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Neurological Intensive Care
NewYork-Presbyterian Hospital developed one of the first Neuro ICU programs in the country and is the only academic Neuro ICU center in the area. Because it is an academic center, patients here may have access to the latest investigational treatments. The state-of-the-art Neurological Intensive Care Unit (neuro-ICU), located at NewYork-Presbyterian Hospital/Columbia University Medical Center, founded in 1983, is one of the oldest programs of its kind in the United States. The neuro-ICU unit at NewYork-Presbyterian Hospital/Weill Cornell Medical Center moved into new facilities housing an extensive designated opened in November, 2003.
In addition to a rich concentration of neuro-ICU resources, NewYork-Presbyterian Hospital enjoys a luxury few centers can boast – several experienced neurointensivists – that make the Hospital a major transfer center.
Our Neuro ICU's expert team of physicians and nurses has extensive training and experience in both neurology and critical care. They provide round-the-clock surveillance, state-of-the-art monitoring technology, and specialized treatments aimed at minimizing any immediate or delayed brain damage and maximizing a patient's chance for full recovery.
For patients with severe neurological conditions that can threaten both survival and brain function, the neurological intensive care unit (NICU) and the specialists who staff it are the last line of defense against neurological damage. Examples of these conditions include:
- subarachnoid hemorrhage
- ischemic stroke,
- status epilepticus,
- traumatic brain injury
- certain serious neuromuscular disorders (myasthenia gravis or Guillain-Barre´ syndrome, which can cause life-threatening paralysis)
- tumors or infections of the brain or spinal cord
But with the national shortage of neurointensivists and the rarity of dedicated NICUs, few centers have the expertise and technology to provide the necessary care. High-volume centers with the appropriate specialists and equipment, such as NewYork-Presbyterian Hospital, are essential in the care of these patients.
The primary goal of neurological intensive care is the preservation of as much brain function as possible. Every bit of brain matter saved increases function and the possibility that neural plasticity will contribute to a greater recovery. While we can't undo what brain damage already suffered, we can minimize the amount of continuing damage that can occur over hours, days, or even weeks during or following the crisis.
Before the advent of the NICU, patients were given life support and little chance at recovery. Neurointensivists at NewYork-Presbyterian Hospital advocate doing everything possible – a "full court press" – to preserve brain function and the possibility of a recovery.
There is equipment unique to the NICU, but the most important difference between Neuro ICUs and other ICUs is the expertise of the specialists staffing it. From the nurses to the physicians, the staff of the NICUs at NewYork-Presbyterian Hospital have extensive training and experience in both neurology and critical care.
Through years of experience, neurointensivists become experts at recognizing the conditions under which the brain is at risk and making connections between clinical findings and potential neurological outcomes. And they can do it fast.
Neurointensivists are comfortable with specialized agents, such as those used for long-term sedation, and tools, including intracranial pressure (ICP) monitors. Also, they are adept at marshalling experts in other specialties-neurological surgery, epilepsy, endovascular surgical neuroradiology-to consult when necessary.
Diagnostic Innovations
To implement their approach, neurointensivists have a suite of diagnostic and therapeutic tools that are not found in other ICUs.
NewYork-Presbyterian Hospital's Neuro ICU maintains an arsenal of sophisticated monitoring and diagnostic techniques designed to identify critical problems before permanent neurologic injury occurs. These include:
- Intracranial pressure monitoring, including intraventricular catheters, fiberoptic monitors, subarachnoid bolts, and epidural monitors
- Transcranial doppler (TCD) ultrasonography.
- Single photon emission computerized tomography (SPECT).
- Computed Tomography (CT) Perfusion Imaging.
- Continuous electroencephalogram (EEG) monitoring.
- Invasive hemodynamic monitoring.
- Near-infrared (NIR) spectroscopy.
- Jugular venous oxygen saturation monitoring.
- Continuous brain tissue monitoring and cerebral blood flow probes.
Therapeutic Excellence
Where intensivists are concerned primarily with survival, neurointensivists overlay that concern with a primary interest in brain function, because once brain damage occurs, it is irreversible and untreatable and can compromise severely the patient's quality of life.
In centers without a Neuro ICU or neurointensivist, neurologists are secondary caregivers and intensivists in other specialties often treat brain problems suboptimally. For example, subarachnoid hemorrhage can cause overdrive in the sympathetic nervous system that can injure the heart, an effect that resembles myocardial infarction. Many intensivists will protect the heart, exposing the brain to increased risk of damage from reduced blood flow. From experience, the neurointensivists of NewYork-Presbyterian Hospital know that the hearts in these patients can be pushed, if necessary, to resuscitate the brain, and that the patients can recover heart function later.
While this approach – saving the brain at the expense of the function of other organs – can be laden with risks, it offers the best chance for recovery to some of the sickest neurological patients.
The Neuro ICUs at NewYork-Presbyterian Hospital also are equipped to administer intra-arterial thrombolysis for acute ischemic stroke patients, endovascular coiling for aneurysms, carotid angioplasty and stenting to maintain blood flow to the brain, and plasmapheresis for neuromuscular disorders.
Decompressive hemicraniectomy, a bold new lifesaving procedure that involves the removal of up to half of the skull to alleviate elevated ICP associated with massive strokes, was the subject of a recent National Institutes of Health (NIH)-sponsored trial in which Columbia University College of Physicians & Surgeons participated. Columbia researchers also are exploring the use of both thrombolytic and hemostatic agents for NICU patients with brain hemorrhage.
