DOI: The Greek E-Journal of Perioperative Medicine 2012; 10:83-101

ABSTRACT

The review presents literature data and focuses on the acclaimed need for transition from general to dedicated Neurosurgical/Νeurological or Neuroscience Intensive Care Units (NSICU).

There are solid data from well designed metanalyses showing that at least in the United States, the wider implementation of intensivists in the ICUs, led to significant reductions in ICU and hospital mortality and patient’s length of stay (LOS). Given the variation in ICU physician staffing plans and the potential for reduced mortality implied by these studies, a more rigorous evaluation of the optimal ICU organization is essential. Highly specialized vs. less specialized ICU physician staffing is associated with reduced hospital and ICU mortality and LOS.

Significant developments in the fields of neurology and neurosurgery have led to improved treatments for the critically ill neurological/neurosurgery patient. The institution of a neurointensivist-led team model and the transition from the open unit model to a semiclosed or closed model were associated with an independent positive impact on patient outcomes, lower ICU mortality, reduced LOS, and increased probability of discharge either to a skilled nursing facility or home. Moreover, a lower percentage of complications and improved documentation of important predictive variables in medical records were among other benefits.

Full-time neurointensivists implementation and the institution of dedicated neurocritical care units have also been associated with reduced hospital mortality and resource utilization without changes in readmission rates or long-term mortality.

For patient subgroups such as those with acute intracerebral hemorrhage, acute ischemic stroke and more importantly, traumatic brain injury, admission to a neuro- vs. general ICU is associated with reduced mortality rate, reduction in resource utilization and improved patient outcomes at hospital discharge.Several factors including improved patient care protocols may contribute to this favorable association.

A closed model neuro-intensive care unit with continuous supervision by a critical care team specializing in neurocritical care or neuroanesthesia can provide improved outcomes and reduced length of stay compared to general ICU.

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