Intensive care in the neurosurgical unit--a review of 2,492 patients

The experience with 2,492 patients treated during a 9-year period in a neurosurgical intensive care unit (NICU) integrated into the ordinary neurosurgical wards is reported. The basic admission criterion was the need for ventilator treatment. During the period studied, the stay in the NICU decreased from a mean of 17 to 10 days. With respect to diagnosis, the largest group was patients with brain injuries (36%), followed by subarachnoid hemorrhage (24%), other intracranial bleeding (17%), and tumors (15%). Treatment consisted mainly of controlled ventilation, the duration of which ranged between 1 and 93 days with a mean of 5 days. Invasive monitoring was done relatively seldom, primarily due to a lack of equipment and staff. The incidence of nonneurosurgical complications was low, and the clinical outcome satisfactory. Nevertheless, it is concluded that for the best care of the severely ill neurosurgical patient, a special, well-equipped NICU with an adequate number of highly qualified staff members closely attached to the neurosurgical clinic is crucial.