[Pathology requiring admission to the neurosurgical intensive care]

A patient's admission to an ICU should benefit the patient (either short or long term). Consequently patients admitted to the ICU should be only those neurological-neurosurgical ones with one or more organ failure who need immediate or prolonged therapy with adequate monitoring and technical support not available in other wards. Normally admission depends on may other factors, the most important ones seem to be medico-legal responsibilities of the possible refusal of admission even if due to clinical reasons, organizational problems such as equipment and bed availability. There is a need for pre- and post-surgical monitoring for high risk patients. We routinely admit patients to our ICU according to the following directions: respiratory and or cardio-circulatory failure connected to the neurological pathology, impaired consciousness, neurological signs and symptoms indicating deterioration, loss of airway protective reflexes, seizured in neurological-neurosurgical patients, severe electrolyte, metabolic or nutritional disturbances which may affect the CNS; neurosurgical postoperative control, performance of complex techniques (central venous and arterial catheterization, ICP monitoring), management of multiorgan donors suitable for therapeutic transplant. The groups of pathologies observed in our ICU during 1991 where the follow-up: 442 neurological-neurosurgical patients--head trauma 141 (32%)--cerebral tumours 88 (19.9%)--vasculopathies 135 (30.6%)--others 77 (17.5%). 228 (51.5%) patients stayed for a period less than three days. According to our experience we can affirm that causes for patient's admission to neuro-ICUs are various, the legal organizational reasons have a great importance compared to the clinical ones.