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Introduction <p>Neuromonitoring plays an integral part of neurocritical care decision making in patients with acute brain injury, as it facilitates detection of physiological changes with the goal to mitigate further neurological deterioration and prevent secondary brain injury. There are increasing efforts being made to understand how the care of neurocritical patients is delivered globally, but there is little information about the use of neuroimaging and neuromonitoring in Lower Middle-Income Country. We aimed to investigate the availability of different neuromonitoring tools in intensive care units in Mexico.</p> Methods <p>This was a prospective observational survey focused on gathering current neuroimaging and neuromonitoring practices in Mexico. We used a web-based survey using Google Forms (©2024 Google) to query practicing intensive care physicians in all states in Mexico. The questionnaire consisted of two sections with 27 questions.</p> Results <p>A total of 66 responses were included in the final analysis, that represent 65% of the states in Mexico (21 out of 32 states). Most ICUs reported not having access to a neurointensivist (79%, 52/66). Computed Tomography (CT) was available around the clock in 97% of ICUs (64/66), while CT angiography (CTA) was available 24/7 in 20% of ICUs (13/66) with only daytime availability in 35% (23/66) of ICUs. The most available invasive monitor in Mexico was the jugular bulb oximetry, which was available in 62% of ICUs (41/66). One third of ICUs (34%, 29/66) reported the use of invasive ICP monitoring. Of those, ventriculostomy was the most commonly use type of catheter, followed by the intraparenchymal ICP monitor, epidural and subdural ICP monitors. Brain tissue oxygen monitor (pbtO<sub>2)</sub> was only available in less than third of ICUs, 14% (5/66). Only 62% percent (41/66) of hospitals had 24/7&#xa0;access to a neurosurgeon.</p> Conclusion <p>The availability of neuroimaging and neuromonitoring is limited in ICUs in Mexico, despite a sizeable proportion of neurocritical care patients. This may be in part driven by resources constraints, as well as lack of neurocritical care and neurosurgical access in many centers. There is an unmet need for recruiting and training in neurocritical care and neurosurgery.</p>

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Neuroimaging and neuromonitoring access in Mexico, where to focus?

  • 期刊论文

  • 发表日期：

    2025年5月6日

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  • Julio C. Mijangos-Méndez,
  • Lucia Rivera-Lara,
  • Teresa Mejia-Martínez,
  • Jose J. Elizalde-González,
  • Guadalupe Aguirre-Avalos,
  • Aarti Sarwal,
  • Aarti Sarwal,
  • Abad Quetzalcoatl Ortega-Pérez,
  • Adrián Velázquez-Jáuregui,
  • Alberto Valles Guerrero,
  • Alejandro González Mora,
  • Alejandro Rios Ramírez,
  • Ana Alicia Velarde Pineda,
  • Antonio Hernández Bastida,
  • Arturo Guardado Rosales,
  • Blanca Esthela Granado Mata,
  • Brenda Dolores Díaz Romero,
  • Carlos Alberto Gutierrez Martinez,
  • Carlos Larios Luna,
  • Carlos Olan Uscanga,
  • Carmen Patricia García Hernández,
  • Consuelo Jiménez Ramos,
  • Damián Gutiérrez-Zárate,
  • Eduardo Abelardo Revilla Rodriguez,
  • Eliseo Varela Martínez,
  • Emmanuel Mejía Aragon,
  • Fabricio Ortiz Larios,
  • Felipe De Jesús Montelongo,
  • Francisco Javier Chavez Muro,
  • Francisco Pérez Fabela,
  • Gilberto De Jesús Cituk Cutz,
  • Paul Alejandro Cerda García,
  • Gladys Eugenia García Gamez,
  • Hector Alfonso Barragan Mar,
  • Javier Ruíz Perez,
  • Jesus Ernesto Salazar Garcia,
  • Jocelyn Cruz Perez,
  • Jorge Luis Patiño Flores,
  • Jorge Rodríguez Hinojosa,
  • Jose Alejandro Saucedo Valentín,
  • Jose Antonio Luviano Garcia,
  • Jose Carlos Gasca Aldama,
  • José De Jesús Gutierrez Marfileño,
  • José Francisco López Baca,
  • José Iván Rodríguez De Molina Serrano,
  • Julia Teresa Rochín Parra,
  • Julio César Felipe Contreras Corral,
  • Karina Ortíz Martínez,
  • Luis Alejandro Sánchez Hurtado,
  • Luis Fernando Nuñez Espinoza,
  • Manuel José Rivera Chavez,
  • María Josefina Castro Martinez,
  • Martha Susana Pérez-Cornejo,
  • Michell Estrella Montalvo Aguilar,
  • Miguel Angel Ibarra-Estrada,
  • Miguel Felipe Castillo Hernandez,
  • Missael Vladimir Espinoza Villafuerte,
  • Nelson García Alvarez,
  • Oswaldo Samuel Hernández Herrera,
  • Yareny María Peña Mercado,
  • Pável Eledin Aguilera González,
  • Ricardo Guzman-Rojas,
  • Rosa Elena Zamudio Jaramillo,
  • Sergio Moreno García,
  • Sergio Reyes Inurrigarro,
  • Sofía Jiménez Lomas,
  • Sophia Selene Torres Valdez,
  • Tania Torija Ortega,
  • Ulises Wilfrido Cerón Díaz,
  • Victor Hugo Cervantes López,
  • Iris X. Ortiz-Macias,
  • Adriana B. Castañeda Marquez,
  • Jennifer Gómez Aguilera

摘要

Introduction

Neuromonitoring plays an integral part of neurocritical care decision making in patients with acute brain injury, as it facilitates detection of physiological changes with the goal to mitigate further neurological deterioration and prevent secondary brain injury. There are increasing efforts being made to understand how the care of neurocritical patients is delivered globally, but there is little information about the use of neuroimaging and neuromonitoring in Lower Middle-Income Country. We aimed to investigate the availability of different neuromonitoring tools in intensive care units in Mexico.

Methods

This was a prospective observational survey focused on gathering current neuroimaging and neuromonitoring practices in Mexico. We used a web-based survey using Google Forms (©2024 Google) to query practicing intensive care physicians in all states in Mexico. The questionnaire consisted of two sections with 27 questions.

Results

A total of 66 responses were included in the final analysis, that represent 65% of the states in Mexico (21 out of 32 states). Most ICUs reported not having access to a neurointensivist (79%, 52/66). Computed Tomography (CT) was available around the clock in 97% of ICUs (64/66), while CT angiography (CTA) was available 24/7 in 20% of ICUs (13/66) with only daytime availability in 35% (23/66) of ICUs. The most available invasive monitor in Mexico was the jugular bulb oximetry, which was available in 62% of ICUs (41/66). One third of ICUs (34%, 29/66) reported the use of invasive ICP monitoring. Of those, ventriculostomy was the most commonly use type of catheter, followed by the intraparenchymal ICP monitor, epidural and subdural ICP monitors. Brain tissue oxygen monitor (pbtO2) was only available in less than third of ICUs, 14% (5/66). Only 62% percent (41/66) of hospitals had 24/7 access to a neurosurgeon.

Conclusion

The availability of neuroimaging and neuromonitoring is limited in ICUs in Mexico, despite a sizeable proportion of neurocritical care patients. This may be in part driven by resources constraints, as well as lack of neurocritical care and neurosurgical access in many centers. There is an unmet need for recruiting and training in neurocritical care and neurosurgery.