Teleneurointensive Care Unit (TeleneuroICU): Expanding the Reach of Subspecialty NeuroICU Care

Abstract

Teleneurointensive care unit (“TeleneuroICU”) evaluation entails audiovisual (AV) remote assessment of neurocritical care patients or intensive care unit (ICU) patients with neurological issues warranting a neurological consultation. Inherent to the TeleneuroICU examination is a review of vital signs, clinical findings such as level of consciousness, pupillary size and reactivity, extraocular movements, motor function, neurological deficits, and basic sensory functions. The neurologic examination for TeleneuroICU, however, must be adapted to the current limitations of the technology. Compared to telestroke for tissue plasminogen activator (tPA) considerations and use of the National Institutes of Health (NIH) Stroke Scale, TeleneuroICU examinations are more difficult than a bedside neurological examination because the neurologist cannot directly examine the patient. Common causes for TeleneuroICU consultations include coma, stroke, seizure, neurological prognostication after cardiac arrest or traumatic brain injury, weakness, and abnormal movements in ICU patients. To perform TeleneuroICU consultations effectively, a bedside nurse is often used to complete additional parts of the neurological examination, and to review “paraclinical” data essential for adequate assessment, such as neuroimaging and laboratory studies, vital signs, and electroencephalography (EEG) data. The ability of the hub teleneurointensivist to function in critical care settings depends upon the quality and reliability of the video and robotic equipment at the spoke, and upon the technical and communications skills of the assistants and nursing personnel at the spoke. Robotic AV equipment suitable for the assessment of total neurologic function is under constant development. Due to the growing shortage of neurointensivists and neurologists to evaluate ICU patients, we predict an increasing demand for TeleneuroICU consultations.