The field of medicine has always been in the state of constant evolution. Researchers have been relentlessly investigating challenging problems that appeared confusing and difficult to address both at the bedside as well as in the laboratories. As a result, clinicians have benefitted from learning new findings and elucidating previously equivocal and debatable issues. Along with remarkable advances in the recent years, particularly in the therapeutic aspect, the field of neurology is no longer considered merely a field of phenomenology and simply admiring the localization and neuronal circuits around it. Today, there are numerous acute and long-term therapies that are supported by scientific evidence of improving conditions of patients with illnesses in both central and peripheral nervous systems.
The idea of neurologic critical care is to provide acute medical therapies and appropriate interventions in a prompt fashion by monitoring the patients in one area by specially trained neurointensivists and nurses. It is by no means surprising to observe dedicated units with adequate staffing producing improved outcomes in both medical-surgical as well as neurologic intensive care units as people in critical condition require constant monitoring. As with many critical illnesses in general, acute brain injuries and other neurologic emergencies are complicated with time-sensitive matters. In order to provide adequate assessment and therapies without any delays, competency in being able to recognize acute changes in neurologic function cannot be overemphasized. By the same argument, other end organs in critical condition also require the same degree of close monitoring and rapid treatment. Patients with acute, severe brain injuries are often accompanied by other organ failures at the time of presentation and/or during the ICU stay. Priorities may differ between each case, but it is of paramount importance that all organs must be treated successfully in order to achieve favorable outcomes. For instance, it is physiologically impossible to improve brain oxygenation without addressing ARDS for a patient with both problems. It is true that as long as patients receive adequate care, it may not matter as to who is providing it. However, providing critical care medicine for a number of different injured organs by a system that requires consultants, who are not staffing the unit constantly, may possibly lead to delay in both diagnosis as well as providing therapy. Multiorgan failure needs a multidisciplinary team approach and adequate staffing. This text is written for that very reason. Readers will find that this book is not just about the brain. It is about all organ insufficiencies and failures along with neurologic illnesses in an effort to reflect the real-life challenges in a modern NeuroICU where care goes beyond the scope of classic neurology. The overall content is synthesized with another main concept: practicality. When an intensivist is faced with life-threatening neurologic and medical emergencies, pathophysiology and epidemiology are not as essential as step-by-step management plan. The flow of content is written with case-based, question-and-answer format in order to simulate the real life of making ICU rounds, which makes it easier and more interesting to read. By having 50 percent neuro and 50 percent critical care, this text may serve as a helpful tool in preparation for neurocritical care board certification examination, as well as for daily clinical work for anyone who provides critical care medicine for patients with acute brain injury and other organ failures.
Kiwon Lee, MD
New York City