Critical Care in Neurosurgery in Developing Countries

Abstract

Neurological patients managed in specialized intensive care units have better outcomes than those managed in general intensive care units. However, such management strategies cannot be applied to Nepalese healthcare entirely. Effective management is affected by its difficult geographical location (difficulty in transporting sick patients due to the lack of motorable roads and almost nonexistent effective air transport systems) and virtual nonexistence of neurointesivists in the country. While some ‘supplies’ for the treatment of serious neurosurgical patients are readily available (e.g. central venous pressure lines, arterial lines, ventricular drainage catheter etc.) in major neurosurgical centers in Nepal, others are scarce (e.g. adequate operating room capacity, intracranial pressure monitors, Swan Ganz catheters etc.). In this review an attempt has been made to distill the pertinent literature in the field and recommend what is applicable in the third world countries like Nepal where a profound physical and human resource constrains exist. In addition, realistic proposals for improvement of the current situation are made.