Current trends in neurosurgical critical care medicine

We conducted a survey of neurosurgeons to discover how they manage specific problems commonly seen in critically ill neurosurgery patients and compared the responses with relevant investigations published in the neurosurgical literature over the past 10 years. The 101 Chiefs of Neurosurgery of every North American academic training program were sent copies of two consecutive surveys for distribution to their attending staff. Among the topics covered were indications for steroid administration, prophylaxis of gastrointestinal bleeding, indications for insertion of ICP monitoring devices and use of prophylactic antibiotics while they are in place, and fluid restriction in patients with cerebral edema. Replies were strictly anonymous. A Medline Computer search for the period 1976-1989 was carried out for each topic. We received 136 and 67 replies each to our two surveys. Over 90 clinical and laboratory studies published in major medical journals, many randomized and prospective, were reviewed. Two trends were evident: (a) a noticeable lack of uniformity among neurosurgeons with respect to management of the same problem; (b) little or no basis of support in the literature for many management practices. Based on these studies and the responses to our survey, we suggest an examination of current clinical practices.