Do Neurocritical Care Units Save Lives? Measuring The Impact of Specialized ICUs
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EDITORIAL
Do Neurocritical Care Units Save Lives? Measuring The Impact of Specialized ICUs Andreas H. Kramer • David A. Zygun
Published online: 18 March 2011 Ó Springer Science+Business Media, LLC 2011
A variety of organizational models have been used to deliver care to critically ill patients with neurologic disorders. Primary care may be provided by general intensivists, who often rely heavily on consultative support from neurosurgeons and neurologists. This approach is especially common in Australia, New Zealand, Canada and some European countries. Intensive care units (ICUs) organized in this fashion are usually ‘‘closed’’, meaning that admissions and discharges are largely the responsibility of the attending intensivist. In this case, there are typically daily multidisciplinary rounds with a single team of clinicians. An alternative method is for primary care to be delivered by neurosurgeons or neurologists, in this case depending greatly on consultative input from various subspecialists. The corresponding ICUs are frequently ‘‘open’’; that is, at any given time, there may be multiple attending physicians with patients admitted under their care, each of which, in turn, has numerous consultants involved. This approach has, historically, been the most common to be used in the United States.
Electronic supplementary material The online version of this article (doi:10.1007/s12028-011-9530-y) contains supplementary material, which is available to authorized users. A. H. Kramer (&) Departments of Critical Care Medicine & Clinical Neurosciences, Hotchkiss Brain Institute, Foothills Medical Center, University of Calgary, Calgary, Canada e-mail: [email protected] D. A. Zygun Departments of Critical Care Medicine, Clinical Neurosciences & Community Health Sciences, Hotchkiss Brain Institute, Foothills Medical Center, University of Calgary, Calgary, Canada
The skill set of ICU bedside nurses and ancillary health professionals (e.g., respiratory therapists, pharmacists, social workers, and rehabilitation staff) may also vary. In ‘‘general ICUs’’, these individuals are usually well-trained in the provision of physiologic support, especially to patients with multi-organ failure; however, specific nuances that are important to neurocritical care patients may sometimes be under-recognized. In contrast, in specialized ICUs, nurses are specifically trained to detect and treat neurologic deterioration in a timely fashion; in this case, however, there may be less experience in the management of systemic complications. As a specialty, neurocritical care seeks to combine the advantages of each of these preceding models. Neurointensivists and neurocritical care nurses are content experts in both critical care and neurologic disorders. These individuals are trained especially to recognize when brain- and spinalcord-injured individuals have unique physiologic considerations in relation to other critically ill patients. Thus, their presence influences the ‘‘ICU culture’’ to become highly focused on neuroprotectio
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