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Delivering neurocritical care in resource-challenged environments

Shrestha, Gentle S.; Goffi, Alberto; Aryal, Diptesh

Current Opinion in Critical Care: April 2016 - Volume 22 - Issue 2 - p 100–105
doi: 10.1097/MCC.0000000000000285
NEUROSCIENCE: Edited by J. Claude Hemphill

Purpose of review Resource-challenged environments of low and middle-income countries face a significant burden of neurocritical illness. This review attempts to elaborate on the multiple barriers to delivering neurocritical care in these settings and the possible solutions to overcome such barriers.

Recent findings Epidemiology of neurocritical illness appears to have changed over time in low and middle-income countries. In addition to neuro-infection, noncommunicable neurological illnesses like stroke, traumatic brain injury, and traumatic spinal cord injury pose a significant neurocritical burden in resource-limited settings. Many barriers that exist hinder effective delivery of neurocritical care in resource-challenged environments. Very little information exists about the neurocritical care capacity. Research and publications are few. Intensive care unit beds and trained personnel are significantly lacking. Awareness about the risk factors of preventable conditions, including stroke, is lacking. Prehospital care and trauma systems are poorly developed. There should be attempts to leverage neurocritical care in these settings with focus on promoting research, local training, capacity building, preventive measures like vaccination, raising awareness, and developing prehospital care.

Summary Considering the disease burden and potentials to improve outcome, attempts should be made to develop neurocritical care in resource-challenged environments.

Video abstract

aDepartment of Anesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal

bInterdepartmental Division of Critical Care Medicine

cDepartment of Medicine, University of Toronto

dDepartment of Medicine, Division of Respirology (Critical Care), University Health Network, Toronto, Canada

Correspondence to Gentle S. Shrestha, MD, FACC, EDIC, FCCP, Department of Anesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal. Tel: +977 9841248584; e-mail:

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