FEATURED PROGRAM
Neurointensive Care in Liberec,
Czech Republic
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.
In 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.
In 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
38