Neurocritical Care Outcomes, Research, and Technology

Abstract

eurocritical care (NCC) is a specialty drawing professionals with background training in neurology, neurosurgery, anesthesiology, internal medicine, and emergency medicine. Since the 1980s, NCC has grown into an organized subspecialty with establishment of neurointensive care units (neuro-ICUs) and professional organizations. The most prominent dedicated society, the Neurocritical Care Society (NCS), founded in 2002, counts more than 2500 members, with neurologists comprising the largest primary specialty (Rakela Miller, NCS, written communication, June 5, 2018). Neurocritical care education varies among different countries. In the United States, neurocritical care subspecialization can be pursued through fellowship training after completion of residency training in neurology, neurosurgery, anesthesiology, internal medicine, or emergency medicine, or as additional training after completing a critical care fellowship program. Fellowships are accredited by 2 organizations: United Council for Neurologic Subspecialties (UCNS) and, for neurosurgeons, Committee on Advanced Subspecialty Training. Currently, there are 68 UCNSaccredited neurocritical care programs and 22 Committee on Advanced Subspecialty Training programs; the numbers are growing. Among 1374 UCNS-certified diplomats in neurocritical care, 576 (41.9%) are board-certified neurologists (Becky Swanson, UCNS, written communication, April 17, 2018). Following efforts to integrate neurocritical care with other subspecialties, neurocritical care has recently been approved as a subspecialty by the American Board of Medical Specialties. It is yet to be seen how this approval will affect organization and education.In other countries, the proportion of neurologists within the pool of neurointensivists varies, but independently, the addition of neurocritical care has opened a new career path to neurologists IMPORTANCE Neurocritical care has grown into an organized specialty that may have consequences for patient care, outcomes, research, and neurointensive care (neuroICU) technology.OBSERVATIONS Neurocritical care improves care and outcomes of the patients who are neurocritically ill, and neuroICUs positively affect the financial state of health care systems. The development of neurocritical care as a recognized subspecialty has fostered multidisciplinary research, neuromonitoring, and neurocritical care information technology, with advances and innovations in practice and progress.CONCLUSIONS AND RELEVANCE Neurocritical care has become an important part of health systems and an established subspecialty of neurology. Understanding its structure, scope of practice, consequences for care, and research are important.

Feasibility and Efficacy of a Resiliency Intervention for the Prevention of Chronic Emotional Distress Among Survivor-Caregiver Dyads Admitted to the Neuroscience Intensive Care Unit

“…An institutional review board-approved recruitment video, which included 2 dyads who successfully completed a prior feasibility study, 18 was used as needed. Inclusion criteria for patients were as follows: (1) Randomization, Allocation Concealment, and Follow-up…”

“…Advanced technologies have transformed the quality of care for patients with critical neurologic illness admitted to the intensive care unit (ICU), contributing to increased survival and more favorable discharge dispositions. 1 However, as more and more patients survive their neuroscience ICU stays, the long-term psychiatric sequelae associated with the sudden, life-threatening, and often traumatic onset of acute neurological injury (ANI) are becoming increasingly recognized. These psychiatric sequelae affect not only the survivors but also the informal caregivers 2 who support and attend to them through their hospitalizations and beyond.…”

Bringing EEG Back to the Future: Use of cEEG in Neurocritical Care

“…1 Multidisciplinary intensive care unit (ICU) teams have demonstrated improvement in outcomes of diverse patient populations, such as ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic brain injury. 1,2…”

Organization of a Neurointensive Care Unit

“…2 Over the years, the neurocritical care units (NCCUs) have evolved from larger multidisciplinary ICUs into freestanding units, not limited only to postoperative neurosurgical patients but also involving integrated management of other conditions of the central nervous system and their complications. 3 The most commonly admitted patients in a NCCU are of stroke, head injury, brain tumors, and posthypoxic encephalopathy, whereas those with spinal cord injuries, status epilepticus, myasthenic crisis, Guillain-Barré syndrome, and neurological infections are relatively less common. 4 There is compelling evidence to believe that such patients, when cared for in a specialist NCCU tend to have better outcomes than if treated in a multidisciplinary unit.…”