Handbook of Neurocritical Care: Second Edition

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As a nurse who is very hands-on and spends most of her time in the clinical area, I value a textbook that combines clinical practice and knowledge. This textbook is ideal for nurses who want to understand practical issues that may be experienced while caring for the critically ill at the bedside. The authors obviously have great knowledge and experience in this arena, and have ensured that they have updated topics from the first edition such as sepsis and neurointensive care.

All chapters have sections on trouble shooting, such as resolving outflow problems in peritoneal dialysis and problems associated with electrocardiogram monitoring. These are the sorts of clinical problem that inexperienced nurses have concerns about and want to be able to remedy systematically at the bed space.

This book will also appeal to experienced critical care nurses, especially as a reminder if they have not made use of certain skills or experienced certain illnesses for a long time. It will also appeal to pre-registration and post-registration courses in intensive care nursing, especially as it has a 'test yourself' section at the end of each chapter — but it is very easy to cheat because the answers are just under the questions!

The book is in a logical order, and highlights the need for critical care skills to be expanded outside the geographical area, improving early recognition of critical illness and improving ward care of the critically ill. As a critical care outreach Clinical Nurse Specialist, this is music to my ears.


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All critical care nurses need to be aware of the bigger picture, and not isolate themselves from the rest of the hospital. Hence, there is the need for a comprehensive textbook, which remains a daunting task, considering the multidisciplinary nature of the practice of neurocritical care, and the rapidly advancing knowledge base of the specialty.

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This current textbook is written to fill that niche, the 1st edition of which was published in , shortly after the formation of the Neurocritical Care Society, when there were few textbooks available on this topic. Unlike the other textbooks on this subject, which are primarily edited by neurologist—neurointensivists, the 3 editors of this book come from the primary disciplines of anesthesiology and neurosurgery, although there are plenty other contributors representing other disciplines.

Critical Care Specialist, Neurologist: Julian P. Yang, MD

The contributions of anesthesiologists are very evident in this textbook, as few neurocritical care textbooks have such a comprehensive and in-depth treatise of airway management, intraoperative management, and postoperative complications. The editors are all faculty of the University of Florida at Gainesville the Senior Editor moved to Geisinger Health System in Pennsylvania before this edition , and many contributors are faculty members from the University of Florida. There are contributors from other parts of the country, however, as well as Europe.

Unlike other available textbooks, which tend to focus solely on the clinical practice of neurocritical care, this is more a comprehensive textbook than a clinical handbook, starting with basic science and then moving to the clinical disciplines, while emphasizing the best practice based on available evidence. This adds special strength to this textbook but also accounts for some potential weakness that can be improved on in future editions. The first 3 section titles are very descriptive, but the last 3 particularly the last 2 do not readily convey what is covered, and it is somewhat of an inconvenience for a reader interested to look up a specific topic, for example, traumatic brain injury.

The first section covers a brief history of the evolution of critical care and neurocritical care as well as the organization of a neurocritical care unit. Although neurocritical care is evolving rapidly into a specialty practiced only by neurointensivists, the authors are careful to point out the multidisciplinary nature and the contributions made by many specialties.

The second section covers the basic science and is comprehensive and provides a ready reference for the clinical materials.

ISBN 13: 9781441968418

Section 3 covers invasive and noninvasive monitoring in the neurointensive care unit NICU. Because the focus is on bedside neuromonitoring in the NICU, this section does not provide adequate coverage of other potentially useful diagnostic tests, such as single-photon emission computed tomography and xenon blood flow.

The description on electroencephalogram could have included some basic information, such as the nomenclature of the International 10—20 system, so the novice can interpret the figures appropriately. Transcranial Doppler is increasingly used to monitor emboli and diagnose patent foramen ovale, and these indications should be added.

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Section 4 covers the general medical problems seen in patients with neurologic disorders in the NICU. The prehospital care and airway management chapters are particularly worth reading for any nonanesthesiologist neurointensivist. These entities are well covered, and the best practices are delineated. In the chapter on intracranial hemorrhage, however, the intracerebral hemorrhage score as an important prognosticator is uncharacteristically omitted.

Section 6 covers miscellaneous topics, including neuroradiology, neuroanesthesia, postoperative misadventures, rehabilitation, brain death, and ethical issues. In addition, a chapter on pharmacotherapy summarizes all commonly used drugs in the NICU. The chapter on postoperative misadventures is outstanding, providing a wealth of clinical scenarios relevant to the postoperative care of the neurosurgical patient.

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This book is very comprehensive in nature and heavy in materials as well as in weight, comprising nearly pages. As indicated in the foreword by Dr. Kenton, this book follows the neurologic patient from the emergency room to the operating room and then to the NICU, providing a perspective not readily apparent in other textbooks. For neurologist—neurointensivists not familiar with the nuances of difficult airway management and anesthetic drugs and techniques, this is a very valuable reference text.

Fast Facts About Neurocritical Care

No textbook, however, is perfect. Because of the time lag from preparation to publication, all textbooks suffer from a relative lack of currency and cannot include important materials published after the book has gone to print. For example, the direct oral anticoagulants dabigatran and rivaroxaban are not even mentioned in this book. Results of the latest clinical trials, such as the Surgical Trial in Intracerebral Hemorrhage II, also are not included.

Most of the chapters only have references up to , although some include references. One of the omissions is in the chapter on hypothermia, where results from the National Acute Brain Injury Study: Hypothermia II are not mentioned, nor are the results from the Pediatric Hypothermia Trial.

These results, as well as the latest results from the hypothermia trial after cardiac arrest, considerably weaken the promise of hypothermia as a therapeutic adjunct. As mentioned previously, this is truly a comprehensive textbook and not a handbook and thus one cannot find a simple algorithm or shortcuts to a management problem. The chapter on neuroimaging illustrates this point; it is comprehensive and informative, but it is not formatted within a clinical context.


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Magnetic resonance imaging is covered before computed tomography, whereas in clinical practice the reverse would be true. It also does not provide guidance as to the most logical way in the diagnostic approach, when a busy clinician may want to know which magnetic resonance sequence would provide the quickest and greatest yield as a screening test. In the chapter on Sedation and Analgesia, no sedation scale is listed although mentioned in the text , and there is no discussion on the assessment of delirium using the confusion assessment method for the intensive care unit, and the role of early mobilization, a current topic of interest to all intensivists.

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The other common problem with a multiauthored text is the frequent overlap and lack of cross-referencing, with many topics and drugs discussed in more than one chapter. Thanks to the editorial oversight, these issues are kept to a minimum. Reference is another potential problem; with so many references being cited, it is impossible to avoid errors.

For example, in Chapter 35, the use of barbiturate coma and the lack of efficacy of tirilazad are all referenced to the same wrong citation.