Intensive Care Medicine

, Volume 40, Issue 4, pp 484–495

Neurological examination of critically ill patients: a pragmatic approach. Report of an ESICM expert panel

  • Tarek Sharshar
  • Giuseppe Citerio
  • Peter J. D. Andrews
  • Arturo Chieregato
  • Nicola Latronico
  • David K. Menon
  • Louis Puybasset
  • Claudio Sandroni
  • Robert D. Stevens
Conference Reports and Expert Panel

DOI: 10.1007/s00134-014-3214-y

Cite this article as:
Sharshar, T., Citerio, G., Andrews, P.J.D. et al. Intensive Care Med (2014) 40: 484. doi:10.1007/s00134-014-3214-y

Abstract

Objective

Many patients admitted to the intensive care unit (ICU) have pre-existing or acquired neurological disorders which significantly affect their short-term and long-term outcomes. The ESICM NeuroIntensive Care Section convened an expert panel to establish a pragmatic approach to neurological examination (NE) of the critically ill patient.

Methods

The group conducted a comprehensive review of published studies on the NE of patients with coma, delirium, seizures and neuromuscular weakness in critically ill patients. Quality of data was rated as high, moderate, low, or very low, and final recommendations as strong, weak, or best practice.

Summary and Conclusions

The group made the following recommendations: (1) NE should be performed in all patients admitted to ICUs; (2) NE should include an assessment of consciousness and cognition, brainstem function, and motor function; (3) sedation should be managed to maximize the clinical detection of neurological dysfunction, except in patients with reduced intracranial compliance in whom withdrawal of sedation may be deleterious; (4) the need for additional tests, including neurophysiological and neuroradiological investigations, should be guided by the NE; (5) selected features of the NE have prognostic value which should be considered in well-defined patient populations.

Keywords

ComaNeurological examinationCritical illnessSedationDeliriumNeuroimaging

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Tarek Sharshar
    • 8
    • 9
  • Giuseppe Citerio
    • 3
  • Peter J. D. Andrews
    • 1
  • Arturo Chieregato
    • 2
  • Nicola Latronico
    • 4
  • David K. Menon
    • 5
  • Louis Puybasset
    • 6
  • Claudio Sandroni
    • 7
  • Robert D. Stevens
    • 10
  1. 1.Centre for Clinical Brain Sciences and NHS Lothian, Western General HospitalUniversity of EdinburghEdinburghUK
  2. 2.Anaesthesia and Intensive Care Medicine, CTOAzienda Ospedaliera Universitaria CareggiFlorenceItaly
  3. 3.Neuroanaesthesia and Neurointensive Care Unit, Anestesia e RianimazioneSan Gerardo Hospital, MonzaMilanItaly
  4. 4.University Division of Anesthesia and Intensive Care MedicineUniversity of BresciaBresciaItaly
  5. 5.Department of AnaesthesiaUniversity of CambridgeCambridgeUK
  6. 6.Neuro Intensive Care Unit, Department of Anesthesia and Intensive Care Pitié-Salpêtrière HospitalUniversity Pierre et Marie Curie, Paris VI, Assistance-Publique Hôpitaux de ParisParisFrance
  7. 7.Department of Anaesthesiology and Intensive CareCatholic University School of MedicineRomeItaly
  8. 8.Service de Réanimation Polyvalente Raymond Poincaré Teaching HospitalUniversity of Versailles, Assistance-Publique Hôpitaux de ParisGarchesFrance
  9. 9.Laboratoire d’Histopathologie et de Modèles Animaux Instiut PasteurParisFrance
  10. 10.Neurosciences Critical Care DivisionJohns Hopkins University School of MedicineBaltimoreUSA