Neurological Critical Care

Neurocritical care is a multidisciplinary specialty that focuses holistically on the intensive care management of patients with life-threatening and disabling insults to the brain, spinal cord, nerves, and muscles. Neurointensivists manage patients with acute illnesses such as stroke, brain trauma, and seizures (for more information, see the webpage of the Neurocritical Care Society). These patients have a wide array of complex medical, neurologic, and psychosocial needs that are best addressed in the collaborative and specialized environment of a neurointensive care unit.

The Neurology/Neurosurgery Intensive Care Unit (NNICU) at Barnes-Jewish Hospital is a world-class, state-of-the-art 20-bed facility that admits 2,000 patients each year with a variety of neurological and neurosurgical disorders. BJH is a Comprehensive Stroke Center and Level 1 Trauma Center that is consistently ranked as one of the best and busiest hospitals in the nation. Our NNICU admits more than 400 patients each year with hemorrhagic strokes including subarachnoid and intracerebral hemorrhage. It is staffed by Magnet-Certified and neuroscience-trained nurses and facilities for continuous EEG monitoring, non-invasive hemodynamic and cardiac monitoring, a portable brain CT scanner, and fiber optic bronchoscopy.

The NNICU is directed by Dr. Salah Keyrouz and staffed by four board and UCNS-certified neurointensivists. The section head of neurocritical care is Dr. Michael Diringer, past president of the Neurocritical Care Society. Medical care is enhanced by close collaborations with Neurology, Neurosurgery, and Interventional Neuroradiology as well as a full-time clinical pharmacist, six certified and experienced acute care nurse practitioners, four fellows, as well as rotating residents from the highly-rated neurology, neurosurgery, and emergency medicine training programs. The care provided by this neurocritical care team is routinely evaluated and scrutinized by quality improvement initiatives, and improved by implementation of clinical care protocols.

The NNICU has also long been the focus of NIH- and American Heart Association-sponsored research projects evaluating the pathophysiology of acute brain injuries. The unit is in the unique position of having a dedicated research PET (positron emission tomography) scanner located within the ICU itself, allowing the study of how best to optimize cerebral physiology in the most critically ill patients. We also have a full-time research coordinator and a database nurse who prospectively tracks quality initiatives within the unit. Research findings from our investigators have earned numerous awards including the “Best Scientific Abstract” award for research presented at the annual meetings of the Neurocritical Care Society for three consecutive years (2008-2010), and resulted in numerous important publications (for a list of recent publications).