The complexity of neurocritical care requires a shift from traditional, discipline-specific practice toward a collaborative, interdisciplinary model. This review explores the conceptual and practical framework of interdisciplinary collaboration in neuro-intensive care units, examining the roles of key specialists including neurosurgeons, neurologists, intensivists, pharmacists, nutritionists, and rehabilitation experts. We discuss the benefits of coordinated care in improving patient-centered outcomes, reducing morbidity and mortality, and enhancing intensive care unit efficiency. Emerging evidence supports the integration of neurointensivists, structured communication tools, and team-based decision-making as essential components of modern critical care delivery. This article provides a comprehensive review of current strategies and proposes directions for advancing interdisciplinary practice in neurocritical care settings.

Antimicrobial resistance has emerged as a critical global health challenge. Significant variability in antibiotic prescribing practices underscores the urgent need for high-quality evidence to inform optimal antibiotic prescribing policies. The ideal duration of antimicrobial therapy remains uncertain, and a one-size-fits-all approach is far from ideal. In this review, we examine bacterial growth kinetics and antibiotic pharmacodynamics and explore various strategies for determining the duration of antibiotic therapy: fixed duration, biomarker-guided, clinical course-based, and the more recent double-trigger approach.

Nurse-led glycemic management in critical care settings has been demonstrated to reduce the incidence of dysglycemia, including hyperglycemia and hypoglycemia, while stabilizing glycemic variability, contributing to enhanced patient outcomes. This scoping review aimed to identify nurse-led glycemic management protocols in intensive care units, analyze their components (e.g., target glucose range, monitoring frequency, and implementation methods), and evaluate their effectiveness. Seven databases, including PubMed and CINAHL, were searched for studies published between January 2015 and April 2025. Studies were selected using predefined inclusion criteria, and two independent reviewers evaluated methodological quality using the JBI critical appraisal tool. Ultimately, seven quasi-experimental studies were included. Most protocols employed continuous intravenous insulin infusions (n=5), whereas others focused on hypoglycemia management (n=2). The target glucose levels ranged from 100-180 mg/dl, and the monitoring intervals varied from 15 minutes to 4 hours depending on the protocol type. All protocols excluded patients on oral diets and those receiving intermittent enteral nutrition. Four studies used printed guidelines with manual adjustments, whereas three employed computerized decision-support systems. The studies indicated that nurse-led glycemic control management was associated with reductions in both glycemic variability and in the incidence of hyper- and hypoglycemia. These findings highlight the need for evidence-based updates to nurse-led glycemic control protocols in critical care for safe and effective management through a multidisciplinary approach.

Acute brain injuries-including traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage-exhibit profound pathophysiological heterogeneity, yet are often managed using standardized treatment protocols. While evidence-based guidelines have improved outcomes at a population level, they frequently overlook patient-specific variations in cerebral compliance, autoregulation, and metabolic reserve. This review explores the evolving paradigm of personalized neurocritical care, which integrates dynamic multimodal monitoring, individualized intracranial pressure management strategies, and real-time physiological indices such as pressure reactivity index, cerebral perfusion pressure optimization, and waveform analytics. We highlight the role of noninvasive modalities including quantitative pupillometry, transcranial Doppler, optic nerve sheath diameter ultrasound, near-infrared spectroscopy, and electroencephalography as adjuncts when invasive monitoring is limited or contraindicated. Furthermore, we examine tissue-level monitoring using brain oxygen tension and cerebral microdialysis and emerging blood-based biomarkers such as glial fibrillary acidic protein and neurofilament light. These tools provide granular insight into evolving secondary injury processes. In parallel, advances in artificial intelligence (AI) and machine learning enable deep phenotyping, predictive modeling, and integration of high-dimensional data including imaging, physiology, and omics-based profiles. The development of digital twin models further supports individualized simulation and therapeutic planning. While challenges remain in implementation, data harmonization, and resource availability, the convergence of physiologic monitoring, molecular profiling, and computational modeling offers a transformative pathway toward precision medicine in neurocritical care.

Post-hemorrhagic hydrocephalus (PHH) is a frequent complication of aneurysmal subarachnoid hemorrhage (aSAH), yet the relationship between serum magnesium (Mg) level and PHH remains unclear. To our knowledge, this is the first prospective study to specifically examine the association between admission serum Mg level and PHH in aSAH patients. In this prospective, multicenter study (October 2019-October 2024), 131 patients with confirmed aSAH were enrolled from four neuro-intensive care units. Patients were stratified by admission serum Mg level as <2.2 mg/dL or ≥2.2 mg/dL. The primary outcome was PHH incidence; secondary outcomes were cerebral vasospasm (CV), delayed cerebral ischemia (DCI), and 30-day modified Rankin Scale (mRS) score. Baseline characteristics were similar between groups. Serum Mg ≥2.2 mg/dL was not significantly associated with reduced vasospasm, DCI, or poor functional outcome. However, serum Mg >2.5 mg/dL correlated with lower PHH incidence in univariate analysis (odds ratio, 0.36; P=0.027) but not in multivariate analysis (P=0.136). Independent predictors of PHH were posterior circulation aneurysm, high Fisher grade, and high Hunt and Hess grade. Poor 30-day mRS was independently associated with high Fisher and Hunt and Hess grades. Admission serum Mg level was not independently associated with PHH, although a potential protective trend was noted at higher levels (>2.5 mg/dL). These findings suggest a possible role of Mg in PHH prevention. Further prospective trials are warranted to clarify the therapeutic potential of Mg and to establish optimal monitoring and correction strategies in aSAH management.

Body weight can fluctuate during critical illness due to factors such as fluid shifts, nutritional status, the type of acute illness, and underlying comorbidities. We investigated the association between acute body weight variability (WV) and clinical outcomes in critically ill pediatric patients. We retrospectively analyzed data from patients aged 1 month to 18 years who were admitted to the pediatric intensive care unit (PICU) of a university-affiliated tertiary hospital between August 2017 and July 2021. WV was defined as the percentage difference between the measured body weight at PICU admission and the usual body weight, obtained either from recent hospital records or caregiver reports. Associations between WV and clinical outcomes, including PICU mortality and ventilator-free days (VFDs), were assessed. Of the 926 patients, 74 (8.0%) died. Median WV was significantly higher in non-survivors than in survivors (8.7% vs. 0.0%; P<0.001). Increased WV was independently associated with higher mortality (hazard ratio [HR], 1.102; 95% CI, 1.073-1.131) and fewer VFDs (odds ratio [OR], 0.599; 95% CI, 0.524-0.684). Combining WV with Pediatric Index of Mortality 3 score significantly improved mortality prediction over either parameter alone (area under the curve, 0.888; P=0.047). Higher WV at PICU admission is independently associated with adverse clinical outcomes, including increased mortality and fewer VFDs. WV could complement existing mortality prediction models in pediatric critical care.

Early mobilization after cardiac surgery is crucial for enhancing recovery, minimizing complications, and promoting timely discharge. The 6-minute walk test (6MWT) is a validated measure of functional capacity; however, its use during the early postoperative period-particularly in Intensive care Unit (ICU) settings in India-remains underexplored. This study assesses the safety, feasibility, and functional performance outcomes of the 6MWT administered on postoperative days (PODs) 2 to 4 and identifies factors associated with test completion. A cohort-based observational study was conducted in a tertiary care ICU between June and September 2021. In total, 150 cardiac surgery patients aged 30-70 years were enrolled. Inclusion required hemodynamic stability, no vasopressor/inotropic support, and ambulation from POD 2. The 6MWT was administered per the American Thoracic Society guidelines. Clinical, demographic, and physiological parameters were recorded and analyzed using descriptive statistics, paired t-tests, and regression analyses. Of the 150 patients, 140 completed the test. The mean age was 52±14 years, and 75% of participants were male. Mean walking distances improved from 78.14 m (21.7% of predicted) on POD 2 to 193.51 m (53.75%) on POD 4. Completion rates increased from 40.0% to 99.2%. Physiological responses remained within safe limits, and no serious adverse events occurred. The regression analyses identified education, diet, and oxygen saturation as positive predictors and comorbidities, being female, oxygen use, and physical occupation as negative predictors. The 6MWT is a safe, feasible, and informative tool for assessing early functional recovery in stable post-cardiac surgery ICU patients to aid individualized rehabilitation and discharge planning.

Predicting the weaning outcomes is critical, since premature or delayed extubation is associated with an increased risk of mortality. This study aimed to compare two physiological indices, thoracic fluid content (TFC) and diaphragmatic excursion (DE), for predicting weaning success in mechanically ventilated patients. This observational cohort study involved 100 mechanically ventilated patients with congested lungs who were eligible for weaning. Patients' TFC and DE were measured using electrical cardiometry and ultrasonography, respectively, before starting the spontaneous breathing trial. Following extubation, patients were grouped into successful and failed-weaning groups, with failure defined as reintubation or a need for non-invasive ventilation within 48 hours. Respiratory and cardiovascular variables were compared. The receiver operating characteristic (ROC) curve was used to assess the ability of TFC and DE to predict weaning success. Successful weaning occurred in 73 patients (73%) and failed weaning occurred in 27 patients (27%). The two groups' baseline characteristics were comparable; however, TFC and DE were significantly different between the failed- and successful-weaning groups (P<0.001). The area under the ROC curve (AUC) exhibited moderate predictive abilities of both the TFC and DE in predicting weaning success (AUC, 0.805, cutoff <40 kΩ-1 and AUC, 0.774, cutoff >1.45 cm). In the cardiac patient subgroup, TFC exhibited high predictive ability (AUC, 0.861), but DE did not achieve comparable results (AUC, 0.750). Both TFC and DE are significant predictors for successful weaning from mechanical ventilators. In particular, a TFC of <40 kΩ-1 demonstrated an excellent ability to predict weaning success in patients with low ejection fraction.

Multi-organ distress syndrome (MODS) causes morbidity in patients with trauma. This study evaluates the effectiveness of interleukin-33 (IL-33), which reflects tissue damage and the inflammatory response, as a MODS indicator in patients with trauma. Patients with trauma admitted to our trauma center between July 2022 and July 2023 were included. IL-33 levels were measured in blood samples for 4 days. Correlations with clinical and laboratory indicators, including initial IL-33 levels, were analyzed to identify independent predictors of MODS. Among the 87 patients enrolled, 20 developed MODS. Initial IL-33 levels were elevated in the MODS group, compared with the non-MODS group. In the non-MODS group, IL-33 levels increased on day 1 and then declined, whereas in the MODS group, IL-33 levels were highest at admission (day 0) and decreased continuously through day 3. In patients with detectable initial IL-33 levels, the measured levels correlated with higher Abbreviated Injury Scale 5 scores and the Injury Severity Score (ISS). A logistic regression analysis revealed the ISS and delta neutrophil index as factors contributing to MODS progression. The findings suggest that initial IL-33 levels are elevated in the MODS group, compared with non-MODS group, and exhibit a rapidly declining trend, showing an initial association with MODS that was not maintained in a multivariate analysis. These findings suggest that IL-33 might have relevance in assessing trauma severity; however, further validation is required before it can be considered a biomarker for MODS.

Systemic inflammation following cardiopulmonary bypass (CPB) can interfere with analysis of routine clinical and biochemical parameters. Procalcitonin (PCT) is a potential biomarker for diagnosing early postoperative sepsis in pediatric patients following cardiac surgery utilizing CPB. This study aimed to evaluate the diagnostic accuracy of PCT compared to other biomarkers, especially C-reactive protein (CRP), in this clinical setting. A prospective single-center study was conducted over a 10-month period during the coronavirus disease 2019 (COVID-19) pandemic (2021-2022), enrolling 89 pediatric patients postcardiac surgery. PCT, CRP, and complete blood count were analyzed, and area under the curve (AUC) was employed for statistical analysis. PCT and CRP demonstrated moderate discriminatory ability with AUCs of 0.678 and 0.635, respectively. White cell count exhibited fair discriminatory power, and platelet count performed poorly in distinguishing septic from nonseptic cases (AUC: white cell count, 0.545; platelet, 0.486). PCT and CRP hold promise as diagnostic markers for early postoperative sepsis in pediatric cardiac surgery patients. However, these biomarkers are not adequate standalone indicators, emphasizing the continued need for clinical judgment supported by multiple diagnostic parameters.