Critical Care Neurology Research Articles

A Novel Therapeutic Approach: Managing Severe Alcoholic Hepatitis Complicated by Guillain-Barré Syndrome (AMSAN Subtype) Using Multidisciplinary Precision Care

We report the first documented case of a 41-year-old male diagnosed with severe alcoholic hepatitis (AH) complicated by Guillain-Barré syndrome (GBS), specifically the acute motor and sensory axonal neuropathy (AMSAN) variant. The combination of these two life-threatening conditions posed unique challenges, especially given the conflicting immunosuppressive and neuroinflammatory therapeutic demands. This case highlights a pioneering multidisciplinary approach, utilising corticosteroid therapy for AH alongside plasmapheresis (PLEX) for GBS. The patient showed significant improvement in both hepatic and neurological functions, underscoring the critical role of personalised, integrative care in managing complex comorbidities. This case sets a precedent for future clinical protocols in critical care hepatology and neurology.

Clinical practice guidelines for the care of patients with a chronic subdural haematoma: multidisciplinary recommendations from presentation to recovery

Introduction A chronic subdural haematoma (cSDH) is an encapsulated collection of fluid and blood degradation products in the subdural space. It is increasingly common, affecting older people and those living with frailty. Currently, no guidance exists to define optimal care from onset of symptoms through to recovery. This paper presents the first consensus-built recommendations for best practice in the care of cSDH, co-designed to support each stage of the patient pathway. Methods Guideline development was led by a multidisciplinary Steering Committee with representation from diverse clinical groups, professional associations, patients, and carers. Literature searching to identify relevant evidence was guided by core clinical questions formulated through facilitated discussion with specially convened working groups. A modified Delphi exercise was undertaken to build consensus on draft statements for inclusion in the guideline using survey methodology and an in-person meeting. The proposed guideline was subsequently endorsed by the Society for British Neurological Surgeons, Neuroanaesthesia and Critical Care Society, Association of Anaesthetists, British Association of Neuroscience Nurses, British Geriatric Society, and Centre for Perioperative Care. Results We identified that high quality evidence was generally lacking in the literature, although randomised controlled trial (RCT) data were available to inform specific recommendations on aspects of surgical technique and use of corticosteroids. The final guideline represents the outcome of synthesising available evidence, consensus-built expert opinion and patient involvement. The guideline comprises 67 recommendations across eight major themes, covering: presentation and diagnosis, neurosurgical triage and shared decision-making, non-operative management, perioperative management (including anticoagulation), timing of surgery, intraoperative and postoperative care, rehabilitation and recovery. Conclusions We present the first multidisciplinary guideline for the care of patients with cSDH. The recommendations reflect a paradigm shift in the care of cSDH, recognising and formalising the need for multidisciplinary and collaborative clinical management, communication and decision-making delivered effectively across secondary and tertiary care.

Nurses’ Understanding and Practice of Minimal Stimulation in the Pediatric Intensive Care Unit

Background Pediatric patients receiving neurologic and neurosurgical critical care undergo many procedures that result in stimulation of the sympathetic nervous system, which increases their risk of poor outcomes. Nurses typically implement a variety of interventions to minimize such stimulation; however, minimal stimulation has not been specifically defined in the literature or described as a standardized bundle of care. Objective To examine pediatric intensive care unit nurses’ interpretation and practice of minimal stimulation in patients with neurologic and neurosurgical conditions and specifically to triangulate nurses’ descriptions of this practice with related findings in the literature. Methods This was a qualitative, descriptive, exploratory study that used naturalistic inquiry. Results A total of 13 pediatric intensive care unit nurses participated in the study. Three primary themes were identified regarding minimal stimulation: (1) new knowledge and practice, (2) communication, and (3) impact of minimal stimulation. Conclusions The findings of this study help to establish a working definition of the nursing practice of minimal stimulation and provide a basis for future research. More detailed study is needed on the concept of a standardized minimal stimulation bundle and its impact on patient outcomes.

Chinese expert consensus on cerebral monitoring in patients with extracorporeal membrane oxygenation

With the significant increase in the use of extracorporeal membrane oxygenation in patients with severe respiratory failure, cardiogenic shock, and cardiopulmonary resuscitation, complications related to extracorporeal membrane oxygenation are increasingly being taken seriously. Cerebral injury is one of the most serious complications during extracorporeal membrane oxygenation treatment, and is an important factor affecting the hospital mortality rate and long-term quality of life. Due to the use of analgesics, sedatives, and muscle relaxants interfering with neurological physical examination results, cerebral injury that occurs during extracorporeal membrane oxygenation therapy is not easily detected in a timely manner. Therefore, bedside cerebral monitoring has important value in quickly detecting cerebral injury in patients with extracorporeal membrane oxygenation and providing early intervention guidance. Therefore, Extracorporeal Life Support Professional Committee of Chinese Medical Doctor Association organized relevant experts across the country to develop the"Chinese expert consensus on cerebral monitoring in patients with extracorporeal membrane oxygenation", this expert consensus is based on the pathological and physiological mechanisms of cerebral injury in patients with extracorporeal membrane oxygenation. It is based on the current application status of cerebral monitoring technologies such as neurological physical examination, plasma brain injury biomarkers, brain imaging, intracranial pressure, cerebral blood flow, brain oxygen, electroencephalogram, and somatosensory evoked potential. Combining the special clinical application scenarios of extracorporeal membrane oxygenation and integrating the latest evidence-based medical evidence, we have formed 15 consensus recommendations which can be referenced by professionals in critical care medicine, neurology, cardiovascular disease, respiratory and critical care, emergency medicine, and other fields. Given the particularity, complexity, and individual differences of critically ill patients, the recommendations formed by this expert consensus need to implement personalized strategies.

Utility of EEG in neurological emergencies and critical care

EEG is useful for evaluation of pathophysiology and prognostication of neurocritically ill patients, as it provides non-invasive, real-time monitoring of cerebral function. There have been recently a lot of advances in research on critical care EEG according to the American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology. Based on the latest knowledge, this review discusses clinical utilization of EEG in neurocritically ill patients, including critical care continuous EEG monitoring, and key points of interpretation of critical care EEG, classifying main purposes into three points: detection of electrographic and electroclinical seizures, consideration of special encephalopathies, and evaluation and prognostication of cerebral function. Neurologists should have fundamental ability to read and interpret critical care EEG and support treating physicians in terms of therapeutic strategy.

Early tracheostomy for neurologic critical care patients improves neurologic function and reduces pulmonary infections.

To evaluate the clinical efficacy of early tracheotomy in neurologic critical care patients. A retrospective analysis was conducted on 100 patients with severe craniocerebral injury (SCI) who underwent percutaneous tracheotomy at The First Affiliated Hospital, Zhejiang University School of Medicine from January 2021 to February 2022. Of them, 52 cases (observation group) received the procedure within 24 hours of injury, while 48 patients (control group) received the procedure after 24 hours. Therapeutic efficacy was assessed using the National Institutions of Health Stroke Scale (NIHSS) criteria. The utilization rates of antibiotics, muscle relaxants, and sedatives during hospitalization, along with mechanical ventilation duration, and the length of intensive care were recorded for comparative analyses. Additionally, blood gas indicators, Glasgow Coma Scale (GCS) score, and Disability Rating Scale (DRS) score were compared before and after treatment. Pulmonary infection and case fatality rates were also recorded and compared. The early prognosis of patients was assessed based on their GCS scores during a 3-month postoperative follow-up, and risk factors for adverse prognosis were identified. The effective rate was evidently higher in the observation group compared to the control group. No statistical inter-group difference was identified in the utilization rate of antibiotics or sedatives during hospitalization (all P>0.05), but the observation group had a lower utilization rate of muscle relaxants than the control group (P<0.05). The observation group showed markedly shorter mechanical ventilation duration and length of intensive care compared with the control group (all P<0.05). Both groups demonstrated significant improvements in blood gas indices, GCS and DRS scores after treatment, with significantly greater improvement in the observation group (all P<0.05). The observation group exhibited lower pulmonary infection and case fatality rates than the control group (all P<0.05). GCS score >3 upon admission, DRS score >15 upon admission, and tracheotomy after 24 h of injury were all independent risk factors for poor early prognosis in patients with SCI. Tracheotomy for SCI patients within 24 hours of injury can effectively improve therapeutic efficacy, enhance neurologic function, and reduce the risk of disability and pulmonary infection.

The Role of Rehabilitation in Neurological Critical Care: Innovations in Early Mobilization

The Role of Rehabilitation in Neurological Critical Care: Innovations in Early Mobilization

Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement from the American Heart Association and Neurocritical Care Society.

The critical care management of patients after cardiac arrest is burdened by a lack of high-quality clinical studies and the resultant lack of high-certainty evidence. This results in limited practice guideline recommendations, which may lead to uncertainty and variability in management. Critical care management is crucial in patients after cardiac arrest and affects outcome. Although guidelines address some relevant topics (including temperature control and neurological prognostication of comatose survivors, 2 topics for which there are more robust clinical studies), many important subject areas have limited or nonexistent clinical studies, leading to the absence of guidelines or low-certainty evidence. The American Heart Association Emergency Cardiovascular Care Committee and the Neurocritical Care Society collaborated to address this gap by organizing an expert consensus panel and conference. Twenty-four experienced practitioners (including physicians, nurses, pharmacists, and a respiratory therapist) from multiple medical specialties, levels, institutions, and countries made up the panel. Topics were identified and prioritized by the panel and arranged by organ system to facilitate discussion, debate, and consensus building. Statements related to postarrest management were generated, and 80% agreement was required to approve a statement. Voting was anonymous and web based. Topics addressed include neurological, cardiac, pulmonary, hematological, infectious, gastrointestinal, endocrine, and general critical care management. Areas of uncertainty, areas for which no consensus was reached, and future research directions are also included. Until high-quality studies that inform practice guidelines in these areas are available, the expert panel consensus statements that are provided can advise clinicians on the critical care management of patients after cardiac arrest.

Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement From the American Heart Association and Neurocritical Care Society.

The critical care management of patients after cardiac arrest is burdened by a lack of high-quality clinical studies and the resultant lack of high-certainty evidence. This results in limited practice guideline recommendations, which may lead to uncertainty and variability in management. Critical care management is crucial in patients after cardiac arrest and affects outcome. Although guidelines address some relevant topics (including temperature control and neurological prognostication of comatose survivors, 2 topics for which there are more robust clinical studies), many important subject areas have limited or nonexistent clinical studies, leading to the absence of guidelines or low-certainty evidence. The American Heart Association Emergency Cardiovascular Care Committee and the Neurocritical Care Society collaborated to address this gap by organizing an expert consensus panel and conference. Twenty-four experienced practitioners (including physicians, nurses, pharmacists, and a respiratory therapist) from multiple medical specialties, levels, institutions, and countries made up the panel. Topics were identified and prioritized by the panel and arranged by organ system to facilitate discussion, debate, and consensus building. Statements related to postarrest management were generated, and 80% agreement was required to approve a statement. Voting was anonymous and web based. Topics addressed include neurological, cardiac, pulmonary, hematological, infectious, gastrointestinal, endocrine, and general critical care management. Areas of uncertainty, areas for which no consensus was reached, and future research directions are also included. Until high-quality studies that inform practice guidelines in these areas are available, the expert panel consensus statements that are provided can advise clinicians on the critical care management of patients after cardiac arrest.

A Survey of Pediatric Neurocritical Care Fellowship Training in North America

BackgroundPediatric neurocritical care (PNCC) has emerged as a field to care for children at the intersection of critical illness and neurological dysfunction. PNCC fellowship programs evolved over the past decade to train physicians to fill this clinical need. We aimed to characterize PNCC fellowship training infrastructure and curriculum in the United States and Canada. MethodsWeb-based survey of PNCC fellowship program leaders during November 2019 to January 2020. ResultsThere were 14 self-identified PNCC fellowship programs. The programs were supported by Child Neurology and/or Pediatric Critical Care Medicine divisions at tertiary/quaternary care institutions. Most programs accepted trainees who were board-eligible or board-certified in child neurology or pediatric critical care medicine. Clinical training consisted mostly of rotations providing PNCC consultation (n = 13) or as a provider on the pediatric intensive care unit-based neurointensive care team (n = 2). PNCC-specific didactics were delivered at most institutions (n = 13). All institutions provided training in electroencephalography use in the intensive care unit and declaration of death by neurological criteria (n = 14). Scholarly activity was supported by most programs, including protected time for research (n = 10). ConclusionsWe characterized PNCC fellowship training in the United States and Canada, which in this continuously evolving field, lays the foundation for exploring standardization of training going forward.

Ketamine dose reporting and dose responsiveness for chronic pain.

Journal Article Accepted manuscript Ketamine Dose Reporting and Dose Responsiveness for Chronic Pain Get access Steven P Cohen, MD, Steven P Cohen, MD Depts. of Anesthesiology & Critical Care Medicine, Neurology, Physical Medicine & Rehabilitation, and Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MDDepts. of Physical Medicine & Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD Address correspondence to: Steven P. Cohen, M.D., Pain Medicine, Dept. of Anesthesiology and Critical Care Medicine, 550 N. Broadway, Suite 301, Baltimore, MD 21205, Tel: 410-955-7246; E-mail: scohen40@jhmi.edu. Search for other works by this author on: Oxford Academic PubMed Google Scholar Chachrit Khunsriraksakul, PhD, Chachrit Khunsriraksakul, PhD Medical Student, Penn State College of Medicine, Hershey, PA Search for other works by this author on: Oxford Academic PubMed Google Scholar Seffrah J Cohen, Seffrah J Cohen River Hill High School, Clarksville, MD Search for other works by this author on: Oxford Academic PubMed Google Scholar Jee Youn Moon, MD, PhD Jee Youn Moon, MD, PhD Dept. of Anesthesiology, Seoul National University, Seoul, Korea Search for other works by this author on: Oxford Academic PubMed Google Scholar Pain Medicine, pnad059, https://doi.org/10.1093/pm/pnad059 Published: 11 May 2023 Article history Received: 01 May 2023 Accepted: 03 May 2023 Published: 11 May 2023

The Completion of a PGY-1 Neurology Bootcamp Leads to Increased Trainee Knowledge and Confidence in Neurologic Emergencies Management and Procedural Skills (P2-2.001)

<h3>Objective:</h3> To evaluate the impact of an end-of-the-year, post-graduate year 1 (PGY-1) simulation-based neurology bootcamp on trainee knowledge, self-confidence, and skill independence regarding acute neurologic emergencies management and bedside procedural skills. <h3>Background:</h3> The post-graduate year 2 (PGY-2) neurology resident is often the first line of triage for evaluation of acute neurologic deterioration on the inpatient neurology service, requiring autonomy and responsibility. We implemented and evaluated a bootcamp prior to this critical training period. <h3>Design/Methods:</h3> In this prospective cohort study, 14 rising PGY-2 neurology residents attended a two-day bootcamp with a simulation-based curriculum led by neurology faculty practicing cerebrovascular, critical care, and inpatient neurology medicine. Pre- and postbootcamp, trainees completed multiple-choice knowledge assessments and via Likert scales, self-reported confidence in managing neurologic emergencies. Faculty observed and rated trainee ability to independently perform five neurologic procedures (lumbar puncture, external ventricular drain [EVD] management, botulinum toxin injection for migraine, digital fundoscopy, and pupillometry), with residents additionally reporting their own perceived degree of independence. <h3>Results:</h3> Proportion of trainees demonstrating independence per faculty rating significantly increased for all five procedural skills post-bootcamp (for all, p &lt; .05). Trainee self-reported independence of EVD management, pupillometry, and fundoscopy skills also increased postbootcamp (for all, p &lt; .05), with &lt; 25% of trainees reporting total independence pre-bootcamp to 50%, 86%, and 79% post-bootcamp, respectively. Knowledge assessment scores increased from a pre-bootcamp mean of 54% of questions correct to mean 70% correct (p = 0.002), driven by increases in vascular neurologic emergency and procedural knowledge. On a 5-point Likert scale, trainee self-reported confidence in emergency management increased from median 2.5 (a little confident) to median 4 (fairly confident) (p &lt; .001) <h3>Conclusions:</h3> A simulation-based, two-day bootcamp with focus on acute cerebrovascular neurologic emergencies and neurologic procedural skills showed significant improvements in trainee knowledge along with faculty-observed and self-reported confidence and independence. <b>Disclosure:</b> An immediate family member of Dr. Swetlik has received personal compensation for serving as an employee of Pfizer. Dr. Buletko has nothing to disclose. Dr. Marquardt has nothing to disclose. Dr. Higgins has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Organon. Ms. Hassett has nothing to disclose.

291: DEVELOPING DELPHI EXPERT CONSENSUS RULES FOR A DIGITAL TWIN MODEL OF THE NEURO CRITICAL CARE UNIT

Introduction: In the past 20 years, the concept of the digital twin has been utilized in other fields to track the operations of wind turbines, monitor the status of spacecraft, and even create a model of the Earth for climate research While artificial intelligence holds much promise for the neurocritical care unit, these models should be clearly based on an understanding of underlying physiological variables rather than be opaque “black box” models. Our group has previously created such a digital twin model to predict acute response to treatment of sepsis. This project expands on our previous work by developing a similar model for the critical care of acute ischemic stroke. Methods: A panel of 18 experts in the field of critical care reviewed the clinical practice and pathophysiological statements related to neurology critical care. The core group of investigators developed statements based on a Directed Acyclic Graph (DAG) describing pathophysiology surrounding acute neurological issues encountered in the practice of Neurocritical Care (NCC). A modified Delphi method (3 rounds) was used to gauge agreement on 20 statements (120 sub statements) using a 7-point Likert scale. Agreement was defined a-priori by >80% selection of a 6 (“agree”) or 7 (“strongly agree”). Results: Consensus was achieved on 58 (48.3%) expert statements after completion of 2 rounds. After completion of 3rd round, the level of consensus increased to 93 (77.5%) expert statements. Some statements garnered 100% consensus in the first round of DELPHI such as “Reperfusion of ischemic stroke can lead to improvement of stroke.” Other statements required revision to capture the nuances of clinical practice before gaining consensus. For example, when the severity of infection was incorporated into the statement “Infection can lead to low blood pressure.” consensus increased from 56% to 100%. Conclusions: Our study demonstrated the feasibility of application of the DELPHI process to generate consensus among experts for use in development of a “digital twin” artificial intelligence model for use in the Neuro ICU. Compared to other models which rely on “black-box” associative artificial intelligence, our proposed causal AI model is based on a solid foundation of expert rules and casual mechanisms.

Hearing Loss from S. Suis Meningitis In A Middle-Aged Couple

Hearing Loss from S. Suis Meningitis In A Middle-Aged Couple

Implementation of neurocritical care in Thailand.

Dedicated neurointensive care units and neurointensivists are rarely available in Thailand, a developing country, despite the high burden of life-threatening neurologic illness, including strokes, post-cardiac arrest brain injury, status epilepticus, and cerebral edema from various etiologies. Therefore, the implementation of neurocritical care is essential to improve patient outcomes. With the resource-limited circumstances, the integration of neurocritical care service by collaboration between intensivists, neurologists, neurosurgeons, and other multidisciplinary care teams into the current institutional practice to take care of critically-ill neurologic patients is more suitable than building a new neurointensive care unit since this approach can promptly be made without reorganization of the hospital system. Providing neurocritical care knowledge to internal medicine and neurology residents and critical care fellows and developing a research system will lead to sustainable quality improvement in patient care. This review article will describe our current situation and strategies to implement neurocritical care in Thailand.

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2021

AbstractThis review is a synopsis of selected articles from neuroscience, neuroanesthesia, and neurocritical care from 2021 (January–December 2021). The journals reviewed include anesthesia journals, critical care medicine journals, neurology, and neurosurgical journals as well as high-impact medical journals such as the Lancet, Journal of American Medical Association, New England Journal of Medicine, and Stroke. This summary of important articles will serve to update the knowledge of anesthesiologists and other perioperative physicians who provide care to neurosurgical and neurocritical care patients. In addition, some of the important narrative reviews that are of interest to neuroanesthesiologists are also listed.

Neurocritical Care

Neurologic critical care encompasses the management of many nervous system diseases when they present in the extremes of severity. Core conditions managed in the neuroscience intensive care unit (ICU) include stroke, cerebral hemorrhage, status epilepticus (SE), myasthenia gravis (MG), Guillain-Barré syndrome (GBS), traumatic brain and spinal cord injury, and high-risk postoperative neurosurgical patients. The skills and knowledge base required to care for patients with such conditions, and the life-threatening complications associated with them, are drawn from both traditional neurology and from critical care medicine. This chapter covers specialized monitoring in the neurologic intensive care unit and special conditions such as acute intracranial hypertension, acute ischemic stroke, intracerebral hemorrhage, venous sinus thrombosis, myasthenia gravis, GBS, seizure and status epilepticus, spinal cord injury, and traumatic brain injury. The chapter includes 8 tables and 5 figures. Tables provide common etiologies of acute intracranial hypertension; general prophylactic measures, medical interventions, surgical interventions, and stepwise treatment protocol for acute intracranial hypertension; drugs that can exacerbate weakness in myasthenia gravis, cholinergic drug dosage equivalents and duration of action, and antiseizure medications used in status epilepticus. Figures illustrate the Monro-Kellie Doctrine, intracranial pressure waveform and plateau waves, typical herniation patterns, large stroke with malignant edema, and examples of nontraumatic intracerebral hemorrhage. This chapter contains 114 references.

Predicting Community Discharge for Occupational Therapy Recipients in the Neurological Critical Care Unit.

Occupational therapy in the neurological critical care unit (NCCU) may enable safe community discharge by restoring functional ability. However, the influence of patient characteristics and NCCU occupational therapy on discharge disposition is largely unknown. To examine how patient factors and receipt of occupational therapy predict discharge disposition for NCCU patients. Retrospective cross-sectional cohort study of electronic health records data from adults admitted to the NCCU between May 2013 and September 30, 2015. NCCU in a large urban academic hospital. Adults age 18 yr or older (N = 1,134) admitted to the NCCU. Outcomes and Measures: Using logistic regression with discharge disposition as the dependent variable, we entered sex, age, length of stay (LOS), baseline Glasgow Coma Scale score, Elixhauser Comorbidity Index, and receipt of occupational therapy services as predictor variables. Of NCCU patients, 39% received occupational therapy. Younger age, shorter LOS, lower comorbidity burden, and not receiving occupational therapy services increased the likelihood of discharge to the community. Men who received occupational therapy were less likely to be discharged to the community than men who did not receive occupational therapy. As age increased, differences in the probability of community discharge decreased between recipients and nonrecipients of occupational therapy services. Our results suggest that patients receiving occupational therapy services in the NCCU may have a lower likelihood of community discharge. However, these findings may result from therapist's consideration of the safest discharge location to ensure the greatest balance between independence and support. What This Article Adds: This study's findings suggest that receipt of occupational therapy in the NCCU is associated with higher likelihood for noncommunity discharge (i.e., to inpatient rehabilitation, skilled nursing, or long-term care). However, activity limitations and comorbidity burden may be greater for recipients of occupational therapy, and these NCCU patients are presumably less prepared for community discharge.

Postoperative Delirium: A Literature Review of Management in Intensive Care Unit

Perioperative delirium is a wide-ranging problem that directly affects primary clinical results. The anesthesiologist must understand how to define and diagnose delirium, identify patients at high risk of delirium, identify predisposing factors to adjust the care plan appropriately, and manage delirium in the acute postoperative period. Delirium is an organ dysfunction in critically ill patients, independently associated with improved morbidity. Research on delirium in hospitalized patients (including critically ill patients) has increased exponentially in the last decade. This study emphasizes the need for a mechanistic explanation of delirium to help advance the research that ultimately leads to its prevention and treatment. In this study, multinational and multidisciplinary clinicians, and researchers from the fields of critical care medicine, psychiatry, anesthesiology, neurology, and pharmacy sought to collaborate in the management of delirium in the intensive care unit (ICU).

Postoperative Delirium: A Literature Review of Management in Intensive Care Unit

Perioperative delirium is a wide-ranging problem that directly affects primary clinical results. The anesthesiologist must understand how to define and diagnose delirium, identify patients at high risk of delirium, identify predisposing factors to adjust the care plan appropriately, and manage delirium in the acute postoperative period. Delirium is an organ dysfunction in critically ill patients, independently associated with improved morbidity. Research on delirium in hospitalized patients (including critically ill patients) has increased exponentially in the last decade. This study emphasizes the need for a mechanistic explanation of delirium to help advance the research that ultimately leads to its prevention and treatment. In this study, multinational and multidisciplinary clinicians, and researchers from the fields of critical care medicine, psychiatry, anesthesiology, neurology, and pharmacy sought to collaborate in the management of delirium in the intensive care unit (ICU).