Outcome in neurocritical care: advances in monitoring and treatment and effect of a specialized neurocritical care team.

OBJECTIVE: To review current advances in the treatment of critically ill neurologic patients, including specialized care by neurointensivists.
DESIGN: Review article. MAIN DISCUSSION AND
CONCLUSIONS: Significant developments in the fields of neurology and neurosurgery have led to improved treatments for the critically ill neurologic patient. The major areas reviewed include neuromonitoring, disease-specific treatments, and specialized neurocritical care units and team. The current trend is for the application of the so-called multimodality neuromonitoring, which includes the use of several monitoring techniques, including intracranial pressure, brain electrophysiology, brain metabolism and oxygenation, and cerebral blood flow, among others. Many new therapies that have been introduced are discussed, including thrombolytic therapy for acute ischemic stroke, induced hypothermia for comatose survivors of cardiac arrest, and endovascular coiling for ruptured cerebral aneurysms. Lastly, the introduction of neurointensivists and neurocritical care units has been associated with reduced hospital mortality and resource utilization without changes in readmission rates or long-term mortality rates.