Abstract
Modern neurological intensive care began with the use of respiratory care principles established during European poliomyelitis epidemics and expanded into the wider field that encompassed all acute and critical aspects of neurological and neurosurgical disease. Since the foundation of the Neurocritical Care Society (NCS) in 2003 and publication of the journal Neurocritical Care in 2004, papers in this medical subspecialty has increased explosively. The NCS is composed of multiprofessional healthcare providers that are dedicated to improve the care and outcomes of patients with life-threatening neurological illnesses by promoting quality patient care, professional collaboration, research, training and advocacy. The neurointensivist defragments and harmonizes the care of his or her patients by taking responsibility for basic elements of intensive care that might otherwise be provided by multiple subspecialists. In the United States, over 100 neurological intensive care units (neuro-ICUs) have been established. Detailed core curriculum for neurointensivists is prepared under formal recognition and acceptance by the United Council of Neurologic Subspecialties. Commonly managed conditions in neuro-ICUs include stroke, neurotrauma, seizures and epilepsy, neuromuscular diseases, infections, inflammatory and demyelinating diseases, encephalopathies, neuroendocrine disorders, movement disorders, various clinical syndromes, perioperative neurosurgical care, neurorehabilitation, and pharmacotherapeutics. Expertise in neurological intensive care involves procedural skills and proficiency with standard forms of intensive-care monitoring as well as specialized forms of neurological monitoring (i.e., intracranial pressure and continuous electroencephalograph monitoring) and interventions (i.e., therapeutic hypothermia and thrombolytic reperfusion therapy). Recent meta-analysis on neuro-ICUs indicated statistically significant reduction in mortality and an increased proportion of patients with a favorable outcome. Both the stroke care unit and neuro-ICU manage severe stroke patients, the latter being more rational in treating various kinds of critically ill neurological conditions including stroke mimics. A standard educational program for neurointensivists to establish sophisticated neuro-ICUs is now warranted in Japan.
