Abstract
- The complexity of neurocritical care requires a shift from traditional, discipline-specific practice toward a collaborative, interdisciplinary model. This review explores the conceptual and practical framework of interdisciplinary collaboration in neuro-intensive care units, examining the roles of key specialists including neurosurgeons, neurologists, intensivists, pharmacists, nutritionists, and rehabilitation experts. We discuss the benefits of coordinated care in improving patient-centered outcomes, reducing morbidity and mortality, and enhancing intensive care unit efficiency. Emerging evidence supports the integration of neurointensivists, structured communication tools, and team-based decision-making as essential components of modern critical care delivery. This article provides a comprehensive review of current strategies and proposes directions for advancing interdisciplinary practice in neurocritical care settings.
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Key Words: critical care; neurointensivist; neurologist; neurosurgeon; pharmacist; rehabilitation
INTRODUCTION
Neurocritical care has evolved dramatically over the past two decades. Once characterized by the isolated management of intracranial pathologies, it now encompasses a wide array of complex clinical scenarios involving hemodynamic instability, respiratory failure, metabolic disturbances, and prolonged functional impairment. The traditional model of care—defined by siloed contributions from individual specialists—has proven insufficient to address the interconnected needs of this patient population. Increasingly, there is recognition that only through interdisciplinary collaboration can clinicians deliver comprehensive, responsive, and high-quality care in the neuro-intensive care unit (neuro-ICU) [1,2].
By design, neurocritical care units are inherently multidisciplinary in nature. Within academic medical centers, the neurocritical care team typically comprises resident physicians from a range of specialties—most commonly neurology, neurosurgery, and anesthesiology—as well as neurocritical care fellows. In both academic and non-academic healthcare settings, advanced practice providers also play an integral role in patient management [3]. The broader interdisciplinary team extends well beyond physicians to include intensive care nurses with specialized expertise in critical care, clinical pharmacists with training in neuropharmacology, respiratory therapists, physical and occupational therapists, speech-language pathologists, case managers, social workers, and registered dietitians. Collectively, these professionals contribute diverse but complementary skill sets that are essential for delivering comprehensive, patient-centered care to individuals with severe neurological illness.
Given the inherent complexity and multisystem involvement characteristic of patients in the neuro-ICU, both medical and surgical interventions are indispensable components of comprehensive care. Moreover, the contributions of critical care nurses, clinical pharmacists, rehabilitation specialists, and other allied health professionals are integral to optimizing patient outcomes. As such, the management of neurocritically ill patients cannot be adequately addressed through a purely multidisciplinary framework, wherein disciplines operate in parallel. Rather, an interdisciplinary approach—characterized by active collaboration, shared decision-making, and unified treatment goals—is essential for delivering high-quality, patient-centered neurocritical care.
This review seeks to define the interdisciplinary model in the context of neurocritical care, clarify the roles of key team members, examine emerging tools that facilitate integration, and evaluate the current evidence supporting this approach. Practical considerations for implementation, along with future directions, will also be discussed.
FROM MULTIDISCIPLINARY TO INTERDISCIPLINARY CARE
A crucial conceptual distinction must be drawn between “multidisciplinary” and “interdisciplinary” care. While multidisciplinary teams are composed of diverse specialists working in parallel—each contributing their own recommendations and expertise—such efforts are often fragmented. Decisions are made sequentially, sometimes in isolation, and frequently without the benefit of real-time input from all stakeholders. In contrast, interdisciplinary care involves collaborative planning, shared goals, continuous communication, and collective decision-making [1,4].
Within the neuro-ICU, interdisciplinary care translates to joint bedside rounds, synchronized treatment plans, and dynamic reevaluation of patient priorities. It promotes cognitive diversity, reduces miscommunication, and supports more agile responses to deterioration. The transition from parallel to integrated care is not merely semantic—it is foundational to improving safety, efficiency, and patient-centered outcomes [2].
RATIONALE FOR INTERDISCIPLINARY COLLABORATION IN NEUROCRITICAL CARE
Neuro-ICUs across institutions globally adopt varying structural models, typically classified as open, closed, or semi-open/semi-closed configurations [5]. In open-unit models, individual physicians—often from different specialties—retain admitting privileges and maintain responsibility for the ongoing management of their patients. Conversely, closed units are characterized by centralized oversight, whereby a dedicated team of critical care providers assumes full responsibility for all patients within the unit. Although closed models are more resource-intensive, they are generally associated with improved coordination of care. While no definitive comparative study has been published specifically evaluating outcomes between these two models within neurocritical care settings, available evidence indicates that patients with acute neurological conditions experience superior outcomes when managed within specialized neuro-ICUs—particularly under the care of board-certified neurointensivists [1,6].
In contrast to exclusively medical or surgical ICUs, the neurocritical care environment demands a particularly high level of interprofessional collaboration, most notably between neurointensivists, neurologists and neurosurgeons. Achieving optimal patient outcomes in this setting is often dependent on the cultivation of mutual trust, professional respect, and joint participation in complex clinical decision-making processes. A nationwide mail-based survey conducted in 2013 targeting vascular, neurological, and cardiothoracic surgeons identified frequent conflicts between surgical teams and critical care physicians [7]. However, despite the recognized value of interdisciplinary integration, such collaboration is not without inherent challenges. These conflicts were most commonly related to divergences in treatment goals and disagreements regarding the management of patients with poor postoperative prognoses. Additional insights were offered by a 2015 investigation conducted across seven ICUs within a large tertiary academic medical center. This study revealed that, while intensivists, surgeons, and nursing staff generally demonstrated mutual professional respect, interpersonal conflict was more likely to arise in areas of overlapping clinical authority—particularly in the absence of consistent communication and coordinated rounding practices [8]. Notably, the implementation of structured interdisciplinary rounds was associated with a marked reduction in the frequency and intensity of such conflicts. In the context of neuro-ICUs, clinical disagreements frequently arise concerning the selection and timing of diagnostic or therapeutic interventions—whether medical, surgical, or procedural—particularly in cases involving complex or uncertain prognoses. Such decisions often require nuanced deliberation that incorporates prognostic assessment, evaluation of risk–benefit ratios, and careful consideration of ethical implications. Providing effective guidance to patients and their families in navigating these high-stakes decisions necessitates close, empathetic, and well-coordinated collaboration between neurosurgical and neurocritical care teams.
Patients admitted to the neuro-ICU often present with devastating conditions such as aneurysmal subarachnoid hemorrhage (aSAH), traumatic brain injury (TBI), intracerebral hemorrhage, ischemic stroke with malignant edema, and refractory status epilepticus. These pathologies are frequently accompanied by systemic complications, including acute respiratory distress syndrome, sepsis, cardiac arrhythmias, renal failure, and critical illness polyneuropathy. Moreover, their clinical courses are unpredictable and highly dynamic, with rapid deterioration often requiring immediate, coordinated interventions [1,9]. No single specialty possesses the requisite expertise to manage this full spectrum of needs. Neurosurgeons may excel at surgical decision-making and intracranial pressure (ICP) management but may not be best equipped to oversee ventilation strategies or nutritional plans. Conversely, intensivists bring extensive knowledge of hemodynamic support and sedation but may lack the neurosurgical perspective necessary for critical operative decisions. Only through an interdisciplinary framework can such diverse but essential perspectives be synthesized into cohesive patient care [2,4].
ROLES AND RESPONSIBILITIES WITHIN THE INTERDISCIPLINARY TEAM
Optimal care in the neurocritical care unit necessitates a coordinated, interdisciplinary approach, wherein each team member brings a distinct yet complementary expertise. The core team typically comprises neurosurgeons, neurologists, neurointensivists, ICU nurses, critical care pharmacists, clinical nutritionists, and rehabilitation therapists. Together, these professionals collaborate to address the multifaceted needs of critically ill neurological patients (Figure 1).
Neurosurgeons
The responsibilities of neurosurgeons in the neurocritical care unit extend well beyond the confines of the operating theater. While their role in surgical decision-making remains central—particularly in determining the timing and appropriateness of operative intervention—they also serve as vital contributors to postoperative and longitudinal management. Surgical procedures frequently encountered in the neuro-ICU context include hematoma evacuation for intracerebral or subdural hemorrhage, decompressive craniectomy for malignant cerebral edema, aneurysm clipping or coiling for cerebrovascular pathology, tumor resection, and complex spinal or functional neurosurgical procedures [4,9-11].
Following surgery, neurosurgeons are integral to the postoperative care of patients with cerebrovascular disease, neuro-oncologic conditions, and spinal cord pathology. Their expertise is essential in managing complications such as elevated ICP, cerebral edema, hydrocephalus, seizures, and neurological deterioration. Neurosurgeons often lead decisions regarding cerebrospinal fluid diversion strategies, including external ventricular drainage or lumbar drainage, and frequently determine the need for imaging follow-up and neuromonitoring adjustments. In the ICU setting, neurosurgeons routinely perform bedside procedures such as the insertion of intraparenchymal or intraventricular ICP monitoring catheters [12]. They interpret neuromonitoring data in the broader clinical and radiological context, allowing for timely interventions that may prevent secondary brain injury. Unlike providers who rely solely on numerical data, neurosurgeons contribute an invaluable perspective derived from direct intraoperative visualization of pathological anatomy—for example, having observed a swollen or ischemic brain during surgery, they may question a falsely reassuring ICP reading or identify subtle signs of deterioration that others may overlook.
Their firsthand familiarity with the intraoperative appearance of cerebral and spinal pathology enhances their ability to contextualize postoperative changes and critically assess imaging findings. This operative insight is particularly important in complex cases where standard monitoring metrics may be misleading, or where aggressive intervention must be weighed against the structural integrity of previously visualized tissue.
Neurologists
Neurologists are essential members of the interdisciplinary neurocritical care team, particularly in the management of seizures, post-operative neurological deficits, and disorders of consciousness. Their expertise in electroencephalography (EEG) is critical for the detection and characterization of seizure activity, including non-convulsive status epilepticus—a frequent, often underdiagnosed cause of neurological deterioration in critically ill patients. Studies have reported that non-convulsive status epilepticus occurs in approximately 10%–30% of comatose or stuporous patients in the ICU, with particularly high prevalence in those with SAH, TBI, and post-craniotomy states [13-16]. This underscores the vital importance of early and continuous EEG monitoring in the neuro-ICU to guide timely antiepileptic treatment and prevent secondary neuronal injury.
In addition to seizure management, neurologists play a central role in both the treatment and prevention of cerebral infarction—particularly delayed cerebral ischemia following SAH or ischemic events related to large vessel occlusion or cardioembolism. Their input is often crucial in formulating individualized antithrombotic strategies, interpreting advanced neuroimaging, and conducting serial neurological assessments to detect subtle clinical changes. Moreover, neurologists are often responsible for guiding neuroprotective strategies and determining candidacy for revascularization therapies. Although clinical perspectives may occasionally differ between neurologists and neurosurgeons—particularly regarding timing of intervention or the use of antiplatelet and anticoagulant therapies—such interdisciplinary discourse typically enhances diagnostic precision and fosters more balanced, patient-centered decision-making [4,9]. Through their specialized expertise, neurologists significantly contribute to the prevention of secondary brain injury and the overall quality of neurocritical care.
Neurointensivists
Neurointensivists function as systemic integrators within the neurocritical care environment, overseeing the complex physiological interplay between the injured brain and the rest of the body. Their core responsibilities encompass the management of mechanical ventilation, titration of sedation and analgesia protocols, administration of vasoactive and inotropic agents, and the interpretation of advanced hemodynamic monitoring modalities such as pulse contour cardiac output (PiCCO) and Swan-Ganz catheter-derived measurements. These tools enable precise optimization of cerebral perfusion pressure (CPP) and systemic hemodynamics, which are essential in preventing secondary brain injury [1,2,4].
A critical aspect of neurointensivist-led care involves comprehensive respiratory management. Due to impaired levels of consciousness, many neurocritically ill patients are unable to maintain airway patency or effectively clear secretions, predisposing them to ventilator-associated complications such as pneumonia and acute respiratory distress syndrome [17,18]. Aspiration, atelectasis, and neurogenic pulmonary edema are also frequently encountered [19,20]. Consequently, proactive lung-protective ventilator strategies—including appropriate use of positive end-expiratory pressure, low tidal volume ventilation, and meticulous secretion management—are essential components of care [19]. Respiratory failure is not merely a coincident pathology, but a primary determinant of ICU morbidity and mortality in this population.
Infectious complications are also common in the neuro-ICU, with ventilator-associated pneumonia, catheter-related bloodstream infections, urinary tract infections, and enterocolitis representing frequent and often overlapping challenges [21]. Immunosuppression secondary to severe neurological injury, combined with prolonged hospitalization and invasive monitoring, further increases vulnerability to sepsis and multiorgan failure. As such, neurointensivists play a pivotal role in early infection detection, empiric antimicrobial stewardship, and source control. Additionally, patients may experience various forms of circulatory shock—including septic, hypovolemic, cardiogenic, or neurogenic shock—all of which require nuanced hemodynamic monitoring and tailored resuscitation strategies. These systemic derangements, if uncorrected, can exacerbate cerebral ischemia and worsen neurological outcomes [22-24].
Ultimately, the neurointensivist’s ability to synthesize neurological priorities with systemic stabilization measures is indispensable. Through vigilant cardiopulmonary management, infection control, and metabolic optimization, neurointensivists not only preserve organ function but also enhance the likelihood of meaningful neurological recovery. The increasing inclusion of dedicated neurointensivists in neurocritical care units has been associated with improved survival, reduced ICU length of stay, and enhanced functional outcomes [1,2,4].
Neuro-ICU Nurses
Neuro-ICU nurses are the frontline providers of continuous, high-acuity care in neurocritical settings, serving as both clinical executors and coordinators within the interdisciplinary team. Their role extends well beyond traditional nursing functions, encompassing advanced neurological assessments, interpretation of ICP trends, titration of vasoactive infusions, seizure surveillance, and early detection of subtle neurological deterioration. Given the rapidly evolving and time-sensitive nature of neurocritical conditions, the vigilance and responsiveness of nurses are often pivotal in initiating timely interventions and escalating concerns to the broader medical team.
A core responsibility of neuro-ICU nurses is the implementation and maintenance of neuromonitoring protocols. This includes calibration, troubleshooting, and trend documentation of devices such as external ventricular drainages, intraparenchymal ICP monitors, cerebral perfusion monitors (e.g., pressure reactivity index [PRx]), and continuous EEG. Their capacity to synthesize physiological data—such as correlating abrupt changes in ICP with posturing or altered level of consciousness—enables rapid clinical responses that may prevent secondary brain injury.
A systematic review of 20 ICU-based studies revealed that lower nurse-to-patient ratios significantly reduce hospital mortality by 14%, shorten ICU lengths of stay, and improve infection control and patient satisfaction [25]. Conversely, elevated workloads correlate with increased adverse events and diminished patient safety. A study evaluating the presence of a certified nurse specialist as ICU head nurse demonstrated significant reductions in ICU mortality (odds ratio [OR], 0.52) and mechanical ventilation rates (OR, 0.20), underscoring the influence of advanced nursing leadership on critical care outcome [26].
Pharmacists
Critical care pharmacists contribute significantly to medication safety, therapeutic drug monitoring, and individualized dosing—especially in patients with renal or hepatic dysfunction. In neurocritical care, they play a vital role in managing antiepileptic drugs, sedation agents, anticoagulation protocols, and parenteral nutrition. Studies have demonstrated that pharmacist involvement leads to a measurable reduction in drug-related problems, decreased prescribing errors, and improved documentation [27,28]. Critical care pharmacists play an essential role in optimizing pharmacotherapy within the neuro-ICU, contributing significantly to medication safety, therapeutic drug monitoring, and individualized dosing strategies—particularly in patients with renal or hepatic dysfunction. In the context of neurocritical care, their responsibilities often encompass the management of antiseizure medications, sedative and analgesic regimens, anticoagulation protocols, and parenteral nutrition support.
Patients with acute neurological injuries—such as ischemic or hemorrhagic stroke—frequently require prolonged ICU stays due to the complexity of their clinical course. As a result, many of these individuals are exposed to extended durations of pharmacologic therapy, increasing the likelihood of cumulative drug toxicity, adverse effects, and drug–drug or drug–disease interactions [29,30]. For example, sedatives, antiseizure drugs, and vasopressors may accumulate or exhibit altered pharmacokinetics in critically ill patients, particularly in the presence of organ dysfunction. Close pharmacist surveillance is therefore crucial to ensuring both therapeutic efficacy and the early detection of complications. Studies have demonstrated that the involvement of critical care pharmacists leads to a substantial reduction in drug-related problems, fewer prescribing errors, and improved documentation practices [30,31]. In addition, pharmacist-driven interventions have been shown to enhance antimicrobial stewardship, improve nutritional support, and reduce ICU costs through optimized medication use [31]. In the neuro-ICU setting, their specialized knowledge in neuropharmacology further enhances interdisciplinary decision-making and contributes meaningfully to patient safety and outcomes.
Nutritionists
Nutritional support, though often underemphasized in critical care, plays a vital role in the recovery and prognosis of neurocritically ill patients. Individuals with TBI or SAH commonly enter a hypermetabolic and catabolic state, requiring early and carefully tailored nutritional interventions [32]. Current guidelines recommend the initiation of enteral nutrition within 24 to 48 hours of ICU admission in hemodynamically stable patients, as early feeding has been associated with improved clinical outcomes, including reduced infectious complications, shortened ICU stays, and decreased mortality [27,33]. Nutritionists are instrumental in individualizing care plans that include caloric prescriptions, protein targets, micronutrient supplementation, and glycemic control—all of which are crucial for maintaining nitrogen balance, supporting immune function, facilitating wound healing, and preserving lean body mass. The administration of immune-modulating enteral formulations, such as those enriched with arginine, omega-3 fatty acids, and nucleotides, may further attenuate inflammation and promote neuroprotection [5].
Emerging evidence has highlighted a strong correlation between nutritional status and functional outcomes in stroke patients [34-36]. Malnutrition or delayed nutritional intervention has been independently associated with increased mortality, longer hospitalizations, and poorer neurological recovery in both ischemic and hemorrhagic stroke populations. This growing body of literature reinforces the need for proactive and continuous nutritional assessment and intervention as an integral component of neurocritical care.
Rehabilitation Therapists
Early mobilization and rehabilitation in the neuro-ICU play a critical role in mitigating the consequences of prolonged immobilization, including ICU-acquired weakness, critical illness myopathy, and long-term cognitive impairment [37,38]. However, the timing of rehabilitation interventions must be judiciously selected, as premature mobilization in the setting of elevated ICP or hemodynamic instability may pose clinical risks. To this end, rehabilitation physicians work in close coordination with neurosurgeons and intensivists to assess patient readiness, determine safe thresholds for mobilization, and develop individualized rehabilitation protocols tailored to neurological and systemic status. They also facilitate seamless transitions to post-acute rehabilitation centers equipped for complex neurological care.
Importantly, rehabilitation is not merely supportive but constitutes a central therapeutic modality in neurocritical care. A growing body of evidence supports that early initiation of structured rehabilitation following acute brain injury significantly enhances the likelihood of meaningful functional recovery [39,40]. Rehabilitation interventions—encompassing physical, occupational, and speech therapies—promote neuroplasticity, prevent secondary complications, and improve independence in activities of daily living. As such, rehabilitation represents one of the few interventions capable of directly influencing long-term neurological outcomes in patients with acquired brain injury. Accordingly, early and sustained rehabilitation is now regarded as a cornerstone of recovery and a key determinant of post-ICU quality of life and functional independence.
MANAGING INTERDISCIPLINARY CONFLICTS THROUGH STRUCTURED ROUNDS
In real-world neuro-ICU practice, interdisciplinary conflicts often arise from differing clinical priorities—for example, between neurosurgeons and intensivists regarding ventilation strategies that affect ICP, or between nurses and physicians concerning sedation targets and mobilization timing. Structured interdisciplinary rounds can effectively mitigate such conflicts by establishing predictable communication routines and shared decision-making frameworks. Key elements include pre-round briefings to align goals, closed-loop communication to confirm understanding, and explicit role assignments to clarify clinical ownership. When disagreements occur, standardized strategies such as the “two-challenge rule,” data-driven discussion based on objective physiologic trends, and time-limited clinical trials (e.g., testing an intervention under defined safety criteria) facilitate resolution while maintaining mutual respect. Persistent or values-based conflicts should prompt timely family meetings or ethics consultations to ensure transparent and patient-centered decision-making. Through these structured approaches, structured interdisciplinary rounds transform potential conflicts into opportunities for collaboration and consensus building within the neuro-ICU team.
EMERGING TOOLS FOR INTERDISCIPLINARY INTEGRATION
The implementation of advanced tools and technologies has significantly enhanced the precision, personalization, and interdisciplinary coordination of care in neurocritical settings. Among these, the PRx has emerged as a cornerstone of modern cerebral autoregulation monitoring (Figure 2) [9,27]. PRx quantifies the correlation between slow waves of mean arterial pressure and ICP, yielding a dynamic assessment of cerebrovascular reactivity. A positive PRx indicates impaired autoregulation—typically reflecting a pressure-passive state—while a negative or near-zero PRx suggests preserved cerebrovascular responsiveness. This data enables the calculation of optimal cerebral perfusion pressure (CPPopt)—the CPP at which autoregulation is most intact—providing individualized targets for hemodynamic management. Application of PRx-guided CPPopt has been associated with improved outcomes in patients with TBI and other forms of acute brain injury, especially when deviations from CPPopt are minimized over time. The integration of PRx into clinical workflows demands coordinated contributions across disciplines: neurosurgeons must interpret PRx values in light of surgical pathology and intracranial compliance, neurointensivists adjust hemodynamic targets accordingly, critical care nurses monitor waveform trends in real-time.
Beyond physiologic monitoring, ICU diaries represent a non-pharmacological intervention that addresses the psychosocial dimensions of critical illness. These diaries—maintained by ICU staff and, when possible, by family members—document daily events, clinical progress, and emotional milestones during the ICU stay. Several randomized controlled trials and meta-analyses have shown that the use of ICU diaries significantly reduces the incidence of post–intensive care syndrome and post-traumatic stress disorder among survivors of critical illness [41-43]. The therapeutic value of ICU diaries lies in their ability to bridge memory gaps, reconstruct fragmented experiences, and humanize the ICU environment. The adoption of these tools exemplifies the evolving landscape of neurocritical care, in which data-driven decision-making and patient-centered communication must coexist.
BARRIERS AND CHALLENGES TO IMPLEMENTATION
Despite its proven benefits, interdisciplinary care remains underutilized in many institutions. Barriers include institutional hierarchies, limited staffing resources, lack of formal training programs, and cultural resistance to shared authority. Furthermore, smaller hospitals may lack access to dedicated neurointensivists or rehabilitation services, limiting their ability to adopt full interdisciplinary models [1,4,44,45]. Addressing these challenges requires administrative support, investment in personnel training, and adaptation of interdisciplinary frameworks to resource-limited settings. Despite the well-documented advantages of interdisciplinary collaboration in neurocritical care, its widespread adoption remains inconsistent across institutions. A multitude of structural, organizational, and cultural barriers impede the full integration of interdisciplinary models. Resource constraints—particularly within smaller or community-based hospitals—further limit the feasibility of interdisciplinary implementation. Many such facilities lack access to full-time neurointensivists, specialized rehabilitation personnel, or trained clinical pharmacists, all of whom are essential for a functioning interdisciplinary neuro-ICU team. The absence of these professionals often results in fragmented care delivery and diminished adherence to evidence-based protocols. Moreover, limited ICU bed capacity and inadequate funding for infrastructure and workforce expansion further exacerbate disparities in the availability of interdisciplinary services [1,4].
Another critical barrier is the lack of standardized training pathways in interdisciplinary neurocritical care. Although fellowships in neurocritical care are growing, formal cross-training among neurologists, neurosurgeons, intensivists, and allied health professionals remains limited [44]. As a result, interprofessional understanding and role clarity are frequently insufficient, leading to clinical redundancy, miscommunication, or hesitation in joint decision-making.
FUTURE DIRECTIONS
The formal recognition of neurocritical care as a distinct subspecialty represents a critical step toward the broader institutionalization of interdisciplinary models in neuro-ICU settings [1]. As certification pathways continue to evolve through national and international societies, they offer a framework for defining core competencies, ensuring uniformity in training, and legitimizing the specialized skill set required for integrated neurocritical care delivery. In parallel, the development and implementation of standardized protocols—including evidence-based care bundles, interdisciplinary rounding structures, and triage algorithms—are expected to enhance both the quality and reproducibility of care across diverse institutions. Looking ahead, future research should aim to delineate the optimal composition and operational structure of interdisciplinary teams, identifying which combinations of professional roles, rounding frequency, and communication modalities are most strongly associated with improved clinical outcomes, cost-efficiency, and patient satisfaction.
Moreover, the incorporation of artificial intelligence (AI) and predictive analytics into neurocritical care workflows may revolutionize the field by enabling personalized risk stratification, early detection of clinical deterioration, and adaptive decision support. Machine learning algorithms applied to high-frequency physiological data (e.g., EEG, ICP, CPP, oxygenation indices) can augment clinician judgment and offer actionable insights in real-time [4,9].
Ultimately, the future of neurocritical care will be shaped by how successfully the field aligns its technological advancements with human-centered, team-based care models—balancing precision with compassion, and innovation with interdisciplinary integration.
CONCLUSIONS
Interdisciplinary collaboration is not merely a recommendation—it is a necessity in the neuro-ICU. The complexity, acuity, and ethical sensitivity of neurocritical care demand a model in which diverse specialties work together seamlessly toward common goals. By fostering a culture of integration, mutual respect, and shared responsibility, we can deliver more efficient, humane, and effective care to the most vulnerable patients. As the field continues to evolve, interdisciplinary collaboration should be recognized as a cornerstone of excellence in acute and critical neuroscience care.
KEY MESSAGES
▪ Interdisciplinary collaboration is essential for optimizing outcomes in neurocritical care, integrating the expertise of neurosurgeons, neurologists, neurointensivists, nurses, pharmacists, nutritionists, and rehabilitation therapists into a unified care model.
▪ Timely, coordinated interventions—such as seizure detection, cerebral perfusion pressure optimization, infection control, and early rehabilitation—require seamless communication and shared clinical responsibility across disciplines.
▪ Structured interdisciplinary frameworks improve patient survival, reduce intensive care unit complications, and enhance long-term neurological recovery, underscoring their importance as a standard of care in modern neurocritical practice.
NOTES
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CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
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FUNDING
This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Science and ICT (MSIT) (Grant number: 2022R1A2C2011941, RS-2022-NR070396). Additional support was provided by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant number: RS-2024-00438911), and by the Asan Institute for Life Sciences, Asan Medical Center (Seoul, Republic of Korea) under grant numbers 2025IP0031-1 and 2025IF0001-1 to Seungjoo Lee.
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ACKNOWLEDGMENTS
None.
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AUTHOR CONTRIBUTIONS
Conceptualization: HJ, SBK, SL, MK. Methodology: HJ, SBK, SL, MK. Formal analysis: MK. Data curation: HJ, SL, MK. Visualization: MK. Project administration: SL, MK. Funding acquisition: Writing - original draft: MK. Writing - review & editing: MK. All authors read and agreed to the published version of the manuscript.
Figure 1.Neurocritical care interdisciplinary team. ICU: intensive care unit.
Figure 2.Real-time cerebrovascular reactivity monitoring using a pressure reactivity index. The image displays a neurocritical care monitoring setup that includes real-time assessment of cerebrovascular reactivity using the pressure reactivity Index. PRx quantifies the correlation between slow waves of mean arterial pressure and intracranial pressure, providing a dynamic, bedside measure of autoregulatory function. This parameter is increasingly utilized to optimize cerebral perfusion pressure on an individualized basis, thereby guiding goal-directed hemodynamic management in patients with severe brain injury.
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