neurointensive

Neurointensive care, also known as neurocritical care, is a medical specialty and hospital unit dedicated to the management of patients with life-threatening neurological or neurosurgical conditions. Neurointensive care units are typically staffed by neurointensivists—physicians trained in critical care with specialization in neurology or neurosurgery—along with specialized nurses, therapists, and pharmacists. The aim is to prevent secondary brain injury by optimizing cerebral blood flow, oxygen delivery, and metabolic support while monitoring for evolving complications.

Indications include traumatic brain injury, intracerebral and subarachnoid hemorrhage, ischemic stroke, spinal cord injury, status epilepticus, brain tumors with mass effect, post-operative neurosurgical patients, acute coma or encephalopathy, and other severe neurologic emergencies or neuromuscular respiratory failure. Care focuses on advanced monitoring, hemodynamic optimization, respiratory support, and prevention of secondary insults.

Common monitoring modalities include intracranial pressure monitoring, continuous electroencephalography, arterial blood pressure monitoring, brain tissue oxygen monitoring, and, in some centers, microdialysis. Targeted management aims to maintain adequate cerebral perfusion pressure, control intracranial pressure, ensure sufficient oxygenation, and preserve normothermia. Sedation and analgesia are used to optimize comfort and reduce cerebral metabolic demand, with careful weaning guided by neurologic assessments. Ventilatory management seeks appropriate oxygenation and ventilation; fever control is frequently employed. Additional elements include glycemic control, nutrition, infection prevention, and strategies to prevent seizures or other secondary injuries.

The neurointensive approach relies on a multidisciplinary team and protocol-driven care, with emphasis on early rehabilitation, family involvement, and coordinated transition planning to lower levels of care and toward recovery. Research and multicenter registries contribute to evolving practices in neurocritical care.