Skip to main content Accessibility help
×
Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-20T16:32:35.580Z Has data issue: false hasContentIssue false

Chapter 36 - Building a Case for a Neurocritical Care Unit

Published online by Cambridge University Press:  24 July 2019

Michel T. Torbey
Affiliation:
Ohio State University
Get access

Summary

The birth of neurocritical care (NCC) can be traced to Harvey Cushing’s “anesthesia chart” and to Walter Dandy, who opened the first three-bed unit in the USA for postoperative neurosurgical patients at Johns Hopkins Hospital in Baltimore, Maryland [1]. Modern NCC is a new field that began in the early 1980s in a few isolated hospitals in the USA and Europe. This new area of expertise was needed to provide specialized care for patients with neurological and neurosurgical problems, which until that time was only offered in general intensive care units (ICUs) or in units of less acuity, such as stroke units. In fact, acute neurologic disorders were estimated to occur in 45% of medical ICU patients and neurologic complications to occur in 33% of patients admitted for non-neurological reasons [2]. Because enlightened neurosurgeons, neurologists, and general intensivists realized that a substantial number of ICU patients could be better served by specialists, Neuro-ICUs (NICUs) were gradually established throughout the USA and Europe during the 1990s, often directed and staffed by neurologists with special interest in internal medicine or anesthesiology. Then in 2002, the Neurocritical Care Society (NCS) was formed, with close to 200 members. In 2005, the United Council for Neurological Subspecialties (UCNS) recognized NCC as a new neurological subspecialty and a process was created to accredit US NCC programs and develop an NCC physician certification. In 2008, Leapfrog recognized neurointensivists (NIs) as part of the critical care pool of physicians – an important development since, except for UCNS certification, no American Board of Medical Specialties (ABMS) critical care certification path had existed for NIs. This boosted the subspecialty to new heights, and the NCS grew to over 2500 members (please visit www.neurocriticalcare.org/practitioners/physicians for more information).

Type
Chapter
Information
Neurocritical Care , pp. 421 - 429
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Lang, JM, Meixensberger, J, Unterberg, AW, Tecklenburg, A, Krauss, JK. (2011). Neurosurgical intensive care unit--essential for good outcomes in neurosurgery? Langenbecks Arch Surg, 396: 447451.Google Scholar
Isensee, LM, Weiner, LJ, Hart, RG. (1989). Neurologic disorders in a medical intensive care unit: a prospective survey. J Crit Care, 4: 208210.Google Scholar
Carlson, RW, Weiland, DE, Srivathsan, K. (1996). Does a full-time, 24-hour intensivist improve care and efficiency? Crit Care Clin, 12: 525551.Google Scholar
Angus, DC, Shorr, AF, White, A, et al. (2006). Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations. Crit Care Med, 34: 10161024.Google Scholar
Lilly, CM, Zuckerman, IH, Badawi, O, Riker, RR. (2011). Benchmark data from more than 240,000 adults that reflect the current practice of critical care in the United States. Chest, 140: 12321242.Google Scholar
Multz, AS, Chalfin, DB, Samson, IM, et al. (1998). A “closed” medical intensive care unit (MICU) improves resource utilization when compared with an “open” MICU. Am J Respir Crit Care Med, 157: 14681473.Google Scholar
Pronovost, PJ, Angus, DC, Dorman, T, et al. (2002). Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA, 288: 21512162.Google Scholar
Levy, MM, Rapoport, J, Lemeshow, S, et al. (2008). Association between critical care physician management and patient mortality in the intensive care unit. Ann Intern Med, 148: 801809.Google Scholar
Wilcox, ME, Chong, CA, Niven, DJ, et al. (2013). Do intensivist staffing patterns influence hospital mortality following ICU admission?: a systematic review and meta-analyses. Crit Care Med, 41: 22532274.Google Scholar
Kurtz, P, Fitts, V, Sumer, Z, et al. (2011). How does care differ for neurological patients admitted to a neurocritical care unit versus a general ICU? Neurocrit Care, 15: 477480.Google Scholar
Wallace, DJ, Angus, DC, Barnato, AE, Kramer, AA, Kahn, JM. (2012). Nighttime intensivist staffing and mortality among critically ill patients. N Engl J Med, 366: 20932101.Google Scholar
Varelas, PN, Conti, MM, Spanaki, MV, et al. (2004). The impact of a neurointensivist-led team on a semiclosed neurosciences intensive care unit. Crit Care Med, 32: 21912198.Google Scholar
Suarez, JI, Zaidat, OO, Suri, MF, et al. (2004). Length of stay and mortality in neurocritically ill patients: impact of a specialized neurocritical care team. Crit Care Med, 32: 23112317.Google Scholar
Broessner, G, Helbok, R, Lackner, P, et al. (2007). Survival and long-term functional outcome in 1,155 consecutive neurocritical care patients. Crit Care Med, 35: 20252030.Google Scholar
Lee, MT, Hu, P, Hsi, SC, et al. (2008). Mortality rates under the care of junior and senior surgery residents in a surgical intensive care unit/neurologic intensive care unit: a 5-year retrospective cohort study at Taoyuan Armed Forces General Hospital. J Crit Care, 23: 550555.Google Scholar
Varelas, PN, Hacein-Bey, L, Schultz, L, et al. (2009). Withdrawal of life support in critically ill neurosurgical patients and in-hospital death after discharge from the neurosurgical intensive care unit. J Neurosurg, 111: 396404.Google Scholar
Kramer, AH, Zygun, DA. (2013). Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years. Can J Anaesth, 60: 966975.Google Scholar
Jorgensen, HS, Nakayama, H, Raaschou, HO, et al. (1995). The effect of a stroke unit: reductions in mortality, discharge rate to nursing home, length of hospital stay, and cost: a community-based study. Stroke, 26: 11781182.Google Scholar
Rudd, AG, Hoffman, A, Irwin, P, Lowe, D, Pearson, MG. (2005). Stroke unit care and outcome: results from the 2001 National Sentinel Audit of Stroke (England, Wales, and Northern Ireland). Stroke, 36: 103106.Google Scholar
Alberts, MJ, Latchaw, RE, Selman, WR, et al. (2005). Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition. Stroke, 36: 15971616.Google Scholar
Hemphill, JC 3rd, Bleck, T, Carhuapoma, JR, et al. (2005). Is neurointensive care really optional for comprehensive stroke care? Stroke, 36: 23442345.Google Scholar
Gorelick, PB. (2013). Primary and comprehensive stroke centers: history, value and certification criteria. J Stroke, 15: 7889.Google Scholar
Diringer, MN, Edwards, DF. (2001). Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med, 29: 635640.Google Scholar
Mirski, MA, Chang, CW, Cowan, R. (2001). Impact of a neuroscience intensive care unit on neurosurgical patient outcomes and cost of care: evidence-based support for an intensivist-directed specialty ICU model of care. J Neurosurg Anesthesiol, 13: 8392.Google Scholar
Lerch, C, Yonekawa, Y, Muroi, C, Bjeljac, M, Keller, E. (2006). Specialized neurocritical care, severity grade, and outcome of patients with aneurysmal subarachnoid hemorrhage. Neurocrit Care, 5: 8592.Google Scholar
Varelas, PN, Schultz, L, Conti, M, et al. (2008). The impact of a neuro-intensivist on patients with stroke admitted to a neurosciences intensive care unit. Neurocrit Care, 9: 293299.Google Scholar
Bershad, EM, Feen, ES, Hernandez, OH, Suri, MF, Suarez, JI. (2008). Impact of a specialized neurointensive care team on outcomes of critically ill acute ischemic stroke patients. Neurocrit Care, 9: 287292.Google Scholar
Josephson, SA, Douglas, VC, Lawton, MT, et al. (2010). Improvement in intensive care unit outcomes in patients with subarachnoid hemorrhage after initiation of neurointensivist co-management. J Neurosurg, 112: 626630.Google Scholar
Ryttlefors, M, Howells, T, Ronne-Engstrom, E, Nilsson, P, Enblad, P. (2010). Neurointensive care is justified in elderly patients with severe subarachnoid hemorrhage: an outcome and secondary insults study. Acta Neurochir (Wien), 152: 241249; discussion 249.Google Scholar
Knopf, L, Staff, I, Gomes, J, McCullough, L. (2012). Impact of a neurointensivist on outcomes in critically ill stroke patients. Neurocrit Care, 16: 6371.Google Scholar
Warme, PE, Bergstrom, R, Persson, L. (1991). Neurosurgical intensive care improves outcome after severe head injury. Acta Neurochir (Wien), 110: 5764.Google Scholar
Elf, K, Nilsson, P, Enblad, P. (2002). Outcome after traumatic brain injury improved by an organized secondary insult program and standardized neurointensive care. Crit Care Med, 30: 21292134.Google Scholar
Ghajar, J, Hariri, RJ, Narayan, RK, et al. (1995). Survey of critical care management of comatose, head-injured patients in the United States. Crit Care Med, 23: 560567.Google Scholar
Patel, HC, Menon, DK, Tebbs, S, et al. (2002). Specialist neurocritical care and outcome from head injury. Intensive Care Med, 28: 547553.Google Scholar
Varelas, PN, Eastwood, D, Yun, HJ, et al. (2006). Impact of a neurointensivist on outcomes in patients with head trauma treated in a neurosciences intensive care unit. J Neurosurg, 104: 713719.Google Scholar
Varelas, PN, Corry, J, Rehman, M, et al. (2013). Management of status epilepticus in neurological versus medical intensive care unit: does it matter? Neurocrit Care, 19: 49.Google Scholar
Henderson, GV, Feske, SK. (2004). Analysis of brain death documentation. Neurocrit Care, 1: 262.Google Scholar
Wang, MY, Wallace, P, Gruen, JP. (2002). Brain death documentation: analysis and issues. Neurosurgery, 51: 731735; discussion 735–736.Google Scholar
Varelas, PN, Spanaki, MV, Hacein-Bey, L. (2005). Documentation in medical records improves after a neurointensivist’s appointment. Neurocrit Care, 3: 234236.Google Scholar
Halpern, NA, Pastores, SM, Greenstein, RJ. (2004). Critical care medicine in the United States 1985–2000: an analysis of bed numbers, use, and costs. Crit Care Med, 32: 12541259.Google Scholar
Halpern, NA, Pastores, SM. (2010). Critical care medicine in the United States 2000–2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med, 38: 6571.Google Scholar
Varelas, PN, Abdelhak, T, Wellwood, J, et al. (2010). The appointment of neurointensivists is financially beneficial to the employer. Neurocrit Care, 13: 228232.Google Scholar
Vespa, PM, Miller, C, Hu, X, et al. (2007). Intensive care unit robotic telepresence facilitates rapid physician response to unstable patients and decreased cost in neurointensive care. Surg Neurol, 67: 331337.Google Scholar
Kiphuth, IC, Kohrmann, M, Kuramatsu, JB, et al. (2010). Retrospective agreement and consent to neurocritical care is influenced by functional outcome. Crit Care, 14: R144.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×