I provide comprehensive care to patients in the neurological intensive care unit (NICU) who have sustained serious neurological injuries. These include stroke, intracranial hemorrhage, traumatic brain injury (TBI), prolonged seizures, infection, severe neuromuscular disease or spinal cord injury. I focus on ensuring optimal function of my patients’ supporting organs such as the heart, lungs and kidneys. By doing so, I mitigate my patients’ potential for secondary injuries and facilitate their neurological recovery.
I collaborate with a multidisciplinary critical care team that includes medical residents and fellows, advanced practice providers such as nurse practitioners and physician assistants, clinical pharmacists, physical and occupational therapists, social workers and case managers. As part of a team, I address the medical and neurological needs of my patients using evidence-based care protocols. I assess and care for my patients’ pain and comfort needs daily. I also plan for their medical care needs after their hospital stay, with attention to their post-hospital setting, e.g., their home or a rehabilitation facility.
I have broad research interests that complement the spectrum of patients I care for in the NICU. My research includes characterizing the molecular substrates for energy production in neurons and glial cells, and determining how those substrates may promote functional recovery after neurological injury. Clinically, my research is aimed at investigating how to feed, and what to feed, patients who sustain significant neurological injury, in order to increase the odds of a good functional outcome. (ICU nutrition has been shown to affect patient outcomes, and though it may be the safest among all the ICU interventions we undertake, it may be the most underutilized.)
My other research interests include TBI, the neurological impact of sepsis and the clinical outcomes of intracerebral and intraventricular hemorrhage.
I am also an educator. Education is a key component of my practice in the NICU, where I focus on daily bedside teaching. I teach trainees how to diagnose and care for patients who present with the syndromes listed above. I also teach the fundamental principles of neurocritical care, such as maintaining cerebral blood flow, and how to diagnose and manage intracranial hypertension and hydrocephalus. I teach using advanced neurosurgical and radiographic approaches and other neurodiagnositic techniques. Trainees also learn from me how to undertake invasive procedures that are commonly performed in the critical care setting. During daily rounds, I review and discuss with trainees essential doctrines of general critical care medicine, with a clear focus on evidence-based practice.