Recursos para el cuidado neurocrítico en Colombia: percepción por profesionales al cuidado de los pacientes críticamente enfermos

Abstract

Introduction/objective

Neurocritical care (NCC) is a rapidly growing subspecialty focused on the care of critically ill neurological patients. Despite the ongoing development of this discipline, particularly in high-income countries, there is limited information in Colombia describing the resources available for NCC in critical care units. The objective of this study was to describe the perceptions of professionals responsible for the care of critically ill patients in Colombia regarding the resources available for NCC in the units where they practice.

Methods

A prospective, descriptive, cross-sectional observational study using a self-administered online survey with 18 categorical and perceptual questions about NCC resources in critical care units. The study included demographics, medical specialty, years of clinical practice, NCC training, perceptions of NCC in their institution, NCC resources in their institution, and general perceptions of NCC in Colombia. Two questions addressing death due to neurological criteria were included.

Results

A total of 122 respondents were obtained, 70% men, 67% intensivists with a mean experience of 12.5 years. Ninety-three percent reported training in NCC, and 7% had a NCC subspecialty. Two-thirds assigned a score of 7 or higher out of 10 for the technological capacity and training of their units’ human resources. Fifty-four percent reported not having a neuro-intensivist. Eighty-six percent had at least one clinical guideline for NCC. The most frequently available guidelines were subarachnoid haemorrhage, acute cerebral infarction, traumatic brain injury, and status epilepticus. Ninety-nine percent of respondents used at least one assessment method for the evaluation and monitoring of patients in NCC. The most used methods were clinical examination, neurological assessment scales, and intracranial pressure monitoring. Ninety-nine percent had at least one neuromonitoring technology in their institution for neurologically critical patients. The most frequently available neuromonitoring technologies were lumbar puncture, neuroimaging, and transcranial Doppler. Ninety-six percent of respondents believe that NCC should be developed in Colombia, and 84% consider telemedicine useful for NCC. Ninety percent determine death due to neurological criteria in their practice, and 81% report confidence in its performance.

Conclusion

The survey reveals variability in the availability of resources for NCC, with challenges and opportunities for its development in Colombia. Addressing gaps in education, optimizing multimodal neuromonitoring resources, expanding the number of NCC units, implementing NCC guidelines, standardizing the determination of death by neurological criteria, and expanding telemedicine are essential for improving NCC in the country.