Volume 21, Number 4
December 2014
Introduction his is the tenth anniversary of the first Seminars in Pediatric Neurology devoted to pediatric neurocritical care,1 and this field has come a long way in this time. Only 2 dedicated pediatric neurocritical care teams were in place 10 years ago, but now, dedicated neurocritical care services have been implemented in many of the largest children's hospitals in the United States and Canada. There are now several training programs in pediatric neurocritical care, and educational guidelines for training in it have been devised.2,3 The Seminars in Pediatric Neurology issue from 10 years ago consisted of articles on specific disorders encountered in pediatric neurocritical care, whereas this issue shall also review models for the delivery of care and the current state of the practice of pediatric neurocritical care by child neurologists. The authors are all experts in their specific fields and the leaders in pediatric neurocritical care, and their multiauthored articles emphasize the collaborative nature of this subspecialty of pediatrics and neurology. The first 2 articles review the establishment of programs in neurocritical care for newborns and older children. Dr Hannah Glass is the founding codirector of the Neurointensive Care Nursery at the University of California, San Francisco, and the program director of the Neonatal Neurology fellowship program. Her program created an interdisciplinary service within the neonatal intensive care unit with dedicated neurology care, specialized nursing, intensive monitoring, and standardized management guidelines.4 Dr Mark Wainwright, the medical director of the Pediatric Neurocritical Care Program at Lurie Children's Hospital of Chicago, created the clinical and training programs there. His team consists of child neurologists and pediatric critical care medicine specialists, and his program trains both these subspecialists. These articles describe the implementation of a neurocritical care service and the effect it has on patient care and training. Dr Robert Tasker from Boston Children's Hospital and the director of the Pediatric Neurocritical Care Program there reviews hemodynamics and increased intracranial pressure, the cornerstone of neurocritical care: ensuring an adequate cerebral blood flow and maintenance of the cerebral perfusion pressure needed to prevent secondary neurologic dysfunction. Dr Tasker is one of the leading
T
1071-9091/14/$ - see front matter & 2014 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.spen.2014.12.009
experts in pediatric critical care medicine and pediatric neurocritical care, and his program combines pediatric critical care medicine specialists with a team of child neurologists with the various neurologic subspecialty expertise needed in the pediatric intensive care unit (PICU). The treatment of seizures and status epilepticus constitute the most frequent neurologic disorder encountered in the PICU and the pediatric inpatient setting. Dr Nicholas Abend, the director of the Neurophysiology Laboratory at Children's Hospital of Philadelphia (CHOP), and his colleagues from CHOP update this topic, reviewing the management advances that have occurred over the last 10 years and presenting the status epilepticus treatment protocol used at CHOP. Reye syndrome was one of the first disorders unique to children that highlighted the importance of the multispecialty collaboration needed in the PICU. Traumatic brain injury is similar as it requires collaboration of various specialists in the PICU and for which evidence-based guidelines have been produced. The production of evidence-based guidelines ensures that care is standardized across many locations in which pediatric critical care is delivered. Standardized treatment guidelines also improve patient outcomes. Dr José Pineda, the director of the Neurocritical Care Program at St. Louis Children's Hospital, reviews traumatic brain injury. His research in traumatic brain injury is the first outcomes research in pediatric neurocritical care that demonstrates an improvement in patient outcome when a cooperative program of accepted best practice is implemented.5 This is important research currently lacking in neurocritical care: proving that our treatments improve mortality, morbidity, and quality of life. Pediatric neuroimmunology has become one of the major fields in pediatric neurology. It is estimated that approximately 20% of pediatric neurologic disorders are immune related, and these disorders are frequently encountered in the PICU. Dr Leslie Benson, the assistant director of the Pediatric Neuroimmunology Program at Boston Children's Hospital, provides an excellent summary of this important topic, including a treatment protocol for acute demyelinating disorders.
239
J.J. Riviello
240 Of course, monitoring the brain is critical in neurocritical care, and Dr Zachary Grinspan from the Department of Healthcare Policy and Research and the Department of Pediatrics at the Weill Cornell Medical College and the Komansky Center for Children's Health at New YorkPresbyterian Hospital reviews this topic. This seminar ends with a review of the current practice of pediatric neurocritical care by child neurologists by Dr Cherylee Chang, former president of the Neurocritical Care Society, and me on what is needed for the expansion of this exciting subspecialty of pediatric neurology. We hope this issue presents the current landscape of the practice of pediatric neurocritical care, the importance of dedicated protocols to treat specific disorders, and the training required for child neurologists practicing neurocritical care and child neurologists taking care of children with neurologic disorders in the PICU. The past 10 years have
seen the creation of the specialty of pediatric neurocritical care. We cannot wait to see what the next 10 years bring. James J. Riviello Jr, MD Guest Editor
References 1. Riviello JJ Jr: Introduction: Critical care in pediatric neurology. Semin Pediatr Neurol 11:87-88, 2004 2. Scher MS: Proposed cross-disciplinary training in pediatric neurointensive care. Pediatr Neurol 39:1-5, 2008 3. Lee JC, Riviello JJ Jr: Education of the child neurologist: Pediatric neurocritical care. Semin Pediatr Neurol 18:128-130, 2011 4. Glass HC, Bonifacio SL, Peloquin S, et al: Neurocritical Care for Neonates. Neurocrit Care 12:421-429, 2010 5. Pineda JA, Leonard JR, Mazotas IG, et al: Effect of implementation of a paediatric neurocritical care programme on outcomes after severe traumatic brain injury: a retrospective cohort study. Lancet Neurol 12:45-52, 2013
December 2014
Introduction his is the tenth anniversary of the first Seminars in Pediatric Neurology devoted to pediatric neurocritical care,1 and this field has come a long way in this time. Only 2 dedicated pediatric neurocritical care teams were in place 10 years ago, but now, dedicated neurocritical care services have been implemented in many of the largest children's hospitals in the United States and Canada. There are now several training programs in pediatric neurocritical care, and educational guidelines for training in it have been devised.2,3 The Seminars in Pediatric Neurology issue from 10 years ago consisted of articles on specific disorders encountered in pediatric neurocritical care, whereas this issue shall also review models for the delivery of care and the current state of the practice of pediatric neurocritical care by child neurologists. The authors are all experts in their specific fields and the leaders in pediatric neurocritical care, and their multiauthored articles emphasize the collaborative nature of this subspecialty of pediatrics and neurology. The first 2 articles review the establishment of programs in neurocritical care for newborns and older children. Dr Hannah Glass is the founding codirector of the Neurointensive Care Nursery at the University of California, San Francisco, and the program director of the Neonatal Neurology fellowship program. Her program created an interdisciplinary service within the neonatal intensive care unit with dedicated neurology care, specialized nursing, intensive monitoring, and standardized management guidelines.4 Dr Mark Wainwright, the medical director of the Pediatric Neurocritical Care Program at Lurie Children's Hospital of Chicago, created the clinical and training programs there. His team consists of child neurologists and pediatric critical care medicine specialists, and his program trains both these subspecialists. These articles describe the implementation of a neurocritical care service and the effect it has on patient care and training. Dr Robert Tasker from Boston Children's Hospital and the director of the Pediatric Neurocritical Care Program there reviews hemodynamics and increased intracranial pressure, the cornerstone of neurocritical care: ensuring an adequate cerebral blood flow and maintenance of the cerebral perfusion pressure needed to prevent secondary neurologic dysfunction. Dr Tasker is one of the leading
T
1071-9091/14/$ - see front matter & 2014 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.spen.2014.12.009
experts in pediatric critical care medicine and pediatric neurocritical care, and his program combines pediatric critical care medicine specialists with a team of child neurologists with the various neurologic subspecialty expertise needed in the pediatric intensive care unit (PICU). The treatment of seizures and status epilepticus constitute the most frequent neurologic disorder encountered in the PICU and the pediatric inpatient setting. Dr Nicholas Abend, the director of the Neurophysiology Laboratory at Children's Hospital of Philadelphia (CHOP), and his colleagues from CHOP update this topic, reviewing the management advances that have occurred over the last 10 years and presenting the status epilepticus treatment protocol used at CHOP. Reye syndrome was one of the first disorders unique to children that highlighted the importance of the multispecialty collaboration needed in the PICU. Traumatic brain injury is similar as it requires collaboration of various specialists in the PICU and for which evidence-based guidelines have been produced. The production of evidence-based guidelines ensures that care is standardized across many locations in which pediatric critical care is delivered. Standardized treatment guidelines also improve patient outcomes. Dr José Pineda, the director of the Neurocritical Care Program at St. Louis Children's Hospital, reviews traumatic brain injury. His research in traumatic brain injury is the first outcomes research in pediatric neurocritical care that demonstrates an improvement in patient outcome when a cooperative program of accepted best practice is implemented.5 This is important research currently lacking in neurocritical care: proving that our treatments improve mortality, morbidity, and quality of life. Pediatric neuroimmunology has become one of the major fields in pediatric neurology. It is estimated that approximately 20% of pediatric neurologic disorders are immune related, and these disorders are frequently encountered in the PICU. Dr Leslie Benson, the assistant director of the Pediatric Neuroimmunology Program at Boston Children's Hospital, provides an excellent summary of this important topic, including a treatment protocol for acute demyelinating disorders.
239
J.J. Riviello
240 Of course, monitoring the brain is critical in neurocritical care, and Dr Zachary Grinspan from the Department of Healthcare Policy and Research and the Department of Pediatrics at the Weill Cornell Medical College and the Komansky Center for Children's Health at New YorkPresbyterian Hospital reviews this topic. This seminar ends with a review of the current practice of pediatric neurocritical care by child neurologists by Dr Cherylee Chang, former president of the Neurocritical Care Society, and me on what is needed for the expansion of this exciting subspecialty of pediatric neurology. We hope this issue presents the current landscape of the practice of pediatric neurocritical care, the importance of dedicated protocols to treat specific disorders, and the training required for child neurologists practicing neurocritical care and child neurologists taking care of children with neurologic disorders in the PICU. The past 10 years have
seen the creation of the specialty of pediatric neurocritical care. We cannot wait to see what the next 10 years bring. James J. Riviello Jr, MD Guest Editor
References 1. Riviello JJ Jr: Introduction: Critical care in pediatric neurology. Semin Pediatr Neurol 11:87-88, 2004 2. Scher MS: Proposed cross-disciplinary training in pediatric neurointensive care. Pediatr Neurol 39:1-5, 2008 3. Lee JC, Riviello JJ Jr: Education of the child neurologist: Pediatric neurocritical care. Semin Pediatr Neurol 18:128-130, 2011 4. Glass HC, Bonifacio SL, Peloquin S, et al: Neurocritical Care for Neonates. Neurocrit Care 12:421-429, 2010 5. Pineda JA, Leonard JR, Mazotas IG, et al: Effect of implementation of a paediatric neurocritical care programme on outcomes after severe traumatic brain injury: a retrospective cohort study. Lancet Neurol 12:45-52, 2013
