A need for speed promotes neurointensive care
John Zurasky, M.D.
Providence Brain and Spine Institute
Published March 2012
Over the past 30 years lifesaving technologies have transformed how we practice neurology. As the specialty has grown to meet the needs of inpatient acute and critical care, the number of subspecialties has grown as well.
Among them is neurointensive care, a specialty that combines critical care and neuroscience to treat the sickest patients when time is of the essence. Once limited largely to academic hospitals, neurointensive care specialists are becoming increasingly common in metropolitan tertiary hospitals.
When the same physician can manage the ventilator; monitor cardiovascular and electrolyte status; interpret a neurologic study, such as an EEG, MRI or CT; and perform a neurologic exam, complex patient management decisions can be made quickly.
Although the neurointensivist assumes primary responsibility for the critically ill neurological patient – coordinating both medical and neurologic management – the care is collaborative, involving pulmonary/critical care specialists, neurosurgeons, stroke neurologists, neuromuscular specialists or epileptologists, to name a few. The care team also may involve speech, physical and occupational therapists, case managers and social workers.
This collaboration works best with well-trained bedside nurses, who can detect new problems first. There is no more important partner in the model than the bedside nurse.
Some acute conditions that benefit from the neurointensive care model are:
• Subarachnoid hemorrhage
• Intracerebral hemorrhage
• Traumatic brain injury
• Brain tumors
• Status epilepticus
• Neuromuscular disorders with respiratory failure
• Infections of the brain and spinal cord
• Spinal cord injury
The benefit of the neurointensive care model is documented in medical literature. It has been found to decrease mortality, shorten hospital stays and increase the likelihood of discharge home.
One three-year study of more than 2,300 patients saw lengths of stay in the neurosciences intensive care unit drop from 4.2 days to 3.7 days after the hospital adopted the neurointensive model. There was no change in readmission rates.
Another study, this one of patients with subarachnoid hemorrhage, found that those treated after the introduction of a neurointensive care team were more likely to be discharged home and less likely to be discharged to a rehab facility. And they were significantly more likely to receive definitive aneurysm treatment.
Interestingly, because of the relationship forged with a good neurointensive care team, there is an increase in organ donation from the patients whose aggressive care wasn’t enough.
The goal of any acute care provider is to stabilize the critically ill and return those patients to good health as soon as possible. Thanks to medical advancements and innovative care models, we’re reaching that goal more than ever.
Clinical articles by John Zurasky, M.D.