Neurointensive care
Neurocritical care (or neurointensive care) is a medical field that treats life-threatening diseases of the
MRI scan, Lumbar puncture | |
Specialist | neurointensivists, neurosurgeons |
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History
There have been many attempts to manage head injuries throughout history including
The first neurological intensive care unit was created by Dr. Dandy Walker at Johns Hopkins in 1929.[1] Dr. Walker realized that some surgical patient could use specialized postoperative neurosurgical monitoring and treatment. The unit Dr. Walker created showed a benefit to postoperative patients, than neurologic patients came to the unit. Dr. Safar created the first intensive care unit in the United States in Baltimore in the 1950s.[1] In the 1970s, the benefit of specialized care in respiratory and cardiac ICUs led to the Society of Critical Care medicine being formed. This body created standards for extensive, difficult medical problems and treatments. Over time the need for specialized monitoring and treatments led to neurologic intensive care units.
Modern neurocritical care began to develop in the 1980s. The Neurocritical Care Society was founded in 2002. In 2005, neurocritical care was recognized as a neurological subspecialty.[1]
Scope
The doctors who practice this type of medicine are called neurointensivists, and can have medical training in many fields, including neurology, anesthesiology, emergency medicine, internal medicine, or neurosurgery. Common diseases treated in neurointensive care units include
Neurointensive care centers
Neurological Intensive care units are specialized units in select
Neurointensive care team
Most neurocritical care units are a collaborative effort between neurointensivists,
Neurointensive care nursing
Patients in the neurointensive care units (NICU) are vulnerable due to their primary injury, and in need of help with all their personal hygiene. When planning for nursing interventions it is beneficial to be aware of the patient’s intracranial adaptive capacity, i.e., intracranial compliance, to avoid the development of elevated ICP. All nursing interventions is performed with the aim of benefit for the patient, such as hygienic interventions, preventing pressure ulcers, surgery wound management, endotracheal suctioning when artificial ventilation is needed, among other things. Though, nursing interventions might as well be stressful, and can result in high ICP. Therefore, it is the nurse’s obligation to plan for the interventions so that a balance is achieved between the benefits for the patient’s wellbeing and the risk of raised ICP, which might cause secondary insults. High ICP can be prevented by giving extra sedation before intervention, optimizing the patients position with a raised head and stretched neck to avoid venous stasis. When ICP is > 15 mmHg only the most important interventions are to be performed, to minimize the probabilities of secondary insults.[4]
Neurointensive care procedures
Hypothermia: One third to half of people with coronary artery disease will have an episode where their heart stops. Of the patients who have their heart stopped seven to thirty percent leave the hospital with good neurological outcome (conscious, normal brain function, alert, capable of normal life).[citation needed] Lowering patients body temperature between 32 -34 degrees within six hours of arriving at the hospital doubles the patients with no significant brain damage compared to no cooling and increases survival of patients.[5]
Basic life support monitoring: Electrocardiography, pulse oximetry, blood pressure, assessment of comatose patients.[6]
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.
Intracranial pressure (ICP) management: Ventricular catheter to monitor Brain oxygen and concentrations of glucose and PH. With treatment options of Hypertonic serum, barbiturates, hypothermia and decompressive hemicraniectomy
Common neurointensive care illnesses and treatments
Stroke: Airway management, Maintenance of blood pressure and cerebral perfusion, intravenous fluid management, Temperature control, prophylaxis against seizures, nutrition, ICP management and treatment of medical complications.[7]
Subarachnoid hemorrhage: Find the cause of hemorrhage, treat
Status epilepticus: Termination of
Encephalitis: Airway protection, monitoring of ICP, treatment of seizures if necessary, and sedation if patient is agitated and virial testing hemodynamic stability.[7]
Acute parainfectious inflammatory encephalopathy (Acute disseminated encephalomyelitis (ADEM) and Acute hemorrhagic leucoencephalitis (AHL)): high dose corticosteroids, monitoring of hemodynamic stability.[7]
Multiple sclerosis, Autonomic neuropathy, spinal cord lesion and neuromuscular disease causing respiratory failure: Monitor respiration and respiratory assistance, if necessary to maintain hemodynamic stability.[7]
Spinal cord injury: immobilization, airway protection and oxygenation, management of spinal chock and cardiovascular effects.[9]
See also
- American Board of Psychiatry and Neurology
- American Osteopathic Board of Neurology and Psychiatry
- Developmental Neurorehabilitation
- List of neurologists
- Neurocritical Care Society
- Neurohospitalist, a physician interested in inpatient neurological care
References
- ^ PMID 25257734.
- ^ )
- S2CID 23476865.
- OCLC 1085942911.)
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- S2CID 4673528.
- ^ PMID 12933908.
- PMID 28962812.
- OCLC 1085942911.)
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: CS1 maint: location missing publisher (link) CS1 maint: others (link