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Evolution of neurocritical care.

DOI:10.1097/MCC.0000000000000712 as ‘standard of care’ 20 years ago or even five years ago is now very different in 2020. In particular, neocritical care that focuses on the care of critically ill patients with acute brain and nervous system disorders has grown significantly. In 2000, there were few if any dedicated neurocritical care units (NCCU). Today, data from PRINCE, a multicenter, international, point-prevalence, cross-sectional, prospective, observational, noninterventional study suggests that over two-thirds of patients with neurocritical disorders are managed in dedicated in NCCUs although there remains significant geographic variability [1]. This is important as accumulating data suggests outcomes are improved when appropriate patients are admitted to a dedicated NCCU [2]. The reasons for this association between improved outcome and NCCUs are uncertain but in part are likely associated with advances in technology, diagnostic tools, and care; better understanding of pathophysiology and organization of care. In this edition of Current Opinion in Critical Care (COCC), we have chosen to review ten topics that include prehospital care, diagnosis and monitoring, surgery, pharmacology, and ICU care that until recently were nonexistent, not – feasible or not well appreciated. First, mobile stroke units (MSUs) are described. The MSU concept was first introduced in 2003 but it is only in recent years that MSUs have proliferated with a clear realization that ‘time is brain,’ and with advances in information technology and portable CT scanners. This concept is still evolving and rather than only help in stroke care may gradually morph into a neuro-ER or ICU that is taken to the patient for all types of acute brain injuries [3,4]. Second, in daily practice, the challenge for intensivists is to identify patients who are at risk for secondary injury, determine disease severity, and distinguish responders from nonresponders to therapy. Biomarkers can help answer these challenges, for example, troponin in cardiac disease. Although biomarkers have been used for many years in brain injury interest in their use has increased since the FDA-approved biomarkers (UCH-L1 and GFAP) in early 2018 to help evaluate mild traumatic brain injury (TBI). In addition, the recent advent of