Preface

This book is one born of practicality. Neurosurgeons and neurointensivists work closely together to tackle some of the most challenging cases in the hospital. But with the passion and dedication that characterize both specialties inevitably come debate. In our ICU at Brigham and Women’s Hospital, it is a common sight for us to be haggling over many clinical management issues, ranging from sodium goals to blood pressure management to DVT prophylaxis. Though much of our debates often focus on the specifics of the patient at hand, inevitably, we reach a common refrain, “Is there any evidence for that?”

This book is our attempt at an answer. Over time, we have come to realize that similar debates are likely erupting in NeuroICUs across the United States and the rest of the world. They tend to feature topics that are some of the hardest to deal with—those with either incomplete or inconsistent bodies of evidence where obvious answers elude us. It is exactly for those problems that we felt a book was the most appropriate answer. Currently, it is possible to have near-instant access to any number of systematic reviews and metanalyses on the Internet with the click of a button. However, it was only in a book where we could get world-leading experts to review, opine on, and synthesize the available data on many controversial management topics, stacked one right after the other.

In the following chapters, we have gathered the opinions of some of the most respected and well-published researchers and thought leaders from a wide range of fields, including not just neurosurgeons and neurointensivists, but also otolaryngologists, anesthesiologists, pharmacists, and orthopedic surgeons. In each chapter, we have asked them a nearly impossible question—typically one without any clear answers or consensus—and implored them to answer it (and succinctly no less!). We have been stunned by the quality of their responses. What shines through in their writing is both their command of a difficult body of evidence and the higher-level synthesis of that evidence, which is the marker of true expertise.

It has been our absolute pleasure to read and engage with our authors on these challenging subjects—and we hope you will too. By highlighting and structuring the key controversies in our field, we hope that our readers will be better prepared to resolve them. It is often said that in cutting-edge fields, research is obsolete from the time it is published. This could be said doubly so for a book seeking to review current evidence. But on that day, we would be proud to look back and see that this book helped make itself obsolete just a little bit faster.