General medical care on the neuromedical intensive care unit.

The role of an intensive care unit is to maintain a patient’s normal physiological homeostasis while actively treating the underlying cause of any physiological derangement. Modern neurological intensive care evolved from the neurorespiratory units established in the 1950s to treat patients with respiratory failure caused by poliomyelitis. Thus there has been greater emphasis on the longer term care of the paralysed patient than in the conventional general medical intensive care unit. This review attempts to give an overview of the management of patients treated in the neuromedical intensive care unit (NICU) and is directed towards the general neurologist rather than the intensivist. More detailed texts of neurological and general intensive care are available. Discussion will be targeted towards a number of areas: c respiratory system c cardiovascular system c alimentary system c nosocomial infection and infection surveillance c anticoagulation c patient comfort.