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Head trauma is a major aspect of neurocritical care, and the management of cranial injuries can be traced back to 2000 BC.
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The first contemporary neurointensive care units using mechanical ventilation developed after the poliomyelitis epidemic of the 1920s.
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Modern neurointensive care units use multiple modalities to monitor a diverse patient population.
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The Neurocritical Care Society was founded in 2002 and is a multidisciplinary organization dedicated to progress in the field of neurocritical
The Evolution of Neurocritical Care
Section snippets
Key points
Historical aspects
The history of neurocritical care begins in antiquity, as documented in the Edwin Smith surgical papyrus. This text, named for a nineteenth century Egyptologist who purchased the document in Luxor or Thebes in 1862, is an unfinished textbook on bodily injuries written circa 1700 BC. It is believed to be a copy of an original article written 1000 years prior and describes 48 case reports, including 27 head injuries and 6 spinal cord injuries, many with documented interventions by the
Mechanical ventilation and the birth of critical care medicine
A complete discussion of the history of mechanical ventilation is beyond the scope of this article; however, many key elements to the development of artificial respiration are relevant to critical care medicine as a subspecialty, and particularly neurocritical care. Galen first described using a bellows to ventilate a dead animal artificially through the trachea; later, the Renaissance physician Andreas Vesalius documented the use of a tracheostomy with artificial respiration by inserting a
Head trauma
Traumatic brain injury (TBI) has gained much attention in the news recently, especially regarding sports-related injuries; however, severe TBI due to injuries sustained during periods of war has been a topic of study since antiquity. One of the main indications for trepanation is thought to have been TBI. Trepanation could be performed by scraping, grooving, or boring and cutting, as was performed by the Greeks, using an instrument called a trypanon. Interestingly, many of the ancient skulls
Intracranial pressure
Assessment and management of ICP remains one of the main responsibilities for neurointensivists practicing today. In 1901, Cushing published a landmark study demonstrating the “Cushing response:” a triad of hypertension, bradycardia, and irregular respirations related to intracranial hypertension. Increasing ICP in dogs via infusion of a salt solution directly into the subdural space and recording several physiologic measures, Cushing noted a direct correlation of the increase in arterial blood
Neuromonitoring
The field of neurocritical care is relatively young but has quickly evolved over the last 30 years to involve a multidisciplinary approach to the management of acute neurologic injury. The term “multimodal monitoring” refers to measuring and recording neurospecific variables in real time, in addition to the patient’s cardiac and pulmonary status.
The oldest and most dependable of these variables is the neurologic examination. Vigilant bedside monitoring for neurologic deterioration is difficult
Brain death
With the increasing use of mechanical ventilation in the 1950s, patients who would have previously died from respiratory arrest were being kept alive in ICUs around the world; this resulted in a widely cited French study on coma dépassé (a state beyond coma or irreversible coma) by Mollaret and Goulet published in 1959.74 This study documented 23 patients who lost consciousness and other brainstem function and reflexes but maintained a heartbeat while being kept on mechanical ventilation. This
Cardiopulmonary resuscitation and hypothermia for cardiac arrest
A synopsis regarding the evolution of critical care medicine as a specialty would not be complete without a discussion of cardiopulmonary resuscitation (CPR); however, details regarding positive pressure ventilation were discussed earlier. Peter Safar, an anesthesiologist named the “father of CPR,” first introduced the concept of mouth-to-mouth resuscitation with the head-tilt-chin-lift method to open the patient’s airway, publishing his work in a landmark study in JAMA in 1958.83 Combining the
Future direction
Since its inception, the field of neurocritical care has grown dramatically. Much of this article has focused on TBI and multimodal monitoring where the goal is to prevent secondary injury. An emerging specialty, neurocritical care bioinformatics, attempts to use all the data gathered through multimodal monitoring and analyze these parameters at the bedside in real time to aid in decision-making for complicated cases;90 this may prove to be an exciting new development as we continue to
Summary
Neurocritical care is a diverse and fascinating field that has quickly blossomed from a small group of interested physicians in the 1980s to an established subspecialty encompassing doctors trained in neurology, neurosurgery, internal medicine, and emergency medicine. In 2002 the Neurocritical Care Society was founded in San Francisco, CA by a small group of neurointensivists. The group held its inaugural meeting in Phoenix, AZ in 2003. The United Council of Neurologic Subspecialties, founded
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Demographic and institutional predictors of stroke hospitalization mortality among adults in the United States
2022, eNeurologicalSciCitation Excerpt :The adoption of intravenous thrombolysis and the advent of endovascular thrombectomy fueled by the completion of multiple randomized clinical trials have decreased the morbidity and mortality associated with ischemic stroke [3–12]. These therapies and the institution of neurocritical care units improved the outcomes of patients suffering from severe stroke independent of stroke etiology [13–15] . Notwithstanding these promising trends, stroke remains a leading cause of disability and mortality in the United States (US).
Implementation of Neurocritical Care Is Associated with Improved Outcomes in Traumatic Brain Injury
2017, Canadian Journal of Neurological SciencesA historical delve into neurotrauma-focused critical care
2023, Wiener Medizinische WochenschriftThe Impact of a Neurocritical Care and Neuropalliative Collaboration on Intensive Care Unit Outcomes
2022, American Journal of Hospice and Palliative MedicineOutcome of neurocritical disorders, a multicenter prospective cross-sectional study
2022, Brain and BehaviorOutcome of Neurocritical Disorders, A Multicenter Study from Sudan
2021, Research Square
Disclosures: None.