journal in the very field in China, indicating that Chinese critical care medicine has been officially accepted by the international academia and its academic status has been determined. In September 1997, the Chinese Association of Pathophysiology organized the Chinese Society of Critical Care Medicine. In March 2005, the Chinese Medical Association organized the Chinese Society of Critical Care Medicine had found. In July 2009, Chinese Association of Critical Care Physicians had found under the Chinese Medical Doctor Association. In 2008, Critical Care Medicine had been defined as secondary clinical discipline (Subject code 320.58) by Standardization Administration of the People's Republic of China. In 2009, it was listed in the first clinical discipline (Code 28). In 2001, Chinese Society of Critical Care Medicine under the Chinese Association of Pathophysiology had officially joined the WFSICCM and the Asia Pacific Association of Critical Care Medicine (APACCM), and became a member in both councils. Between 2006 and 2010, Chinese Society of Critical Care Medicine under the Chinese Association of Pathophysiology had become the presidency and member in APACCM, WFSICCM and Global Sepsis Alliance (GSA), respectively. So far, there are a number of critical care physicians from China serve as a member in international academic organizations. In ESICM LIVES 2012, held in Lisbon, Portugal, the Chinese Society of Critical Care Medicine under the Chinese Association of Pathophysiology was invited on behalf of China and gave lectures, showing the elegant demeanor of Chinese scholars. Since 2013, the Annual Congress of Chinese Society of Critical Care Medicine has set up the China-USA Joint forum and China-Europe forum. In 2018, the Chinese Society of Critical Care Medicine started a series of "Belt and Road" academic activities, signed the cooperation agreement with 18 academic community of critical care medicine from respective countries or districts along the Belt and Road, and established a long-term relation of communication and cooperation, indicating that Chinese critical care medicine has intensively participated in international communication and integration. Year 2019 is the 40th year of Chinese construction and development in critical care medicine. Today, Chinese critical care medicine is taking off. It has developed rapidly on a brand-new level, advanced on the highway of professional and standardized development, achieved a series of development and won the praise of peers around the world. Since the establishment of Chinese Society of Critical Care Medicine in March 2005, the scale of annual congresses has expanded year by year, participants increased from mere 1 000 to more than 15 000, contributions increased from hundreds to thousands, exhibiting the prosperity of Chinese critical care medicine. Meanwhile, the society has published guideline series, technical specifications and academic yearbooks, implemented Chinese Critical Care Certified Course (5C training), carried out the continue education program and grassroot education activities, set up the "lifetime achievement award", etc., to promote continuous progress and development in Chinese critical care medicine. The Chinese Association of Critical Care Physicians has greatly contributed to the promotion in critical care specialist training, also push forward the progress. In August 2018, department of critical care medicine was selected in the second batch of standardized training bases for specialists, and began recruitment in both medical and surgical critical care medicine in March 2019. The future of Chinese critical care medicine requires us to make clear the developmental blueprint of the discipline, to persevere with integration and innovation, and to meet the needs of society. Efficient and normative systems are also required in the discipline construction, talent cultivation, diagnosis and treatment system, academic construction, and intelligent application of network data. Particularly, we should vigorously carry out and promote the homogenization of critical care specialist training for talent resources reservation. We should actively promote the establishment of clinical research platforms for critical care medicine, encourage and support multicenter clinical researches. We should promote multi-channel communication in the field at home and abroad, expand the international influence of Chinese critical care medicine step by step, to promote the sustainable development of Chinese critical care medicine, to explore further forefront of modern medicine, to promote greater contribution to human health.

Neurocritical care depends, in part, on careful patient monitoring but as yet there are little data on what processes are the most important to monitor, how these should be monitored, and whether monitoring these processes is cost-effective and impacts outcome. At the same time, bioinformatics is a rapidly emerging field in critical care but as yet there is little agreement or standardization on what information is important and how it should be displayed and analyzed. The Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine, and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to begin to address these needs. International experts from neurosurgery, neurocritical care, neurology, critical care, neuroanesthesiology, nursing, pharmacy, and informatics were recruited on the basis of their research, publication record, and expertise. They undertook a systematic literature review to develop recommendations about specific topics on physiologic processes important to the care of patients with disorders that require neurocritical care. This review does not make recommendations about treatment, imaging, and intraoperative monitoring. A multidisciplinary jury, selected for their expertise in clinical investigation and development of practice guidelines, guided this process. The GRADE system was used to develop recommendations based on literature review, discussion, integrating the literature with the participants' collective experience, and critical review by an impartial jury. Emphasis was placed on the principle that recommendations should be based on both data quality and on trade-offs and translation into clinical practice. Strong consideration was given to providing pragmatic guidance and recommendations for bedside neuromonitoring, even in the absence of high quality data.

Consensus statement on standards for neurocritical care units in low-income and middle-income countries (LMICs).

One of the missions of the Neurocritical Care Society (NCS) is to foster clinical, experimental, and outcomes research focused on developing innovative and cost-effective medical and surgical interventions for acute neurological disorders. To achieve this mission, NCS created a research committee. This committee organized the Neurocritical Care Research Conference. The most important outcome of the First Neurocritical Care Research Conference (September 2009) was the creation of the Neurocritical Care Research Network (NCRN) [1]. Following the success of that first endeavor, the Second Neurocritical Care Research Conference took place in Houston, TX May 18–20, 2012. This symposium was funded by NINDS (1R13NS077610-01, P.I. Jose I. Suarez), Baylor St. Luke’s Medical Center (Neuroscience Center) in Houston, and the Integra Foundation and endorsed by the Baylor College of Medicine (BCM) and the NCS. The overall goal of this interdisciplinary scientific gathering was to bring together a diverse group of academic scientists and physicians with a common interest in understanding and advancing research in multimodality monitoring in neurocritical care diseases, in large part because monitoring patient disease and care is a fundamental aspect of neurocritical care. The need for the design of adequate clinical studies to test these monitoring techniques was addressed in the context of the recently created NCRN to facilitate collaboration and patient enrollment. In addition, this conference provided a unique opportunity for trainees, junior faculty, and other scientists to interact with investigators in the field of neurocritical care. The conference opened with a discussion on new approaches to multifaceted therapeutic bundles in neurocritical care followed by five scientific sessions: (1) Global Brain Monitoring in the Neurocritical Care Unit; (2) Regional Brain Monitoring in the Neurocritical Care Unit; (3) Data Collection and Interpretation; (4) Conventional Clinical Trial Design of Multimodality Monitoring; and (5) Alternative Clinical Trial Design. The meeting had 158 registrants and 135 attendees. This represents a 26 % increase in attendance compared to our first research conference. Attendees came from all parts of the world including the United States, Canada, Latin America, Europe, Japan, India, and the Middle East. We had lively and interesting discussions throughout the meeting. The conference was successful and well received with 94 % stating that it was fair and balanced. At the end of the meeting, there was consensus on two major points: (1) we need a common language to describe the technology available and the information it provides to pursue further research to advance the field and (2) technology alone will not impact upon clinical outcome without specific interventions and pathways that can modify and ameliorate the biochemical cascade unleashed by brain insults. Two projects have since evolved from the Second Neurocritical Care Research Conference: (1) the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care, a collaboration between the NCS, the European Society of Intensive Care Medicine, the Society of Critical Care Medicine, and the Latin & Jose I. Suarez jisuarez@bcm.edu

Neurocritical care depends, in part, on careful patient monitoring but as yet there are little data on what processes are the most important to monitor, how these should be monitored, and whether monitoring these processes is cost-effective and impacts outcome. At the same time, bioinformatics is a rapidly emerging field in critical care but as yet there is little agreement or standardization on what information is important and how it should be displayed and analyzed. The Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine, and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to begin to address these needs. International experts from neurosurgery, neurocritical care, neurology, critical care, neuroanesthesiology, nursing, pharmacy, and informatics were recruited on the basis of their research, publication record, and expertise. They undertook a systematic literature review to develop recommendations about specific topics on physiologic processes important to the care of patients with disorders that require neurocritical care. This review does not make recommendations about treatment, imaging, and intraoperative monitoring. A multidisciplinary jury, selected for their expertise in clinical investigation and development of practice guidelines, guided this process. The GRADE system was used to develop recommendations based on literature review, discussion, integrating the literature with the participants' collective experience, and critical review by an impartial jury. Emphasis was placed on the principle that recommendations should be based on both data quality and on trade-offs and translation into clinical practice. Strong consideration was given to providing pragmatic guidance and recommendations for bedside neuromonitoring, even in the absence of high quality data.

Neurocritical care is a distinct subspecialty focusing on the optimal management of acutely ill patients with life-threatening neurologic and neurosurgical disease or with life-threatening neurologic manifestations of systemic disease. Care by expert healthcare providers to optimize neurologic recovery is necessary. Given the lack of an organizational framework and criteria for the development and maintenance of neurological critical care units (NCCUs), this document is put forth by the Neurocritical Care Society (NCS). Recommended organizational structure, personnel and processes necessary to develop a successful neurocritical care program are outlined. Methods: Under the direction of NCS Executive Leadership, a multidisciplinary writing group of NCS members was formed. After an iterative process, a framework was proposed and approved by members of the writing group. A draft was then written, which was reviewed by the NCS Quality Committee and NCS Guidelines Committee, members at large, and posted for public comment. Feedback was formally collated, reviewed and incorporated into the final document which was subsequently approved by the NCS Board of Directors.

Review of the history and accomplishments of the Society of Critical Care Medicine (SCCM) to determine appropriate directions for the future. Historical documents of the SCCM, Critical Care Medicine, bioethics and healthcare financing literature, Instant Library of Quotations. Identified (by the author) material containing specific statements concerning goals and objectives at the time of the founding of the SCCM and at intervals. Material supporting and criticizing predictive indices were identified and bioethical treatises concerning patient autonomy and quality-of-life decisions were chosen. Presidential addresses of the first three SCCM presidents, material relevant to preservation of life and alleviation of suffering from bioethical and healthcare financing perspectives. Relevant quotations. Initial goals and objectives were identified. Societal and economic factors changing critical care were analyzed for their effect on current and future SCCM directions and objectives. The founding members set important goals for critical care and patient care, research, education, and organization. From a perspective of what was foreseeable, these goals have been accomplished to an admirable degree. The SCCM has responded to these goals by providing educational programs and fostering research, especially in its annual meetings and through the publication of guidelines in Critical Care Medicine. The SCCM members would do well to read the first three presidential addresses to experience the eloquence and foresight firsthand, particularly with respect to the founders' spirit, considerations of training, scope of care, humanism, organization and relations within and outside of critical care, integration of care, and development of the scientific process at the bedside. There have been major changes in society since the SCCM was founded: the maturation of the concept of patient's autonomy; recognition of quality-of-life values; healthcare financing; and legal and ethical aspects of care. The critical care profession in general, and the SCCM specifically, should seek to develop effective cost-containment strategies and severity of illness or predictive indices. The SCCM should also educate the professions with respect to ethical issues and provide information directly to the public, especially in the areas of advance directives and withholding and withdrawing care. Through these contributions, the SCCM can assume its proper leadership role within medicine, but, of greater importance, in society. In doing so, societal myths and misunderstandings of the capabilities, futility, role, and limitations of critical care can be corrected. The organization and structure of the SCCM are well developed to accomplish these ends. The SCCM leaders are both able and willing. The objectives seem reasonable and should be attainable.

First, Do No Harm: Less Training ≠ Quality Care

To review women's participation as faculty at five critical care conferences over 7 years. Retrospective analysis of five scientific programs to identify the proportion of females and each speaker's profession based on conference conveners, program documents, or internet research. Three international (European Society of Intensive Care Medicine, International Symposium on Intensive Care and Emergency Medicine, Society of Critical Care Medicine) and two national (Critical Care Canada Forum, U.K. Intensive Care Society State of the Art Meeting) annual critical care conferences held between 2010 and 2016. Female faculty speakers. None. Male speakers outnumbered female speakers at all five conferences, in all 7 years. Overall, women represented 5-31% of speakers, and female physicians represented 5-26% of speakers. Nursing and allied health professional faculty represented 0-25% of speakers; in general, more than 50% of allied health professionals were women. Over the 7 years, Society of Critical Care Medicine had the highest representation of female (27% overall) and nursing/allied health professional (16-25%) speakers; notably, male physicians substantially outnumbered female physicians in all years (62-70% vs 10-19%, respectively). Women's representation on conference program committees ranged from 0% to 40%, with Society of Critical Care Medicine having the highest representation of women (26-40%). The female proportions of speakers, physician speakers, and program committee members increased significantly over time at the Society of Critical Care Medicine and U.K. Intensive Care Society State of the Art Meeting conferences (p < 0.05), but there was no temporal change at the other three conferences. There is a speaker gender gap at critical care conferences, with male faculty outnumbering female faculty. This gap is more marked among physician speakers than those speakers representing nursing and allied health professionals. Several organizational strategies can address this gender gap.

Extract Physicians have cared for patients with acute illnesses throughout history. The terminology related to these patients has changed. Sick patients became critically ill patients, and all needed intensive care. After the devastating poliomyelitis epidemics of the 1950s, a new specialty of critical care medicine emerged. Initially, respiratory care units were created for the patients affected by this severe illness, but soon they were transformed into intensive care units. Trauma units and transplant units soon followed. Specialized care for patients with acute neurologic or neurosurgical disease was established in parallel with these developments, but many of the early neuroscience intensive care units were redesigned wards. Specialized physicians and nursing staff delivered multidisciplinary care, recognizing that no one group could function well alone. Inevitably, critical care for the sickest patients was the only option to give them a fighting chance to survive. In the United States, the Society of Critical Care Medicine brought the specialty clearly into focus in the early 1970s, and training program guidelines soon were developed in the United States and abroad. The Neurocritical Care Society was founded in 2002, and accreditation was established through the American Academy of Neurology (United Council of Neurologic Subspecialties). Most importantly, the American Board of Medical Specialties has approved creation of a neurocritical care subspecialty, and Accreditation Council for Graduate Medical Education–accredited fellowships and a new board examination are planned.

A variety of technologies have been developed to assist decision-making during the management of patients with acute brain injury who require intensive care. A large body of research has been generated describing these various technologies. The Neurocritical Care Society (NCS) in collaboration with the European Society of Intensive Care Medicine (ESICM), the Society for Critical Care Medicine (SCCM), and the Latin America Brain Injury Consortium (LABIC) organized an international, multidisciplinary consensus conference to perform a systematic review of the published literature to help develop evidence-based practice recommendations on bedside physiologic monitoring. This supplement contains a Consensus Summary Statement with recommendations and individual topic reviews on physiologic processes important in the care of acute brain injury. In this article we provide the evidentiary tables for select topics including systemic hemodynamics, intracranial pressure, brain and systemic oxygenation, EEG, brain metabolism, biomarkers, processes of care and monitoring in emerging economies to provide the clinician ready access to evidence that supports recommendations about neuromonitoring.

Surviving Sepsis Campaign.

Background There are no evidence‐based resources guiding the perioperative management of patients with moyamoya syndrome who are undergoing revascularization surgery. We investigated practice patterns among a transdisciplinary group aiming at identifying possible heterogeneity of practices on key components of care that warrant prospective studies. Methods We disseminated a web‐based Qualtrics survey internationally to physician members of the following: Neurocritical Care Society, Society of Critical Care Medicine, American Academy of Neurology, Society for Neuroscience in Anesthesiology and Critical Care, American Association of Neurological Surgeons, Asian Society of Neuroanesthesia and Critical Care, Indian Society of Neuroanesthesia and Critical Care, Japanese Society for Neuroscience in Anesthesiology and Critical Care, and World Federation of Neurosurgical Societies. The survey contained questions on demographics and aspects of preoperative, intraoperative, and postoperative care. Results Among the 175 physicians who managed at least 1 adult (aged ≥18 years) undergoing moyamoya revascularization in the preceding 24 months, 18 countries (United States, 84.6%) and 4 disciplines (anesthesiology [44.7%, 76/170], critical care medicine [30.6%, 52/170], neurology [32.4%, 55/170], and neurosurgery [15.3%, 26/170]) were represented. Anesthesiologists preferred total intravenous over volatile anesthesia (56.3%, 40/71 versus 42.3%, 30/71) and arterial line zeroing at the circle of Willis/tragus over the phlebostatic axis/right atrium intraoperatively (84.3%, 59/70 versus 11.4%, 8/70) and postoperatively (68.9%, 42/61 versus 24.6%, 15/61). Intraoperative blood pressure goals were primarily targeted to baseline blood pressure (34.8%, 48/138), whereas postoperative blood pressure goals were mainly determined by neurosurgeon preference (48.9%, 65/133). The predominant hemodynamic target was mean arterial pressure intraoperatively (50.4%, 68/135) and systolic blood pressure postoperatively (48.5%, 63/130). Crystalloid infusion was the preferred method to achieve perioperative hemodynamic goals (median rank, 1.0), followed by colloid infusion (median rank, 2.0) and phenylephrine (median rank, 2.0); however, colloid infusion and phenylephrine were considered contraindicated by 18.2% (10/55) and 20.0% (11/55), respectively. Conclusions We demonstrate perioperative practice heterogeneity for moyamoya syndrome revascularization among physicians for both methods and targets of hemodynamic management, constituting equipoise for prospective studies targeting optimal management strategies.