Diagnosis and treatment
NICU treats a wide range of conditions. These include:
The team uses a wide range of diagnostic, monitoring and treatment techniques to help treat patients in the best possible way. We will be monitoring a variety of measurements, which can include:
Heart rate and rhythm
The levels of oxygen and carbon dioxide in the blood
Level of consciousness
Intracranial pressure (the pressure within the skull)
Cerebral perfusion pressure (the difference between the mean arterial pressure and the intracranial pressure, which gives an estimate of the amount of blood flow to the brain)
There will be tubes, wires and equipment around the patients. Many of our patients are on life-support machines. The unit staff can explain what these are and what they do.
Many of our patients come to us because they have had a serious head injury. Our priorities are to minimise any secondary injuries to the brain, which can be caused by inadequate blood pressure or lack of oxygen.
We might use a monitor to measure the pressure within the head (intracranial pressure) as the brain can swell following injury, or a clot of blood can develop due to bleeding within the brain or between the brain and the skull. We can control this pressure in several ways, including using drugs to heavily sedate and paralyse the patient, increasing their blood pressure, cooling, the use of specialist drains and surgery if needed.
To help patients to recover, we also have active rehabilitation programmes coordinated by the nursing and physiotherapy staff. Patients who have suffered a head injury often require long-term support. We have a head injury specialist nurse who is able to give support and advice to patients and families.
Patients who have suffered a spinal injury often need intensive or high dependency care. Our team’s priority is to prevent secondary damage to the spinal cord and to maximise the potential for recovery. Patients will be nursed, at least initially, with their spine kept straight and may have a collar on to minimise movement of their neck. Some patients will require surgical fixation of their injury whilst others can be left to heal naturally. All patients are managed by the intensive care staff in conjunction with one of the spinal surgeons (who may be a neurosurgeon or an orthopaedic surgeon).
Stroke, subarachnoid haemorrhage or intracerebral haemorrhage
Patients with a stroke due to a blockage in one of the arteries to the brain may be admitted to NICU for clot busting (thrombolysis) treatment. We have a 24-hour service for stroke thrombolysis and these patients require intensive monitoring for up to 24 hours after treatment. Thereafter patients will usually be transferred to the stroke unit for rehabilitation. The care of patients with a stroke is provided jointly by the stroke team and the ICU team.
Patients who have a brain haemorrhage will also often be admitted to NICU. This may be because they need careful monitoring or following treatment. A subarachnoid haemorrhage is a bleed into the subarachnoid space between the brain and its linings. These are often caused by an aneurysm of the blood vessel. An intracerebral haemorrhage is one that occurs into the substance of the brain itself and may be caused by high blood pressure or an arteriovenous malformation (an abnormal collection of blood vessels within the brain). Once a patient is stable they will often undergo an angiogram to get a ‘road map’ of the blood vessels in the brain and to see if there is an aneurysm or another cause that requires treatment. These treatments may be surgical (performed by a neurosurgeon) or done radiologically (by a neuroradiologist)
We have subarachnoid haemorrhage specialist nurses who are able to give support and advice to patients and families.
Guillain-Barré syndrome or myasthenia gravis
Patients with Guillain-Barré syndrome and myasthenia gravis may require NICU care because of difficulties swallowing or with fatigue of their respiratory muscles. Some may be transferred to receive specialist treatments (such as plasma exchange) that are not available on the wards.
Elective neurosurgical patients
Some patients are admitted to NICU because of the type or duration of the operation they are undergoing. These stays are often brief with the patient returning to the ward within 24 to 48 hours if all has gone well.