Neurointensive care

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Neurocritical care or neurointensive care is a branch of medicine with the goal to treat life-threatening diseases of the nervous system and identify, prevent and treat secondary brain injury.

Neurocritical care
Iron Lung ward-Rancho Los Amigos Hospital
Children’s ward at Rancho Los Amigos Hospital in 1954, showing more than 100 persons being helped to breathe by the Iron lung.
System Nervous system
Significant diseases stroke, seizure, epilepsy, aneurysms, Traumatic brain injury, spinal cord injury, status epilepticus, Cerebral edema, encephalitis, meningitis, brain tumor, respiratory failure
Significant tests Computed axial tomography, MRI scan, Lumbar puncture
Specialist neurointensivists, neurosurgeons


History[edit]

There are many examples of attempts to manage neurological injuries throughout history including trepanned skulls found from ancient Egypt and descriptions of neurological treatments in ancient Greek text[1]. Modern, neurointensive care begin with the advent of intensive care centers to treat the polio epidemic during the mid-twentieth century[2]. These early respiratory care units utilized negative and positive pressure units call the “Iron Lung” to aid patients in respiration and greatly decreased the mortality rate of polio[3]. Dr. Ibsen, a physician in Denmark, is thought to have "birthed the intensive care unit”, when he used tracheostomy and positive pressure manual ventilation to keep polio patients alive due an influx of patients and limited resources (only one iron Lung)[4].

The first neurological intensive care unit was created by Dr. Dandy Walker at John Hopkins in 1929[5]. Dr. Walker was a neurosurgeon who that realized that some neurosurgical patients could benefit from specialized postoperative monitoring and treatment. After his unit showed a benefit to post-operative patients, neurologic patients were added. Dr. Safar is credited with creating the first intensive care unit in the United States at Baltimore in the 1950’s[6]. In the 1970’s the benefit of specialized care in respiratory and cardiac ICUs led to the formation of the Society of Critical Care medicine. This body created standards for how patients with extensive and difficult medical problems would be treated. Over time the requirements of intracranial pressure monitoring, frequent detailed neurological examinations, and hypothermia to preserve neurologic function in cardiovascular resuscitated patients led to specialized neurointensive care units.

Modern neurocritical care field developed in the late twentieth century and was formalized in 2002 when the Neurocritical care society was founded. In 2005, Neurocritical care was recognized as a neurological subspecialty[7].

Scope[edit]

The physicians who practice this type of medicine are called neurointensivists, and can have medical training in many fields, including neurology, anesthesiology, emergency medicine, or neurosurgery. Common diseases treated in neurointensive care units include strokes, ruptured aneurysms, brain and spinal cord injury from trauma, seizures (especially those that last for a long period of time- status epilepticus, and/or involve trauma to the patient, i.e., due to a stroke or a fall), swelling of the brain (intracranial edema), infections of the brain (encephalitis), infection of the meninges of the brain or spine (meningitis), brain tumors (especially malignant cases; with neurological oncology), and weakness of the muscles required to breathe (such as the diaphragm). Besides dealing with critical illness of the nervous system, neurointensivists also treat the non-neurological complications that may occur in their patients, including those of the heart, lung, kidneys, or any other body system, including treatment of infections.

Neurointensive care centers[edit]

Neurological intensive care units are specialized units in select tertiary care centers that specialized in the care of critical ill neurological and post neurological surgical patients.

Neurointensive care team[edit]

Most neurocritical care units are a collaborative effort between neurointensivists, neurosurgeons, neurologists, radiologists, pharmacists, physician extenders (such as nurse practitioners or physician assistants), critical care nurses, respiratory therapists, rehabilitation therapists, and social workers who all work together in order to provide coordinated care for the critically ill neurologic patient.

Neurointensive care treatments[edit]

Basic life support monitoring

Electrocardiography, pulse oximetry, blood pressure, hourly nursing assessment of comatose patients. [8]

Hypothermia

32-34 degrees celsius for 12-24 hours.

Neurological monitoring

Serial neurologic examination, assessment of comatose patients (Glasgow Coma Scale plus pupil or four score , ICP (subarachnoid hemorrhages, TBI, Hydrocephalus, Stroke, CNS infection, Hepatic failure), multimodality monitoring to monitor disease and prevent secondary injury in states that are insensitive to neurological exam or conditions confounded by sedation, neuromuscular blockade and coma.

ICP management

Ventricular catheter to monitor brain oxygen and concentrations of glucose and pH. May be used to administer treatments including hypertonic serum, barbiturates, hypothermia and decompressive hemi-craniotomy.

TPA

Monitor patient who receive e TPA Monitor for 24 hours for brain bleeds

Neuromuscular diseases

Monitor Guillain-Barre and acute inflammatory demyelinating polyneuropathy for neuromuscular respiratory failure or autonomic instability


See also


External links


References


External links[edit]

  1. ^ Korbakis, Georgia; Bleck, Thomas (2014). "The Evolution of Neurocritical Care". Crit Care Clin. 30 (4). doi:10.1016/j.ccc.2014.06.001. PMID 25257734. 
  2. ^ Wijdicks, EF (2017). "The history of neurocritical care". Handb Clin Neurol. 140: 3-14. doi:10.1016/B978-0-444-63600-3.00001-5. PMID 28187805. 
  3. ^ Korbakis, Georgia; Bleck, Thomas (2014). "The Evolution of Neurocritical Care". Crit Care Clin. 30 (4). doi:10.1016/j.ccc.2014.06.001. PMID 25257734. 
  4. ^ Wijdicks, Eelco (2017). "The history of neurocritical care". n Handbook of Clinical Neurology. 140: 3-14. doi:10.1016/B978-0-444-63600-3.00001-5. PMID 28187805. 
  5. ^ Korbakis, Georgia; Bleck, Thomas (2014). "The Evolution of Neurocritical Care". Crit Care Clin. 30 (4). doi:10.1016/j.ccc.2014.06.001. PMID 25257734. 
  6. ^ Korbakis, Georgia; Bleck, Thomas (2014). "The Evolution of Neurocritical Care". Crit Care Clin. 30 (4). doi:10.1016/j.ccc.2014.06.001. PMID 25257734. 
  7. ^ Korbakis, Georgia; Bleck, Thomas (2014). "The Evolution of Neurocritical Care". Crit Care Clin. 30 (4). doi:10.1016/j.ccc.2014.06.001. PMID 25257734. 
  8. ^ Le Roux, P; Menon, D.K.; Cirerio, G; Etc (2014). "Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care". Intensive Care Medicine. 40 (9): 1189 - 1209. doi:10.1007/s00134-014-3369-6. PMID 25138226.