Neuroimaging and neuromonitoring access in Mexico, where to focus?

Abstract

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.

Keywords: Intensive care in Mexico; Neurocritical care; Neurocritical care in low- and middle-income countries; Neuromonitoring; Neurosurgery.