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Neurocritical care: why does it make a difference?

Kramer, Andreas H.a; Zygun, David A.b

Current Opinion in Critical Care: April 2014 - Volume 20 - Issue 2 - p 174–181
doi: 10.1097/MCC.0000000000000076
NEUROSCIENCE: Edited by Peter Le Roux

Purpose of review The care of critically ill brain-injured patients is complex and requires careful balancing of cerebral and systemic treatment priorities. A growing number of studies have reported improved outcomes when patients are admitted to dedicated neurocritical care units (NCCUs). The reasons for this observation have not been definitively clarified.

Recent findings When recently published articles are combined with older literature, there have been more than 40 000 patients assessed in observational studies that compare neurological and general ICUs. Although results are heterogeneous, admission to NCCUs is associated with lower mortality and a greater chance of favorable recovery. These findings are remarkable considering that there are few interventions in neurocritical care that have been demonstrated to be efficacious in randomized trials. Whether the relationship is causal is still being elucidated but potential explanations include higher patient volume and, in turn, greater clinician experience; more emphasis on and adherence to protocols to avoid secondary brain injury; practice differences related to prognostication and withdrawal of life-sustaining interventions; and differences in the use and interpretation of neuroimaging and neuromonitoring data.

Summary Neurocritical care is an evolving field that is associated with improvements in outcomes over the past decade. Further research is required to determine how monitoring and treatment protocols can be optimized.

aDepartments of Critical Care Medicine and Clinical Neurosciences, University of Calgary, Calgary

bDivision of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada

Correspondence to Andreas H. Kramer, Clinical Associate Professor, Department of Critical Care Medicine Foothills Hospital, McCaig Tower, 3134 Hospital Drive NW Calgary, AB T2N 2T9, Canada. Tel: +1 403 944 4749; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins