Improving the State of Use and Understanding of Multistate Models in Critical Care*

Critical Care Medicine www.ccmjournal.org 1191 such as imaging and other readily available data, may be captured right now. The diverse range of stroke patient pathophysiology encountered in the ICU may be used to understand how our early ICU decisions impact subsequent morbidity of stroke survivors, months and years later. Expertise is needed to navigate wide arrays of data, discerning potentially complex relationships between variables. For example, initial investigations have taught us that obvious variables and potential physiologic targets such as temperature, blood pressure, or serum glucose where acute aberrations such as fever, hypertension, or hyperglycemia are poor prognostic factors, deliberate interventions to correct such abnormalities may not necessarily directly result in improved outcomes. Although concrete answers to many such fundamental questions remain unknown, more work like the study of van Valburg et al (1) is sorely needed to realize precision medicine of stroke and the impact of neurocritical care. REFERENCES 1. van Valburg MK, Arbous MS, Georgieva M, et al: Clinical Predictors of Survival and Functional Outcome of Stroke Patients Admitted to Critical Care. Crit Care Med 2018; 46:1085–1092 2. Liebeskind DS, Albers GW, Crawford K, et al: Imaging in strokenet: Realizing the potential of big data. Stroke 2015; 46:2000–2006 3. Liebeskind DS: Innovative interventional and imaging registries: Precision medicine in cerebrovascular disorders. Interv Neurol 2015; 4:5–17 4. Liebeskind DS: Mapping the collaterome for precision cerebrovascular health: Theranostics in the continuum of stroke and dementia. J Cereb Blood Flow Metab 2017 Jan 1. [Epub ahead of print] 5. Liebeskind DS, Feldmann E: Imaging of cerebrovascular disorders: Precision medicine and the collaterome. Ann N Y Acad Sci 2016; 1366:40–48 6. Powers WJ, Rabinstein AA, Ackerson T, et al; American Heart Association Stroke Council: 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49:e46–e110