The Early Days of the Neurosciences Intensive Care Unit

Wijdicks, Eelco F. M.; Worden, Wendy R.; Miers, Anne G.; Piepgras, David G.

doi:10.4065/mcp.2010.0815

Cited by 19 publications

(11 citation statements)

References 6 publications

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“…The shifting paradigms of medical care have been especially apparent in the setting of the NICU. What was once a small specialized unit that catered to severely ill, ventilated patients has evolved into a large, multi-specialty and multi-modal entity in which not only neurosurgeons, but also anesthesiologists, neurologists and critical care specialists are charged with caring for an increasingly complex patient population [3]. The development of the neurointensive case sub-specialty was largely driven by high rates of medical errors and inadequate care nationwide; in response, physicians in medicine, anesthesiology and critical care began working together to provide highly specialized neurocritical care in a collaborative setting [4].…”

Section: Discussionmentioning

confidence: 99%

Neurocritical Care Training for the Neurosurgery Resident

EKaloostian¹,

Kim²,

Yonas³

2013

OJMN

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Introduction: Recent data has associated favorable outcomes in patients who were treated in a “semi-closed” intensive care unit and attended to by a devoted team of neurointensivists as opposed to the neurosurgeons. This has led many to question the need for dedicated critical care education in the neurosurgical residency training program. Our aim was to determine what current neurosurgery residents and program directors/chairman thoughts were on NCC education in neurosurgical resident training, and to discuss possible methods to allow for collaboration between the NCC team and the neurosurgeons. Methods: Surveys were sent out electronically to all residency programs. Thirty-nine responses from junior residents, 36 responses from senior/chief residents, and eight responses from program directors/chairman were obtained. Results: No statistical difference between the majority responses of the different level residents, and between program directors/chairman and combined resident responses. Conclusions: Clearly, neurosurgery residents of all levels and program directors/chairman value NCC education and see a valuable role for this knowledge in their future. Most residents however do not want to spend an additional year of fellowship training to become certified neurointensivists. We discuss the role of NCC education in residency training and possible solutions to allow collaboration between the NCC team and the neurosurgical team.

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Section: Discussionmentioning

confidence: 99%

Neurocritical Care Training for the Neurosurgery Resident

EKaloostian¹,

Kim²,

Yonas³

2013

OJMN

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“…A neuroscience intensive care unit (NICU) is a dedicated special care ward for neurological patients who require specialized postoperative care. [24] The origins of the NICU are difficult to delineate, but the units were likely created as early as the 1950s for patients who had suffered severe traumatic brain injuries and needed close monitoring for effective recovery. [24]…”

Section: Methodsmentioning

confidence: 99%

Developments in hybrid operating room, neurointensive care unit, and ward composition and organization for stroke management

et al. 2019

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Stroke is the leading cause of adult disability in the US. Rapid diagnosis and treatment of stroke, in addition to efficacious rehabilitation, is invaluable. The present review aims to report the recent improvements in hybrid operating rooms (hybrid ORs), and in the organization of Neurological intensive care unit (NICUs) and dedicated stroke wards (SWs), which contribute to enhanced stroke treatment. A PubMed literature review was conducted in addition to the collection of other online media releases regarding recent organizational advances in stroke care. PubMed keywords included but were not limited to “neurological intensive care unit,” “hybrid operating room,” and “stroke ward,” while all other online information regarding recent advances in the physical organization was selected and synthesized in accord with its relevance. The current research indicates that hybrid ORs facilitate surgical innovation and improved patient care through the colocation of advanced imaging modalities and surgical capabilities. Moreover, the recent reorganization of NICUs and SWs may lead to better-quality initial treatment and rehabilitation. The present review also considers the current ER triage protocol for stroke patients, and it concludes with relevant considerations relating to the role of the physical hospital structure and organization in stroke care.

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“…Neurointensive care is an area of medicine that spans multiple fields and provides specialized care for critically ill patients with neurological illnesses [ 33 , 34 ]. Neurointensivists are clinical professionals who orchestrate personnel including neurologists, neurosurgeons, consultants, therapists, pharmacists, nurses, and administrators in neurosciences intensive care units (NSICUs).…”

Section: Adaptive Immunity (Fig 3 )mentioning

confidence: 99%

Immunosenescence in neurocritical care

2018

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BackgroundSeveral advanced and developing countries are now entering a superaged society, in which the percentage of elderly people exceeds 20% of the total population. In such an aging society, the number of age-related diseases such as malignant tumors, diabetes, and severe infections including sepsis is increasing, and patients with such disorders often find themselves in the ICU.Main bodyAge-related diseases are closely related to age-induced immune dysfunction, by which reductions in the efficiency and specificity of the immune system are collectively termed “immunosenescence.” The most noticeable is a decline in the antigen-specific acquired immune response. The exhaustion of T cells in elderly sepsis is related to an increase in nosocomial infections after septicemia, and even death over subacute periods. Another characteristic is that senescent cells that accumulate in body tissues over time cause chronic inflammation through the secretion of proinflammatory cytokines, termed senescence-associated secretory phenotype. Chronic inflammation associated with aging has been called “inflammaging,” and similar age-related diseases are becoming an urgent social problem.ConclusionIn neuro ICUs, several neuro-related diseases including stroke and sepsis-associated encephalopathy are related to immunosenescence and neuroinflammation in the elderly. Several advanced countries with superaged societies face the new challenge of improving the long-term prognosis of neurocritical patients.

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The Early Days of the Neurosciences Intensive Care Unit

Cited by 19 publications

References 6 publications

Neurocritical Care Training for the Neurosurgery Resident

Neurocritical Care Training for the Neurosurgery Resident

Developments in hybrid operating room, neurointensive care unit, and ward composition and organization for stroke management

Immunosenescence in neurocritical care

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