The Early Days of the Neurosciences Intensive Care Unit

Abstract

The development of critical care as a specialty and the formation of intensive care units (ICUs) have been well chronicled. The history of ICUs can be approached from different angles: history of units, history of technology, history of understanding and refinements of specific critical illnesses, history of critical care treatments, and even a history of ethics in the ICU. Specialized units were needed with increasing medical and surgical specialization; surgeons were operating on sicker patients with more sophisticated procedures, necessitating a higher level of perioperative observation and care. More generally, physicians and nursing staff recognized that skilled care and increased vigilance could improve outcome. A definitive moment was the emergence of several paralytic poliomyelitis epidemics, including in the United States. In the 1950s, these epidemics resulted in a rapid expansion of ICUs across the United States. These epidemics also led to improvement in mechanical ventilation and were followed by the further characterization of multidisciplinary ICUs, trauma units, transplant units, and postoperative care units. In the early 1970s, the vast majority of large medical institutions had ICUs constructed in their hospitals. The history of neurosciences intensive care units (NICUs) has remained fragmented and insufficiently researched. Neurosurgeon Walter Dandy has been credited with opening the first NICU at Johns Hopkins Hospital in 1932. Indeed, Dandy had the foresight to understand that some neurosurgical patients needed special care, and thus he opened a special ward dedicated to the care of the sicker postoperative neurosurgical patients. In the United Kingdom, the Batten Respiratory Unit at the Institute of Neurology and National Hospital for Nervous Diseases in London opened in 1954 to treat mostly patients with acute neuromuscular disease but also those with stroke and spinal cord disorders who required mechanical ventilation. The beginnings of NICUs, and combined neurology and neurosurgery ICUs, are largely unknown. Many of these first units were for either neurosurgical or neurologic patients. In a broader sense, little is known about the triage of patients with acute neurologic conditions in those days. This vignette explores the development of the NICU in Saint Marys Hospital, Rochester, MN. We discuss the early beginnings of neurosciences intensive care and the role of the nursing division and specialty groups in the 1950s.