Elsevier

Critical Care Clinics

Volume 30, Issue 4, October 2014, Pages 657-671
Critical Care Clinics

The Evolution of Neurocritical Care

https://doi.org/10.1016/j.ccc.2014.06.001Get rights and content

Section snippets

Key points

  • Head trauma is a major aspect of neurocritical care, and the management of cranial injuries can be traced back to 2000 BC.

  • The first contemporary neurointensive care units using mechanical ventilation developed after the poliomyelitis epidemic of the 1920s.

  • Modern neurointensive care units use multiple modalities to monitor a diverse patient population.

  • The Neurocritical Care Society was founded in 2002 and is a multidisciplinary organization dedicated to progress in the field of neurocritical

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

First page preview

First page preview
Click to open first page preview

References (103)

  • G. Kasotakis et al.

    Intraparenchymal vs extracranial ventricular drain intracranial pressure monitors in traumatic brain injury: less is more?

    J Am Coll Surg

    (2012)
  • A. Bekar et al.

    Risk factors and complications of intracranial pressure monitoring with a fiberoptic device

    J Clin Neurosci

    (2009)
  • E.S. Rosenthal

    The utility of EEG, SSEP and other neurophysiologic tools to guide neurocritical care

    Neurotherapeutics

    (2012)
  • K.E. Wartenberg et al.

    Multimodality monitoring in neurocritical care

    Crit Care Clin

    (2007)
  • P.J. Baskett

    The resuscitation greats: Peter J. Safar, the early years 1924-1961, the birth of CPR

    Resuscitation

    (2001)
  • J.T. Hughes

    The Edwin Smith surgical papyrus: an analysis of the first case reports of spinal cord injuries

    Paraplegia

    (1988)
  • J.H. Breasted

    The Edwin Smith surgical papyrus, published in facsimile and hieroglyphic transliteration with translation and commentary

    (1930)
  • E.C. Kelly

    Hippocrates on injuries of the head

  • V.R. Kshettry et al.

    The management of cranial injuries in antiquity and beyond

    Neurosurg Focus

    (2007)
  • J. Lifshutz et al.

    A brief history of therapy for traumatic spinal cord injury

    Neurosurg Focus

    (2004)
  • S.Y. Rahimi et al.

    Medieval neurosurgery: contributions from the Middle East, Spain, and Persia

    Neurosurg Focus

    (2007)
  • A.B. Baker

    Artificial respiration, the history of an idea

    Med Hist

    (1971)
  • R.V. Lee

    Cardiopulmonary resuscitation in the eighteenth century: a historical perspective on present practice

    J Hist Med Allied Sci

    (1972)
  • R. Foregger

    Joseph Black and the identification of carbon dioxide

    Anesthesiology

    (1957)
  • J.B. West

    Joseph Priestley, oxygen, and the Enlightenment

    Am J Physiol Lung Cell Mol Physiol

    (2014)
  • E.A. Underwood

    Lavoisier and the history of respiration

    Proc R Soc Med

    (1944)
  • J.L. Price

    The evolution of breathing machines

    Med Hist

    (1962)
  • P. Drinker et al.

    An apparatus for the prolonged administration of artificial respiration

    J Clin Invest

    (1929)
  • H. Lassen

    The epidemic of poliomyelitis in Copenhagen, 1952

    Proc R Soc Med

    (1954)
  • C.G. Engström

    Treatment of severe cases of respiratory paralysis by the Engström universal respirator

    Br Med J

    (1954)
  • F.C. Rose

    The history of head injuries: an overview

    J Hist Neurosci

    (1997)
  • P.F. McCrory et al.

    Concussion: the history of clinical and pathophysiological concepts and misconceptions

    Neurology

    (2001)
  • A. Di Ieva et al.

    Berengario da Capri: a pioneer in neurotraumatology

    J Neurosurg

    (2011)
  • H.H. Kaufman

    Treatment of head injuries in the American Civil War

    J Neurosurg

    (1993)
  • P. Sargent et al.

    Preliminary notes on the treatment of the cranial injuries of warfare

    Br Med J

    (1915)
  • M. Kinsman et al.

    Harvey Cushing’s early experience with the surgical treatment of head trauma

    J Hist Neurosci

    (2013)
  • G.G. Tabuteau

    The treatment of gunshot wounds of the head, based on a series of ninety-five cases

    Br Med J

    (1915)
  • M.E. Carey

    Cushing and the treatment of brain wounds during World War I

    J Neurosurg

    (2011)
  • M. Faul et al.

    Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths 2002–2006

    (2010)
  • Brain Trauma Foundation et al.

    Guidelines for the management of severe traumatic brain injury

    J Neurotrauma

    (2007)
  • P. Talving et al.

    Intracranial pressure monitoring in severe head injury: compliance with Brain Trauma Foundation guidelines and effect on outcomes: a prospective study

    J Neurosurg

    (2013)
  • L.M. Gerber et al.

    Marked reduction in mortality in patients with severe traumatic brain injury

    J Neurosurg

    (2013)
  • H. Cushing

    Concerning a definite regulatory mechanism of the vasomotor centre which controls blood pressure during cerebral compression

    Johns Hopkins Hospital Bulletin

    (1901)
  • H. Ryder et al.

    The mechanism of change in cerebrospinal fluid pressure following an induced change in the volume of the fluid space

    J Lab Clin Med

    (1953)
  • N. Lundberg et al.

    Continuous recording of the ventricular-fluid pressure in patients with severe acute traumatic brain injury: a preliminary report

    J Neurosurg

    (1965)
  • N. Lundberg

    Continuous recording and control of ventricular fluid pressure in neurosurgical practice

    Acta Psychiatr Scand Suppl

    (1960)
  • S.H. Greenblatt

    The crucial decade: modern neurosurgery’s definitive development in Harvey Cushing’s early research and practice, 1900 to 1910

    J Neurosurg

    (1997)
  • L.H. Weed et al.

    Pressure changes in the cerebro-spinal fluid following intravenous injection of solutions of various concentrations

    Am J Physiol

    (1919)
  • F. Fremont-Smith et al.

    Intra-ocular and intracranial pressure: an experimental study

    Arch Neurol Psychiatry

    (1927)
  • M. Javid et al.

    Effect of urea on cerebrospinal fluid pressure in human subjects: preliminary report

    J Am Med Assoc

    (1956)
  • Cited by (15)

    • Demographic and institutional predictors of stroke hospitalization mortality among adults in the United States

      2022, eNeurologicalSci
      Citation 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).

    • A historical delve into neurotrauma-focused critical care

      2023, Wiener Medizinische Wochenschrift
    View all citing articles on Scopus

    Disclosures: None.

    View full text