Neuro Criticare Unit is the Need of Time!

A well-established NCCU can prevent stroke from evolving or can prevent secondary complications of the traumatic brain injury, with timely intervention

"Neurological critical care does not only encompass the central nervous system of the patient but multiple systems. Hence, neuro criticare is one of the most challenging faculties of the neurological science" - Dr Charudutt Apte Chief Medical Director Sahayadri Hospitals Pune

Science of brain is extremely complicated and yet to be explored. There are various neurological ailments which are classified as neurological emergencies and need specially designed and sophisticated / dedicated care for survival and functional recovery of a patient having one of such ailments.

There are certain reasons to discuss the neurological intensive care (neuro intensive care/ neuro criticare) separately though, intensive care expertise are advising 'decentralisation' of the super-specialty intensive care units into 'one big' ICU. This is because of the fact that, apart from the general intensive care measures which are followed all over world in general ICU, finer, delicate and timely changes are needed in management of a patient suffering from neurological disorder which can be done by a neurologist trained in this speciality only.

Objectives

There are common goals to all intensive care measures which are outlined below:

• To re-establish promptly the disturbed vital function, that is, treating the acute symptoms in a patient threatened by a catastrophe.
• To establish, as quickly as possible, the cause of the disturbed vital functions.
• To introduce, rapidly, treatment against the cause of disturbance in the vital function.

In serving the first goal, a person either trained in faculty of medicine or in anaesthesiology will be sufficient and potent but to serve the second goal, a person trained in field of neurosciences is needed, along with other faculty members, who can diagnose the causes of disturbance and can localise the lesion.

So, in short, neuro-intensive care unit (neuro criticare) is a multi-disciplinary unit which consists of neurologists, neurosurgeons, anaesthesiologist and trained nursing staff, of course which is headed by one of the person from the field of neurosciences. Treatment team also includes social workers, physical therapist, speech-language occupational therapist, nutritionist, clinical pharmacologists and of course clinical psychologist.

Common neurological ailments which are treated at neuro criticare unit are:

• Stroke.
• Brain hemorrhages.
• Traumatic brain injury.
• Tumours of the brain and spinal cords.
• Diseases of peripheral nervous system.
• Many other neurological diseases which necessitate urgent and intensive care medicine.

Neurological diseases and outcome of the diseases, if it is not attended properly at early stage, usually involve multiple systems at the same time, obviously because of the fact that brain controls the body. So, neurological critical care does not only encompass the central nervous system of the patient but multiple systems. Hence, neuro criticare is one of the most challenging faculties of the neurological science.

Because of very short 'golden period' when you can revert/ prevent/ halt the progression of any of the above mentioned pathologies, neuro critical care unit are designed to act promptly in a short time span so that vital functions of the part of central/ peripheral nervous system, which is on the verge of permanent damage, can be resuscitated.

A well-established Neuro Critical Care Unit (NCCU) can prevent stroke from evolving or can prevent secondary complications of the traumatic brain injury, with timely intervention. Proper intensive management of patients suffering from Guillian Barre syndrome (disease of peripheral nerves where all nerves are progressively paralysed), can result in ambulant and functionally independent patient. These are the examples for illustration and there are many more to explain. This is not at all possible without high tech gadgets which really improve the efficiency of the team member working in NCCU. Few of the hi-tech devices are mentioned below:

• High-end ventilators for individualising respiratory needs of patients suffering from the different neurological and neurosurgical diseases.
• Intra Cranial Pressure monitoring devices like bolt and probes which can constantly give us feedback about the pressures and dynamics happening inside the skull, from time-to-time.
• Sophisticated infusion pumps to exactly calibrate the amount of drug which is being transfused to a patient at a particular time.
• Intermittent pneumatic compression devices which help in keeping the leg veins of a drowsy/ paralysed patient's calf veins empty, so as to avoid clot formation in the calves (Deep venous thrombosis).
• Continuous Passive Movements (CPM) machine which is used as an alternative to pneumatic compressions.
• Invasive monitoring system for accurate measurement of vital parameters like blood pressure and pulmonary capillary wedge pressure which help clinician to keep a constant watch over other important systems like cardiovascular system and respiratory system.

NCCU: Need of the Hour

There are many more to discuss about. Along with a trained anesthesiologist, a person trained in the filed of neurological science, can greatly influence the management and final outcome of a patient having serious neurological ailment. Timely adjustments of the medications, delicate control of the ICP, adjustment in the cerebral blood flow and energy metabolism by various means can greatly hasten the recovery of the patient and can prevent long term sequel. This ultimately results in shorter NCCU and hospital stay and in turn less on the financial expenses.

Since neurological disorders are known to be associated with slow pace of recovery and many times patient is left with temporary/ permanent deficits. Hence, NCCU is always augmented by allied departments out of which neuro-rehabilitation and neuro psychological departments are at apex. Hence, it is assumed that neuro criticare is a long drawn affair and needs longer periods of rehabilitation. Financial help can be provided by medical social workers to meager extent which can be greatly increased by governmental participation which unfortunately still haven't reached its goal. Social workers provide great moral support to relatives of neurologically crippled patient's relatives which are one of the major aspects of their services.

In short, neuro criticare is a true team effort where people from all specialities participate actively with competence of their knowledge, for ultimate benefit of the patients. The difference between general intensive care unit and NCCU is its apex, where lies a person from the field of neurosciences who is well trained in attending and managing the neurological and neurosurgical emergencies, which leads to success in terms of reduction in mortality, morbidity, hospital stay, individual cost and ultimately loss to society.

In short, a specialised NCCU, is the need of time and especially so, for a tertiary level healthcare unit, which can affect neurological outcome in positive manner.

ca@sahyadrihospitals.com