CHARLOTTE – When patients come to the neuroscience critical care unit at Novant Health Presbyterian Medical Center, they present with neurological diseases or injuries to the brain or spinal cord.
“Depending on the patient’s state on arrival to the unit, if surgery or intervention isn’t an option, there are different therapies that we can initiate to improve their outcomes,” said Laurie McWilliams, MD, medical director of the neuroscience critical care unit. “The purpose of the neuroscience critical care unit is the access for monitoring and resources, knowing time is brain. The frequent monitoring allows for early detection during a neurologic deterioration, allowing the team to mobilize resources to restore blood flow or reduce swelling while communicating with the interventionists or surgeons for definitive therapies, when indicated.
Here are five fast facts about the neuroscience critical care unit at Presbyterian Medical Center.
1. The neuro intensive care unit (ICU) is a closed unit.
Dr. McWilliams: “We transitioned to this model to ensure that every patient has one physician taking care of all of their medical issues. With our neurology background, we understand the needs of the brain and the spinal cord, in addition to being able to take care of other complications that may occur. “For example, a patient may come in with a stroke and a heart attack at the same time. We know there will be some competing forces because the brain needs the blood pressure elevated, but the heart can’t always take that stress. We’re able to determine the appropriate blood pressure goal to give the brain enough blood flow without putting too much demand on the heart.”
2. Multimodal monitoring is a critical aspect of patient care.
Dr. McWilliams: “We’re a full-fledged ICU. We can intubate our patients, place lines and perform bronchoscopies. We can also incorporate multimodal monitoring for the patients, helping understand the activity of the brain during neurological injury.”
Novant Health’s neuroscience ICU monitoring capabilities include:
- Different types of intracranial pressure (ICP) monitoring devices which measure pressure in the brain. One of the devices, an external ventricular device, measures intracranial pressures. The device also allows the drainage of the cerebrospinal fluid and medication administering, when indicated, to allow higher concentrations within the brain.
- Software with EEG monitoring provides a further level of detail about the depth of patient sedation, the level of blood flow and any changes to blood flow.
- Devices that measure oxygenation in the brain via catheter.
“In the end, for our patients with neurological injury, the brain needs time and rehab to get them to their new baseline.”
Laurie McWilliams, MD, Medical director of the neuroscience critical care unit at Novant Health
3. The rate of mortality for neuro ICU patients is lower than the rate for medical critical care patients.
Dr. McWilliams: “Patients come in after a catastrophic event, but if we can get them through the critical time point, their chances of survival and recovery increase. The majority of these neurological injuries are in areas of the brain where, once we get patients through the critical time period, other areas of the brain can take over and allow them to recover to a new level of functioning.”
4. Rounds are handled systematically, very similar to the academic model, to address all medical issues the patient could be encountering during their stay.
Dr. McWilliams: “We do multidisciplinary rounds that involve the attending, the advanced practice provider, the bedside nurse and our pharmacist. The model allows us to go in-depth with all the patient’s medical problems and allows input from all members of the team.”
5. Patient stays can last 24 hours to several days.
Dr. McWilliams: “Our job in the neuro ICU is to try to keep the medical complications at bay to allow the patients to be able to get to their next level of care, which is rehab. In the end, for our patients with neurological injury, the brain needs time and rehab to get them to their new baseline.”