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The Role of Neurocritical Care

January 04, 2016

Acute brain injury is a serious problem. Even after a patient is assessed, resuscitated and stabilized, that patient is still in danger of a recurrence, progression or complication. This threat highlights the need for close observation, which is best provided in dedicated neurological ICUs.

This practice of neurointensive care (also referred to as neurocritical care) is one of the newest and fastest-growing subspecialties in medicine today. It is unique in its concern with comprehensive multisystem treatment. Neurointensivists manage critically ill patients with stroke, neuromuscular disease, traumatic injury, increased intracranial pressure and other neurological disorders, as well as the associated complications that may follow, especially those of the heart, lung and kidneys.

Given the complexity of severe stroke and potential complications, a neurointensivist works closely with multidisciplinary teams composed of neurosurgeons, neuroradiologists, neurologists, emergency medicine and other medical and surgical specialists, as well as pharmacists, critical care nurses, respiratory therapists, rehabilitation therapists and social workers. Neurointensivists may have training in many fields including neurology, anesthesiology, emergency medicine or neurosurgery.

To help identify critical problems before permanent neurologic injury occurs, neurological intensive care requires proficiency with not only standard ICU protocols (such as heart monitoring and mechanical ventilation) but also specialized forms of neurological monitoring (such as for intracranial pressure and electrical activity) and interventions (such therapeutic hypothermia).

The effectiveness of such comprehensive care in reducing the rates of mortality and morbidity after stroke is demonstrated in numerous studies. In fact, the rapid evolution of neurointensive treatment has helped standardize treatment and increase adherence to best practices.

In September 2012, to recognize the significant investment in infrastructure, staff and training needed for truly state-of-the-art complex stroke care, The Joint Commission and the American Heart Association/American Stroke Association launched a new level of advanced certification: the Comprehensive Stroke Center (or CSC). To attain CSC certification, organizations must not only meet all of the general eligibility requirements for Primary Stroke Center certification, but also:

  • Have dedicated neurointensive care unit beds for complex stroke patients that provide neurocritical care 24 hours a day, seven days a week
  • Use advanced imaging capabilities
  • Coordinate post-hospital care for patients
  • Participate in stroke research

At Dignity Health, we have planned and developed programs to achieve this level of excellence and standard. All are guided by evidence-based practices and established "best of the best" models of care.

Dr. Reza Pirsaheli is a Dignity Health neurocritical care specialist in Sacramento, California-helping stroke patients at Mercy General Hospital, Mercy San Juan Medical Center, Mercy Hospital of Folsom and Methodist Hospital of Sacramento.

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