Neuro HDU

The neurology department at Aster Hospitals has state-of-the-art specialized care units called High Dependency Units (HDUs). Neurointensivists in an HDU provide specialized, round-the-clock care to at-risk neurological patients after they have recovered from an acute episode, such as a stroke or head injury. The HDU at Aster Hospitals provides continuous specialized nursing care and immediate access to emergency treatment measures, thereby improving treatment outcomes after an emergency episode or post-surgery.

After recovering from the first ICU episode, some patients are still at risk of deterioration or developing complications. They need 24-hour specialized nursing care and immediate access to emergency treatment measures. Neurology HDUs serve as intermediary units for the patients discharged from ICU, but need more care than that given in a general ward. HDUs are also called step-down units or intermediary care areas.

Benefits of neurology HDU

Neurology HDUs are essential in managing severe neurological conditions admitted in the emergency and ICUs, specifically after recovery from an initial episode.

Neurology HDUs benefit people as they provide the following:

• Round-the-clock specialized nursing care
• Invasive monitoring care
• Facilities of short-term emergency treatment equipment, such as a mechanical ventilator, oxygen supply, and many more
• Facilities for frequent interventions and therapies that are not available in the general wards
• Support for patients who continue to be at high risk for deterioration, even after initial recovery in ICU
• Higher nursing care due to a higher nurse-to-patient ratio
• Sharing the burden of ICU while providing short-term emergency facilities similar to ICU
• Increased patient satisfaction due to the level of care given
• Lesser postoperative infections
• Cost-effective for the hospital as well as the patient
• HDUs close to the ICU hold additional advantages, as the ICU staff can attend to a repeat emergency episode or acute complications without delay.

Who needs neurological HDU care?

Acute neurological conditions are complex and often require long-term observation and monitoring. The acute stage neurological critical care and treatment is provided in the intensive care units. Doctors may still want to monitor them round the clock, beyond the recovery from an acute episode of medical or surgical conditions. Here, HDUs are the best option, offering round-the-clock intense observation and monitoring of high-risk neurology patients 

Shifting from ICU to HDU involves two approaches:

• The step-up approach involves transferring the patient from the general neurology ward to a neurology HDU on the development or predictability of complications. If needed, a step-up approach can also be employed to transfer from HDU to ICU.
• The step-down approach is when the patient is shifted to HDU from ICU as the condition improves and is not in a critical state. But there is a predicted risk of another episode or complications. The criteria for the step-down approach include clinical stability for at least 24 hours in ICU.

HDUs are unsuitable for admission if more than one body organ has a problem. Chronic neurological conditions without an acute episode do not need care in HDUs.

The main difference between ICU, HDU, and general ward care is the ratio of the nurse to the patient. In the ICU, it is one-to-one; in the HDU, it may be two-to-one in the general ward, and it may be two nurses for 30 patients.

The criteria analyzed by the doctors before discharging the patient from the ICU and shifting to HDU runs as follows:

• Checking for any physical or psychological problems
• Predictability of risks
• Control of acute conditions, such as convulsions
• Haemodynamics stability
• Breathing stability
• Bleeding control
• Consciousness status
• Intracranial pressure maintained
• Brain perfusion

Once the condition becomes stable in HDU and the risk predictability is low, doctors transfer them to the general ward for further care and treatment.

Health Conditions Treated

• Severe brain injury
• Spinal cord injury  
• Brain hemorrhage
• Stroke
• Seizures
• Paralysis or paraplegia
• Impaired consciousness like coma or semi-comatose condition
• Acute respiratory failure in neurological disease
• Peripheral neuropathies such as Guillain Barre syndrome
• Post-operative care after intracranial surgery.