Neurology

Peter O’Donnell Jr. Brain Institute

Neurocritical Care

The Neurocritical Care section is focused on the management of critically ill patients with neurological diseases who require admission to an intensive care unit (ICU). We provide comprehensive care to patients with a variety of life-threatening neurological and neurosurgical disorders including:

  • Traumatic brain injury (TBI)
  • Spinal cord injury (SCI)
  • Intracerebral hemorrhage (ICH)
  • Subarachnoid hemorrhage (SAH)
  • Large hemispheric stroke (LHI)
  • Status epilepticus (SE)
  • Autoimmune encephalitis
  • Myasthenic crisis
  • Guillain-Barre syndrome

We provide post-operative care to patients who have undergone complex neurosurgical procedures. Lastly, we also provide consultative services to help our colleagues in the Medical, Surgical, Cardiac, Cardiothoracic, and Transplant and Burn ICUs care for their patients with neurological complications.

Clinical 

The Neurocritical Care section provides care for patients in three ICUs across Dallas-Fort Worth.

We have a 24-bed, state-of-the-art Neurosciences ICU at the William P. Clements Jr. University Hospital. This ICU was inaugurated in January 2021 and is equipped with the latest technology. Every ICU room has the capability for continuous video-electroencephalographic (video-EEG) monitoring and allows videoconferencing with patients and their families and care providers. The ICU houses two large conference rooms as well as a family consultation room. A CT scanner, magnetic resonance imaging (MRI) scanner, and angiography suites are located next to the ICU. The neurosurgical operating rooms and the post-operative care units are also in close proximity.

A 12-bed Neuro-ICU is located at Parkland Hospital, a Level 1 trauma center which serves as Dallas County’s public hospital. This ICU provides special expertise for the care of patients with TBI, including the ability to monitor brain oxygen, temperature, and intracranial pressure.

Our third ICU is a 12-bed Neuro-ICU at Texas Health Presbyterian Hospital in Dallas that was inaugurated in 2020. 

Research 

The Neurocritical Care division is involved in multiple clinical research efforts and has participated in several clinical trials. We have received funding from:

  • World Federation of Neurology
  • National Institutes of Health (NIH)
  • Department of Defense
  • Patient-Centered Outcomes Research Institute (PCORI)
  • Agnes Marshall Walker Foundation
  • Helene Fuld Health Trust
  • American Academy of Neurology
  • Lone Star Stroke Research Consortium
  • Texas Organization of Nurse Executives
  • Academy of Medical-Surgical Nurses
  • Sigma Theta Tau
  • The Daisy Foundation

Our faculty have published in high-impact journals, such as JAMA, Stroke, JAMA Neurology, Neurology, Journal of Stroke and Cerebrovascular Diseases and Neurocritical Care.

Neurocritical Care Research Page

Education 

The Neurocritical Care section is invested in the education of medical students, residents, and fellows. We host residents from the departments of Neurology, Neurosurgery, Anesthesiology, Emergency Medicine, and Physical Medicine and Rehabilitation. We accept up to three fellows each year for a two-year fellowship training program in Neurocritical Care and participate in the training of fellows from Pulmonary and Critical Care Medicine, Surgical Critical Care, Interventional Neuroradiology, and Vascular Neurology. Nursing education is one of our priorities, and we host a monthly virtual lecture series for nurses within and outside the UTSW community.

Conditions Treated

The Neurocritical Care section provides high-quality, compassionate, state-of-the-art, multidisciplinary comprehensive care to our patients and their families. We provide care to patients admitted through our emergency rooms as well as those referred to us by other hospitals throughout the North Texas region. Common conditions treated by us include:  

  • Traumatic brain injury (TBI)
  • Spinal cord injury (SCI)
  • Intracerebral hemorrhage (ICH)
  • Subarachnoid hemorrhage (SAH)
  • Large hemispheric strokes (LHI)
  • Status epilepticus (SE)
  • Meningoencephalitis
  • Autoimmune encephalitis
  • Myasthenic crisis
  • Guillain-Barre syndrome 

Primary Services

The Neurocritical Care section offers a variety of diagnostic and therapeutic services, including:

  • Continuous quantitative video-EEG
  • Intracranial pressure monitoring
  • Pupillometry
  • Brain-tissue oxygen monitoring
  • Point-of-care ultrasound
  • Transcranial ultrasound Doppler evaluation of the cerebral blood vessels

The proximity to the MRI and CT scanners and the cerebral angiography suite allows rapid and efficient diagnosis and treatment of neurological emergencies.

Collaborative Services

We work closely with the Neurosurgery and Vascular Neurology teams to provide collaborative care for our patients. Our multidisciplinary team includes physicians, nurses, respiratory therapists, pharmacists, dietitians, speech and language pathologists, occupational therapists, physical therapists, and social workers. We believe in a patient- and family-centered model of care, and family members are encouraged to participate in our multidisciplinary rounds.

Section Head 

Venkatesh Aiyagari, M.D.

Providers and Researchers

Physicians:

Researchers:

Advanced Practice Providers:

Research Programs

Neuroscience Nursing Research Center (NNRC)

The NNRC provides guidance to nurses and those interested in nursing research. Faculty and staff work closely with nurses by providing guidance on idea formulation, protocol development, IRB assistance, funding opportunities, coordination of protocol, statistical support, and publication.  The center supports an annual nursing fellowship whereby nurses are mentored through the principal investigator and publication process. Additionally, the center supports several internship programs, including a one-year experience for nursing students to engage in nursing research as well as several summer internship experiences for students who are interested in the medical field.

NNRC webpage

Pupillometry Research Database

The Neurocritical Care section is engaged in research exploring the utility of hand-held pupillometry in critical care. In 2015, we started an “Establishing Normative Data for Pupillometer Assessments in Neuroscience Intensive Care (END-PANIC)” registry of prospectively collected pupillometer readings from patients admitted to Neurocritical Care units with a variety of conditions. This ongoing registry houses data from more than 5,000 subjects admitted to four hospitals in the U.S. (three university and one community hospital) and one hospital in Japan. Exploratory analysis of this database has led to more than 20 publications in the last five years.

Specific Areas of Research

Traumatic Brain Injury

We are engaged in clinical and translational research on Traumatic Brain Injury (TBI) and cerebral concussion. Stephen Figueroa, M.D., is the site PI for the BOOST III study, which is a phase 3, NIH-sponsored multicenter trial assessing the utility of brain oxygenation monitoring in addition to intracranial pressure monitoring to improve outcomes for patients with severe TBI. Our section also participates in the ICU consortium for the TRACK TBI Trial. DaiWai Olson, Ph.D., RN, and Venkatesh Aiyagari, M.D., are studying the utility of pupillometry as a triage tool in TBI and have partnered with Children’s Health in Dallas to study pupillary changes in children with head injuries.

Ischemic Stroke

Christiana Hall, M.D., studies the effect of blood sugar control on patients with an acute ischemic stroke (AIS). She was a co-Principal Investigator of the SHINE trial that demonstrated that early intensive blood sugar control does not improve outcomes in AIS. Dr. Aiyagari is studying the role of pupillometry in assessing midline shift in patients with large hemispheric infarction (LHI). Bappaditya Ray, M.D., studies brain imaging characteristics to predict clinical outcome after mechanical thrombectomy.

Hemorrhagic Stroke

Dr. Ray is the site PI of the NIH-funded ASPIRE study of apixaban vs. aspirin in patients with atrial fibrillation and intracerebral hemorrhage. He also studies the role of biomarkers to risk-stratify patients with aneurysmal subarachnoid hemorrhage (SAH) and predicts clinical outcomes. 

Ethics

Michael Rubin, M.D., studies mechanisms by which medical futility disputes are resolved. He is also researching staff support systems related to the impact of COVID-19 and is involved in multiple projects related to neurologic determination of death. Dr. Rubin is a co-author of the “Brain Death Determination Course” online training module sponsored by the Neurocritical Care Society.

Neuroprognostication

Kartavya Sharma, M.D., conducts research that investigates electroencephalographic markers of neuronal integrity and connectivity, optimizes use of existing biomarkers, such as neuron-specific enolase, and explores the use of new biomarkers, like neurofilament light chain, in accurately predicting long-term outcome after severe brain injury.

Respiratory Failure

David McDonagh, M.D., is the site PI for the multicenter RESCUE III Lungpacer trial. The Lungpacer is a transvenous phrenic nerve stimulator used to improve diaphragmatic function in patients on mechanical ventilation. Other active areas of research encompass various aspects of Neuro-ICU care, such as blood pressure monitoring, nurse-directed multidisciplinary rounds, and quantitative EEG in neurocritical care.

Education Research

Ranier Reyes, M.D., studies the utility of high-fidelity simulation in neurocritical care education, including brain-death determination and the assessment and management of neurological emergencies.

UT Southwestern Simulation Center

Neurocritical Care Fellowships

Clinical Trials