Neurocritical care (or neurointensive care) is a medical field that concerns with the management of life-threatening neurological disorders as well as identifying, preventing and treating secondary brain injury. Patients with neurocritical disorders that require admission to ICU constitute about 10–15% of critical care cases . In addition, many critically ill patients with sepsis or respiratory failure develop neurological complications, such as delirium, non-convulsive status epilepticus, or neuromuscular weakness, which may in turn contribute to morbidity and an increased risk of mortality .
Critical care was an ancient field developed over time. Intensive care begin with centers to treat the poliomyelitis outbreak during the mid-twentieth century. Initially these early respiratory care units utilized a negative and positive pressure unit called the “Iron Lung” to aid patients in respiration and greatly decreased the mortality rate of Poliomyelitis . Dr. BjørnAage Ibsen, a physician in Denmark, "birthed the intensive care unit”, when he used tracheostomy and positive pressure manual ventilation to keep polio patients alive in the setting of an influx of patients and limited resources (only one iron Lung); .
Neurocritical care focuses on the care of critically ill patients with an acute neurological disorders and has developed remarkably in the past few years. However, there is a lack of data that describe the scope of this practice and epidemiological data on the types of patients and treatments used in neurocritical care units worldwide .
ICU neurological cases are of two types, primary neurological cases admitted from the start by neurologist/internist and consultation for neurological manifestations of already admitted patients in ICU under care of internist or intensivist .
There is limited information regarding epidemiological data, disease characteristics, and variability of clinical care and in-hospital mortality of neurocritically ill patients worldwide.
OP Adudu et al from Nigeria studied the outcome in NICU .They found that the overall mortality rate was 52.4% with 86 (87.8%) of the 98 deaths occurring within the first week of ICU admission. Mortality rates were significant for all cases with the exceptions of status epilepticus, spinal cord injuries and Guillain-Barre syndrome. Mortality was directly related to severity of illness as the most critically ill patients that needed the most intervention. Neurological disorders accounted for between 65% and 71.6% of the morbidities in intensive care units .
A Study was done by Ibrahim et al: "Improved Outcomes following the Establishment of a Neurocritical Care Unit in Saudi Arabia", a retrospective before and after cohort study comparing the outcomes of neurologically injured patients. Group1 met criteria for NICU admission but were admitted to the general ICU as the NICU was not yet operational. Group 2 were subsequently admitted thereafter to the NICU once it had opened. The following results were obtained: admission to NICU was a significant predictor of increased hospital discharge with an odds ratio of 2.3 (95% CI: 1.3–4.1; ). Group 2 (n = 208 patients) compared to Group 1 (n = 364 patients) had a significantly lower ICU LOS (15 versus 21.4 days). Group 2 also had lower ICU and hospital mortality rates (5.3% versus 10.2% and 9.1% versus 19.5%, respectively; all ). Group 2 patients had higher discharge glasgow coma scale (GCS) and underwent fewer tracheostomies but more interventional procedures (all). They concluded that admission to NICU, within a polyvalent Middle Eastern ICU, was associated improvement in the mortality and morbidity .
Ines etal in their retrospective study (Predictors for good functional outcome after neurocritical care) in Germany investigated 796 consecutive patients admitted to a non-surgical neurologic intensive care unit over a period of two years (2006 and 2007). They came with the following results: About 60% of all patients suffered from stroke (ischemic stroke: 31% and ICH: 26%). Patients were diagnosed with subarachanoid hemorrege in 5%, epileptic seizures in 12%, meningoencephalitis in 6%, Guillain-Barré-Syndrome and myasthenia gravis in 3%, neurodegenerative diseases and encephalopathy in 3%, cerebral neoplasm in 3%, and intoxications in 3%. The remaining 63 patients were patients outsourced from general ICUs due to space limitations as well as patients temporarily monitored after neuroradiological procedures. Overall in-hospital mortality amounted to 22.5% of all patients, and a good long-term functional outcome was achieved in 28.4%. The parameters age, length of ventilation (LOV), admission diagnosis of intracerebral hemorrhage (ICH), GBS/MG, and inoperable cerebral neoplasm as well as Therapeutic Intervention Scoring System (TISS)-28 on Day 1 were independently associated with functional outcome after one year .