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Neurocritical Care ICU of the Future Improves Care for Neurocritical Patients STORY HIGHLIGHTS With professional certification, fellowship accreditation and increasing national recognition, neurocritical care has grown significantly as a subspecialty. As understanding has grown that silent, nonconvulsive seizure activity leads to poor outcomes, continuous EEG monitoring has become the standard of care in neuro ICUs. The emergence of neurocritical care as a recognized subspecialty over the last two decades has led to the development of comprehensive centers for neurological emergencies where significantly better outcomes can be achieved than from general intensive care units. Paul Vespa, MD, professor of neurosurgery and neurology at the David Geffen School of Medicine at UCLA and director of UCLA Health’s Neurocritical Care Program — which has received the center of excellence designation — discusses the state of the field. How has neurocritical care evolved in recent years? Neurocritical care has grown significantly as a subspecialty in the 21st century, with the development of professional certification, accreditation for neurocritical-care fellowship programs, and the recent recognition by the nonprofit medical quality watchdog Leapfrog Group that neurocritical-care specialists are essential for critically ill brain patients. We used to consider neurocritical care to be a postoperative ward where patients would go just to recover from surgery. They were treated like other critical-care patients with Paul Vespa, MD UCLAHEALTH.ORG 1-844-4UCLADR (1-844-482-5237) heart monitoring, and if they didn’t wake up it was just assumed the prognosis was poor and they were going to die. What has emerged is a brain-specific treatment for these patients. At programs such as ours, it has become critical care for the brain rather than critical care for the heart. What do you mean by that? While traditional critical care monitors the heart with an EKG, neurocritical care uses an EEG to monitor the brain. If we have a patient who is in a coma, for example, rather than focusing only on monitoring blood pressure, heart rate and cardiac arrhythmias, we will administer