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Featured Program: Neurointensive Care in Liberec, Czech Republic

By Currents Editor posted 06-28-2018 16:44

  
By Vera Spatenkova, MD, PhD, head of Liberec NICU, the Academy of Neurointensive Medicine, and the Neurointensive Section of the Czech Society of Intensive Care Medicine

The neurointensive care unit (NICU) of the Neurocenter at the Regional Hospital in Liberec is the first combined neurological and neurosurgical intensive care unit in the Czech Republic. It is located in a 900-bed hospital with a catchment area of approximately half a million people.

Our NICU treats over 1,700 adult patients per year. From brain diseases, we focus mainly on stroke, because we are a complex cerebrovascular centre, one of 10 in the Czech Republic. Tumors are our second most common brain disease, and we accept fewer patients with trauma, hydrocephalus and status epilepticus. Our NICU also provides care for patients with spinal and spinal cord disease, both with and without operations.

The NICU has 18 beds and is divided into three parts: NICU A has five beds in a single room for neurological non-ventilated patients; NICU B has seven beds in a single room for neurosurgical and orthopaedic non-ventilated patients; and NICU C has six separate beds for neurological and neurosurgical patients who require mechanical ventilation. Four of these beds are situated in boxes, the other two in two isolation rooms that have preparatory rooms by their entrances.

Our NICU is led by neurointensivists who originally worked as anaesthetists-intensivists. In the Czech Republic, we do not have a unified system for training neurointensivists, who instead study one of three postgraduate medical fields: neurology, neurosurgery or anesthesiology-intensive care medicine. Our team has physicians from all three fields. Four work exclusively in this NICU, while the rest also work in other parts of the Neurocenter and Orthopaedics Department. Neurologist and neurosurgeon neurointensivists generally take care of non-ventilated patients, while anaesthetists-intensivists look after ventilated patients.

There are 41 nurses working 12-hour shifts exclusively in our NICU. They have a unified Czech postgraduate education system in anesthesiology-intensive care medicine. There are also hospital attendants, rehabilitation and logopaedic specialists.

The unit is fully equipped with bedside general monitoring, including non-invasive cardiac output monitoring, ultrasound and electric impedance tomography (EIT). From multimodality neuromonitoring, we have invasive measurement of intracranial pressure, brain temperature, cerebral microdialysis, invasive and non-invasive brain oxygen measurements, transcranial Doppler untrasonography and portable head CT. This neuromonitoring method is used as standard for patients with severe subarachnoid haemorrhage and brain trauma.

NCS_201806_Neurointensive1.jpgIn our NICU, we place great emphasis on quality control. We monitor patient safety by the daily recording of adverse events according to the Sentinel Events Evaluation (SEE) study of the European Society of Intensive Care Medicine. We have also implemented a preventive multi-modal nosocomial infection protocol monitoring hygienic, epidemiological status and antibiotic policy, which has led to very low rates of nosocomial infections (4.2 percent) and multidrug-resistant bacteria (extended spectrum beta-lactamase, ESBL 0.9 percent; Methicillin-resistant Staphylococcus aureus, MRSA 0.9 percent; nobody with Vancomycin-resistant enterococcus, VRE). There is a similar preventive strategy protocol for hypo and hypernatremia. The efficiency of these protocols has been verified in our published studies.

NCS_201806_Neurointensive2.jpgIn 2014, I initiated the foundation of the Academy of Neurointensive Medicine and the Neurointensive Section of the Czech Society of Intensive Care Medicine in Liberec. Because neurocritical care education is not fully integrated in our country but instead is split into three systems, we are striving to bring these three strands together through our Academy of Neurointensive Medicine. We hold regular workshops and training courses in neurocritical care for physicians from all over the Czech Republic. The world renowned neurocritical care specialist Associate Professor Dr. Raimund Helbok (Pic 6), Department of Neurology, Innsbruck Medical University, has twice been guest speaker at these events, where he gave workshops on multimodal neuromonitoring, and we are planning his third visit for November 2018. On April 30 2018, we held a workshop on safe mechanical ventilation led by Professor Marcelo Amato MD, PhD, from São Paulo, Brazil, who is the world leader in this field.

NCS_201806_Neurointensive3.jpgThe Liberec neurointensive care unit already has the highest quality and the best equipment in our country, and through the Academy of Neurointensive Medicine, we shall support the further development of neurocritical care in the Czech Republic.

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