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  • Chapter 18 - Prognostication in Palliative Care and Neurocritical Care

  • from Part II - Other Topics in Neuroprognostication
  • Edited by David M. Greer, Boston University School of Medicine and Boston Medical Center, Neha S. Dangayach, Icahn School of Medicine at Mount Sinai and Mount Sinai Health System
  • Book:
    Neuroprognostication in Critical Care
    Published online:
    14 November 2024
    Print publication:
    21 November 2024, pp 261-272

  • Summary

    Neuroprognostication, the focus of this book, is crucial toward the management of the highly complex patient in the neurological intensive care unit (Neuro ICU). It is of primary importance to understand the nature of the disease and the potential for recovery. Informed prognostication by neurologically trained physicians has been hypothesized to be a significant reason for the improved outcomes of neurological patients managed in a Neuro ICU versus general medical ICUs.[1]

    Decisions surrounding withdrawal of life-sustaining therapies (WLST) are highly dependent on prognosis. In a retrospective study of Neuro ICU patients who were terminally extubated, family members surveyed most frequently cited quality of life, prognosis, and the patient’s previously known wishes as “very important” in their decision to remove life-sustaining therapy.[2]

    Evidence-based prognostication in the Neuro ICU is difficult, and may be biased by the effect of WLST on patient mortality.