Transcutaneous Auricular Vagus Enhanced Recovery in the NeuroICU

Inclusion Criteria:

* Age ≥18
* Admission to the NeuroICU within 36 hours of onset of an acute medical condition.
* Patient or authorized legal representative should be able to provide consent within 36 hours of ICU arrival
* Presence of at least one predictor of critical illness and/or severe brain / spinal cord injury:

  * Glasgow Coma Scale GCS \>3 \& \<= 12 at admission
  * NIH stroke scale of 6 or greater
  * Requirement for ongoing mechanical ventilation
  * Requirement for ongoing vasopressor support
  * Diagnosis of subarachnoid hemorrhage
  * Diagnosis of intracerebral hemorrhage with hematoma volume \> 5 ml
  * Diagnosis of moderate-severe traumatic brain injury (GCS \>3 \& \<= 12)
  * Refractory Status epilepticus requiring continuous sedative infusions

Exclusion Criteria:

* Systemic immunosuppression
* Receiving ongoing cancer therapy
* Implanted electrical device (e.g., pacemaker, stimulator)
* Bradycardia on admission (Sustained bradycardia on arrival with a heart rate \< 50 bpm for \>5 minutes)
* Risk of imminent death or limitation of care (e.g., Glasgow Coma Scale of 3, pupillary dilatation)
* Expected ICU stay of less than 72 hours, as determined by attending physician or ICU fellow
* Pregnancy
* COVID-19