Chairperson

Critical care

Neurocritical care as a new medical subspecialty has grown rapidly over the last twenty years. During the first half of the 20^th century, neurologists and neurological nurses were the first critical care practitioners to use on a large-scale mechanical ventilation to rescue thousands of patients affected by poliomyelitis epidemics. Respiratory monitoring and ventilation support are still the most common reasons for admissions of patients to the neurological intensive care unit (NICU). The major problem in the NICU is treatment of acute neurological diseases and prevention of all medical complications that determine survival and recovery. Time is a critical factor for rapid diagnoses and therapeutic interventions in many acute neurological disorders. The spectrum of neurological conditions that require critical care includes: traumatic brain and spinal card injury, hemorrhagic stroke (SAH, ICH), severe ischemic stroke, status epilepticus, neuroinfections, and neuromuscular disorders such as myasthenia gravis and Guillain-Barré syndrome. The care provided to these patients should be interdisciplinary and very often it includes: EMS personnel, emergency medicine physicians, neurologists, neurosurgeons, anesthesiologists, and critical care physicians.

It has been proven that the care provided by specially trained neuro-intensive care personnel improves survival, functional outcome and expenses for patients with neurological emergences, who require critical care. The neuro-intensive care physician needs to be trained in all of the skills expected of the general intensive care physician and in addition such physician should be also trained as clinical neuroscientist.

The well known shortage of neurologists is especially seen in emergency rooms and intensive care units. Emergency care requires a response within minutes or just few hours, frequently to the patients who have decreased level of consciousness, impaired airway protection, depressed cough and gag reflexes, respiratory muscle weakness, or who are having epileptic seizures.

Many neuro-intensive care physicians are already members of a recently created professional organization the Neurocritical Care Society, which has its own journal the Neurocritical Care.

The main goal of the EFNS Scientist Panel of Critical Care
is to provide neurocritical care support, research and education in all European countries. Currently the Panel consists of 27 members from 25 European countries (as of September 2009). The Panel will welcome new members. Neurologists and other physicians interested in the field of neurocritical care may wish to contact directly the Panel chairperson (preferably by e-mail).

In the past, members of Critical Care Panel contributed to publications of the EFNS Guidelines on cerebral venous thrombosis, status epilepticus and myasthenia gravis.

During the EFNS Congress in Madrid (2008) we organized Focused Workshop to discuss the current criteria for brain death determination, used in different European countries. It was concluded that EFNS, like other medical societies, has a duty to formulate and implement accurate evidence-based guidelines for the brain death determination. During EFNS Congress in Florence (2009) there will be a joint Teaching Course, organized in collaboration with the Scientist Panel of Neurotraumatology.