Global Neurointensive Care: A Field Yet to Be Born

Neurological conditions represent the leading cause of disability-adjusted life-years (DALYs) and the second leading cause of death globally, with more than 11 million deaths annually, 87% of which occur in low- and middle-income countries (LMICs). While global neurosurgery has emerged as a recognized field with dedicated frameworks for advocacy and action, the critical care continuum of neurological disease has been persistently overlooked. Global neurointensive care (GNIC) does not yet exist as a formally defined discipline, yet its need is urgent and measurable: ICU bed density in LMICs ranges from 0.1 to 2.5 per 100,000 inhabitants compared with 5 to 30 per 100,000 in high-income countries (HICs); a cross-sectional survey of 408 providers from 42 LMICs found that only 36.8% had access to a dedicated neurointensive care unit; and traumatic brain injury (TBI) mortality at 6 months exceeds 37% in Latin American LMICs. This viewpoint defines GNIC, characterizes the epidemiological and structural dimensions of the unmet need with granular supporting evidence, reviews existing initiatives and their limitations, and proposes a 6-domain strategic agenda for its development. GNIC must be established as a field parallel and complementary to global neurosurgery, ensuring the critical care continuum of neurological disease is not abandoned in the global effort towards universal health coverage.