Neurointensivists

Neurointensivists are physicians who specialize in the care of patients with life-threatening neurological and neurosurgical conditions in intensive care units. The field, neurocritical care, focuses on preventing secondary brain injury and optimizing cerebral physiology in conditions such as traumatic brain injury, ischemic and hemorrhagic stroke, subarachnoid hemorrhage, intracranial pressure abnormalities, spinal cord injuries, status epilepticus, brain tumors, and postoperative neurosurgical patients.

Training and certification: Most neurointensivists complete a residency in internal medicine or pediatrics, followed by a critical care fellowship, and then a neurocritical care fellowship. Certification may be offered by subspecialty boards such as the United Council for Neurological Subspecialties or equivalent bodies, depending on the country. Practice patterns vary by region.

Role and responsibilities: They lead multidisciplinary teams in neurocritical care units, overseeing advanced monitoring such as intracranial pressure measurement, brain tissue oxygen monitoring, continuous EEG, and multimodality neuromonitoring. They manage ventilation, sedation, temperature control, glycemic and electrolyte balance, nutrition, delirium prevention, and early rehabilitation planning, and they coordinate with neurosurgery, neurology, neuroradiology, anesthesiology, nursing, and rehabilitation services. They also engage in prognosis discussions and end-of-life care when appropriate.

Impact and settings: Neurointensivists work in major academic centers and specialized hospitals, often in collaboration with researchers to improve outcomes after brain injury and stroke. The specialty emphasizes protocol-driven care, quality improvement, and participation in clinical trials to expand evidence-based practices in neurocritical care.