Chapter 36 - Building a Case for a Neurocritical Care Unit

Summary

The birth of neurocritical care (NCC) can be traced to Harvey Cushing’s “anesthesia chart” and to Walter Dandy, who opened the first three-bed unit in the USA for postoperative neurosurgical patients at Johns Hopkins Hospital in Baltimore, Maryland [1]. Modern NCC is a new field that began in the early 1980s in a few isolated hospitals in the USA and Europe. This new area of expertise was needed to provide specialized care for patients with neurological and neurosurgical problems, which until that time was only offered in general intensive care units (ICUs) or in units of less acuity, such as stroke units. In fact, acute neurologic disorders were estimated to occur in 45% of medical ICU patients and neurologic complications to occur in 33% of patients admitted for non-neurological reasons [2]. Because enlightened neurosurgeons, neurologists, and general intensivists realized that a substantial number of ICU patients could be better served by specialists, Neuro-ICUs (NICUs) were gradually established throughout the USA and Europe during the 1990s, often directed and staffed by neurologists with special interest in internal medicine or anesthesiology. Then in 2002, the Neurocritical Care Society (NCS) was formed, with close to 200 members. In 2005, the United Council for Neurological Subspecialties (UCNS) recognized NCC as a new neurological subspecialty and a process was created to accredit US NCC programs and develop an NCC physician certification. In 2008, Leapfrog recognized neurointensivists (NIs) as part of the critical care pool of physicians – an important development since, except for UCNS certification, no American Board of Medical Specialties (ABMS) critical care certification path had existed for NIs. This boosted the subspecialty to new heights, and the NCS grew to over 2500 members (please visit www.neurocriticalcare.org/practitioners/physicians for more information).