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INTERNATIONAL NEUROCRITICAL CARE Developing Neurocritical Care Programs in Kuwait By Yasser Abulhasan, MBChB, FRCPC Like all high income nations, Kuwait is complex intracerebral hemorrhage (ICH), status epilepticus, grappling with population health problems decompensated neuromuscular diseases, and postoperative that are straining health systems. The top neurosurgical patients. three causes of mortality in Kuwait are ischemic heart disease at 24.2%, stroke Training programs were required to facilitate this change. We at 8.6%, and traffic injuries at 6.7%. An were fortunate to have had the opportunity to train all physicians increase in mortality among the three top rotating through the unit in neurocritical care over the past diagnoses was only seen in stroke between four years. In addition, expert neurocritical care nurses and a 2000-2012. nutritionist from the Montreal Neurological Hospital conducted two separate training courses one year apart. Both of these Despite doubling per capita expenditure on health care from $849 programs got funded by the Kuwaiti Ministry of Health and in 2002 to $1,500 in 2013 – paralleling a population growth from involved nurses and nutritionists from all major ICUs that deal 2.4 to 4.2 million – the actual life expectancy in Kuwait in both with neurocritical care patients. genders is 68 years compared to the overall life expectancy at birth in Kuwait which is 78 years for males and 79 years for females. The Ibn Sina Hospital main ICU is a specialized ICU with an The ten-year difference is due to time lost living with morbidity admitting capacity of 13 beds divided into seven neurological and disability. Compounding these problems are low oil prices beds and six pediatric beds that serve the entire State of Kuwait. and regional security that could destabilize funding for health The Neuro ICU is currently staffed with a neurointensivist from systems. the Faculty of Medicine at Kuwait University to maintain the collaborative ICU approach that was established in 2012. The The Kuwaiti government, a major funder of public health care ICU is also staffed with anesthesiologists, neurosurgeons, and services, harbors an ambitious health care modernization plan neurologists that round in a collaborative fashion. Out of 514 up to 2020 to revamp and implement vast expansion strategies in beds, the hospital has 120 neurosurgical and neurological beds, hospital bed capacity which includes modernization and growth five surgical suites, one of neuroscience. The majority of new hospitals are still in the neurointerventional planning and construction phase. suite, advanced CT and MRI scanners, Since 1981at Ibn Sina Hospital, neurosurgical and neurological outpatient clinics, cases were managed among others. It has a small ICU that and an epilepsy unit underwent multiple milestones. It adopted an open ICU concept among other facilities. which served patients from specialties such as neurosurgery, neurology, transplant, and ophthalmology. Patients were rounded ICU patients get upon by teams from different specialties and no set numbers rounded on by of ICU beds were dedicated to neurosurgical and neurological the neurocritical patients. Leadership was ill defined as availability of dedicated care team and the trained intensivists was sporadic and anesthesiologists had a admitting service consultant role. with the neurocritical care trained nurses at In 2012, the Anesthesia and Critical Care Council of the Kuwaiti the center presenting Ministry of Health designated the adult portion of Ibn Sina ICU the events of the as the Neurological Intensive Care Unit for the country thereby previous 24 hours. transferring non-neurological patients requiring ICU care to Patients get nearby general ICUs. They also approved the appointment of a neurointensivist with the responsibility of directing the unit and facilitating vital collaborations between the Departments of Anesthesiology and Critical Care, Neurosurgery, Neurology, and Neuroradiology. A collaborative ICU concept – a hybrid between a closed ICU and an open ICU – was incorporated with bed management maintained by the Neuro ICU team. Due to the limited number of beds and the growing demand for neurocritical care, admission criteria included complex neurovascular cases with special emphasis on aneurysmal subarachnoid hemorrhage (aSAH), 18


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