Overview of the Neuro-ICU

A neuro-ICU is an intensive care unit devoted to the care of patients with immediately life-threatening neurological problems. Neuro-ICUs came into existence about 25 years ago in response to the need for more specialized knowledge in the growing techniques to recognize and address neurological disorders.

Problems Managed in a Neuro-ICU

In general, a patient may be admitted to a neuro-ICU for the following conditions:

• post-operative brain tumor
• ischemic stroke
• subarachnoid hemorrhage
• traumatic brain injury
• intracranial hemorrhage
• Guillain-Barre syndrome
• subdural hematoma
• myasthenia gravis
• spinal trauma
• status epilepticus
• encephalitis
• meningitis and other central nervous system infections

Other Benefits

The field of neurointensive care covers more than just a wide range of diseases. It also requires specialized knowledge about certain mechanics of the body, such as how the brain controls its blood flow and intracranial pressure. It also requires knowledge of neurological tools such as electroencephalography, which are added to the more typical understandings of ventilator mechanics, cardiac telemetry and intensive blood pressure monitoring and other techniques more typical of a general ICU.

Patients with damage to their nervous system differ in very important ways from patients with damage to other important areas of the body. For example, diseases of the nervous system can affect a patient’s ability to move and communicate. The staff of a neuro-ICU must, therefore, be trained in special examination techniques to gather critical information.

The personal nature of severe neurological illnesses also cannot be understated. Neurological illness can change how a person perceives loved ones and can essentially make them behave like a completely different person. Even worse, some neurological illnesses can seem to rob us of what made us who we were, or even what made us human. The emotional fragility these changes can provoke in friends and family members require special attention. This becomes even more important when discussing topics such as brain death.

The History of the Neuro-ICU

In some ways, the very first intensive care units were neuro-ICUs. The need for ICUs was firmly established in the 1950s because of the paralyzing effect of the polio virus. As paralyzed people with polio lost their ability to breathe, they were placed on the then-new technology of mechanical ventilation.

For decades, intensive care units took care of every type of life-threatening illness, especially those that led to a need for mechanical ventilation. However, the need for more specialized care became increasingly evident as medicine became more complex. In 1977, the first large general academic neuro-ICU in North America was started at Massachusetts General Hospital. From there, they became increasingly popular across the nation and world.

Most neuro-ICUs are found in large academic hospitals, where they get a steady stream of patients. Smaller hospitals may not be able to get enough patients to justify constructing a neuro-ICU, and will either care for the patient in a general ICU or transfer the patient to a different hospital.

Who Works in a Neuro-ICU

Neuro-ICUs are very multi-disciplinary in nature. Neurologists, neurosurgeons, intensive care specialists, and anesthesiologists often work very closely with teams of highly trained nurses, respiratory therapists, nutritional experts, and more.

The benefit of having so many specialists is that a wide range of expertise is brought into the care of each patient. The downside is that unless very close attention is paid to who is speaking, it is easy for friends and families to get confused about who they’re talking to and why. This potential confusion is worsened by the fact that hospital workers must work in shifts, so who you talk to likely depends on the time of day as well. To avoid confusion, ensure that everyone who comes in introduces themselves and describes their role.

Compared with general intensive care units, neuro-ICUs have been associated with lower mortality and shorter hospital stays for disorders like stroke, cerebral hemorrhage, and traumatic brain injury. Intensive care units, in general, can be frightening and confusing places, but with close attention to good communication, a neuro-ICU can be a literal life-saver.