Advances in Neurocritical Care

Neurocritical care unit (NCU) patients are individuals suffering from primary or secondary neurological diseases who also have existing or potential organ dysfunction, requiring intensive medical monitoring and treatment. The key disease types include intracerebral hemorrhage (ICH), cerebral infarction, traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), and patients after cardiac arrest (CA).

Advances in neuromonitoring and intensive care have improved the early recognition and management of these conditions; however, patients with neurocritical illness often present with rapidly evolving and complex pathophysiology, leading to persistently high rates of mortality and disability. Continuous monitoring of electroencephalography, intracranial pressure, and brain tissue oxygen has enabled real-time assessment of cerebral hemodynamics and neural activity. Meanwhile, treatment approaches such as reperfusion therapy for acute ischemic stroke, targeted temperature management for post-CA brain protection, and immunomodulatory or neuroprotective interventions under experimental and clinical investigation are continuously evolving. Moreover, the integration of big data analytics, artificial intelligence, and precision medicine into neurocritical care offers new opportunities for individualized management. By linking multimodal monitoring data with clinical outcomes, researchers aim to identify high-risk populations, predict disease trajectories, and refine personalized interventions. Nevertheless, despite these advances, outcomes for neurocritical patients remain suboptimal, highlighting unresolved challenges related to the complexity of disease mechanisms, secondary brain injury, and therapeutic limitations.

This research topic aims to provide the most recent update of the basic science theory, advanced management protocol, and evolving practices within neurocritical care. The objective is to foster best practices for treatment in NCU and advance both experimental and clinical investigation in the discipline. By expanding knowledge and refining personalized interventions, the research aims to overcome prevailing challenges and improve patient outcomes. We welcome submissions of original research articles, reviews, mini-reviews, comments, etc.

Potential themes include but are not limited to the following:
1. Neurocritical Care Management: From Perioperative to Comprehensive Care
 Perioperative Neurocritical Care Management: Focusing on the precise regulation of hemodynamics, cerebral blood flow, and intracranial pressure (ICP) before and after neurosurgical procedures (e.g., aneurysm clipping, hematoma evacuation).
 Mechanical Ventilation Strategies and Neuroprotection: Exploring the impact of various ventilation modes (e.g., PEEP settings, tidal volume control) on ICP and cerebral oxygenation.
 Pain, Agitation, and Delirium (PAD) Management: Delving into specific PAD assessment tools for neurocritical patients (e.g., RASS, CAM-ICU) and appropriate pharmacological choices.
 The Art of Balancing Antithrombotic and Hemostatic Therapy: Addressing the challenging balance between recanalization (e.g., thrombolysis, thrombectomy) and the risk of hemorrhage in conditions like SAH or large ischemic strokes.
 Targeted Temperature Management (TTM): Discussing the latest evidence for TTM, including hypothermia for hypoxic-ischemic encephalopathy and controlled temperature management for elevated ICP in hemorrhagic stroke.

2. Neural Injury Mechanisms and New Therapeutic Targets
 The "Reperfusion Paradox" in Brain Injury: Deepening the understanding of the mechanisms behind "futile recanalization," where patients experience poor outcomes despite successful vascular reperfusion.
 Secondary Injury Mechanisms in Hemorrhagic Stroke: Focusing on post-ICH or aSAH events, including neuroinflammation, blood-brain barrier breakdown, and iron toxicity.
 Neuroimmunology and Inflammation: Exploring the activation states of microglia (M1/M2) and the involvement of astrocytes and T-lymphocytes in secondary brain injury.

3. Multimodal Monitoring and Advanced Technology
 Application of Multimodal Monitoring: Highlighting the integration of data from various monitoring modalities, such as ICP, brain tissue oxygen pressure (PtiO2), and cerebral microdialysis, to guide treatment decisions.
 Development and Application of Predictive Models: Using big data, machine learning, and artificial intelligence to build prognostic models for neurocritical patients.

4. Brain Injury in Systemic Diseases
 Sepsis-Associated Encephalopathy (SAE): Exploring the mechanisms behind SAE, with a focus on how inflammatory cytokines cross the blood-brain barrier and the role of mitochondrial dysfunction.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Editorial
• FAIR² Data
• FAIR² DATA Direct Submission
• General Commentary
• Hypothesis and Theory
• Methods
• ... View all formats

Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.

Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Editorial
• FAIR² Data
• FAIR² DATA Direct Submission
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Policy and Practice Reviews
• Review
• Study Protocol
• Systematic Review

Keywords: Neurocritical care，Neuroprotection，Neuroimmunology and Inflammation，Reperfusion Injury，Multimodal Monitoring

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.