Intensive care unit (ICU)

Also known as a critical care unit (CCU), intensive therapy unit or intensive treatment unit (ITU) is a special department of a hospital or health care facility that provides intensive care medicine.

Intensive care units cater to patients with the most severe and life-threatening illnesses and injuries, which require constant, close monitoring and support from specialist equipment and medication in order to ensure normal bodily functions.

The critical care management of patients with life-threatening neurological conditions requires the ability to treat neurological injuries, manage medical complications and perform invasive procedures whilst balancing the management of the brain and the body.

Neurological emergencies carry significant morbidity and mortality, and it is necessary to have a multidisciplinary approach involving the emergency physician, the neurologist, the intensivist, and the critical care nursing staff. These disorders can be broadly divided into noninfectious and infectious etiologies. Neurological intensive unit, with emphasis on convulsive status epileptics, myasthenia gravis, Guillain-Barré syndrome, meningitis, encephalitis, and brain abscess 1).

Many patients in an intensive care unit may be unable to self-report their pain. In such cases, the use of observable indicators is recommended. Very little research has explored the validity of the use of behaviours and vital signs for pain assessment of neurocritically ill patients.

Postbrain surgery

A total of 43 postbrain surgery patients were video recorded before, during and 15 minutes after a non-nociceptive (non-invasive blood pressure cuff inflation) and a nociceptive (turning) procedures. Their behaviours and vital signs were collected with a pre-tested behavioural checklist and a data collection computer connected to the bedside monitor. The patients' self-report of pain was obtained whenever possible.

A larger number of pain-related behaviours were exhibited by participants during the nociceptive procedure compared with the non-nociceptive procedure supporting discriminant validation. Among vital signs, only respiratory rate differed significantly between the two procedures. Regarding criterion validation, only behaviours were positively correlated with self-reports of pain.

Behaviours were found valid indicators of pain in neurocritically ill patients after elective brain surgery. Fluctuations in vital signs may suggest the presence of pain, but their validity for such use is not supported. They should only be used in combination with other validated pain assessment methods 2).

see Neurocritical care.

Temperature Management in Neurological and Neurosurgical Intensive Care Unit 3)

Ogbebor O, Tariq S, Jaber T, Super J, Bhanot N, Rana S, Malik K. Neurological Emergencies in the Intensive Care Unit. Crit Care Nurs Q. 2023 Jan-Mar 01;46(1):17-34. doi: 10.1097/CNQ.0000000000000435. PMID: 36415065.
Kapoustina O, Echegaray-Benites C, Gélinas C. Fluctuations in vital signs and behavioural responses of brain surgery patients in the Intensive Care Unit: are they valid indicators of pain? J Adv Nurs. 2014 Apr 21. doi: 10.1111/jan.12409. [Epub ahead of print] PubMed PMID: 24750262.
Lyden P, Brophy G, Deye N, Horn CM. Temperature Management in Neurological and Neurosurgical Intensive Care Unit. Ther Hypothermia Temp Manag. 2016 Nov 9. [Epub ahead of print] PubMed PMID: 27828761.
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