Neurological examination of critically ill patients: a pragmatic approach. Report of an ESICM expert panel

Abstract Objective: Many patients admitted to the intensive care unit (ICU) have pre-existing or acquired neurological disorders which significantly affect their short- term and long-term outcomes. The ESICM NeuroIntensive Care Section convened an expert panel to establish a pragmatic approach to neurological examination (NE) of the critically ill patient. Methods: The group con- ducted a comprehensive review of published studies on the NE of patients with coma, delirium, seizures and neuromuscular weakness in crit- ically ill patients. Quality of data was rated as high, moderate, low, or very low, and final recommendations as strong, weak, or best practice. Sum- mary and Conclusions: The group made the following recommenda- tions: (1) NE should be performed in all patients admitted to ICUs; (2) NE should include an assessment of consciousness and cognition, brain- stem function, and motor function; (3) sedation should be managed to maximize the clinical detection of neurological dysfunction, except in patients with reduced intracranial compliance in whom withdrawal of sedation may be deleterious; (4) the need for additional tests, including neurophysiological and neuroradio- logical investigations, should be guided by the NE; (5) selected fea- tures of the NE have prognostic value which should be considered in well- defined patient populations.