The LINK-Lombardia NeuroIntensive care Network

Abstract

Background: Despite serving over 10 million inhabitants, neurocritical care across the Lombardy region of Italy (from here on Lombardia) remains fragmented and insufficiently mapped, underscoring the need for a structured regional network. This study aimed to evaluate current resources and explore pathways for integration and development.

Methods: In 2024, along with other initiatives, a web-based survey was performed, focusing on hospitals with neurosurgical capabilities and intensive care units (ICUs) to identify variations in service delivery and adherence to evidence-based practices, guiding quality improvement across centers.

Results: Responses were obtained from 19 acute care hospitals with neurosurgical facilities within the regional health service. Ten hospitals (52%) host dedicated neuro-ICUs, including five (26%) that also admit pediatric patients, accounting for a total of 85 beds. In the remaining nine hospitals (47%), neurocritical care is delivered within general ICUs without dedicated beds. Continuous in-house neurosurgical coverage is available in 9 centers (47%), while the others rely on a 24/7 on-call model. All 19 centers (100%) report 24/7 availability of neurologists and neuroradiologists, either in-house or on call. However, access to advanced diagnostic and monitoring technologies remains heterogeneous across sites. Participating centers identified a clear need for standardized protocols and clinical pathways to improve care quality and support evidence-based practices. Priority areas defined by the clinicians include neuroprognostication, end-of-life care and donor management, pediatric neurocritical care, neurointerventional procedures, management of delayed cerebral ischemia following subarachnoid hemorrhage, and post-discharge follow-up. To address these gaps, several multidisciplinary working groups have been established.

Conclusion: Neurocritical care in Lombardia remains highly heterogeneous, with bed availability significantly below international benchmarks. The establishment of a regional network seeks to enhance the quality and equity of care for neurocritical patients, while also fostering clinical research, data sharing, and multidisciplinary collaboration across centers.

Keywords: Harmonizing neurointensive care neurointensive/neuroendovascular facilities; Integrated Trauma Care System; Italian National Health System; Lombardia critical care; Neurocritical care; Neurocritical care network; Regional Health System.

Fig. 1

Geographical distribution of neurocritical care centers in Lombardia (10 neuro-ICUs and 9 general ICUs). The background color scale represents population density by province (inhabitants/km²). Darker green shades indicate higher population density. Centers are identified according to patient admission and the medical staff involved as follows: adult neuro-dedicated ICU with common admissions > 18 years old (neuro-ICU adult); adult general ICU with common admissions > 18 years old (gen-ICU adult); pediatric neuro-dedicated ICU with more than 15 patients admitted per year (neuro-ICU pedia); and sub-intensive neuro unit led by ICU staff (neuro-SUB). Colored dots indicate hospitals according to ICU type. At least one ICU facility is present in each province of the region. Legend: red = gen-ICU adult; blue = neuro-ICU adult; orange = neuro-ICU adult and neuro-ICU pedia; yellow = neuro-ICU adult, neuro-ICU pedia, and neuro-SUB; black = neuro-ICU adult and neuro-SUB

Fig. 2

Logistic area across Lombardia’s acute care hospitals with neurosurgical capabilities. Centers are identified progressively according to patient admission and the medical staff involved as follows: adult neuro-dedicated ICU with common admissions > 18 years old (neuro-ICU); adult general ICU with common admissions > 18 years old (gen-ICU). The presence of medical/surgical specialties are defined as follows: “24/7 in-house” availability, meaning services were available every day of the week around the clock; “24/7 on-call” availability, meaning services were available on call every day of the week around the clock; “12/5” availability, meaning services were available from Monday to Friday around the clock, either in-house or on-call; “NA” not available. ICU: intensive care unit; NCH: neurosurgeon; OR: operating room

Fig. 3

Radiological area across Lombardia’s acute care hospitals with neurosurgical capabilities. Centers are identified progressively according to patient admission and the medical staff involved as follows: adult neuro-dedicated ICU with common admissions > 18 years old (neuro-ICU); adult general ICU with common admissions > 18 years old (gen-ICU). The presence of radiological specialties is defined as follows: “24/7 in-house” availability, meaning services were available every day of the week around the clock. “24/7 on-call” availability, meaning services were available on call every day of the week around the clock. “12/5” availability, meaning services were available from Monday to Friday around the clock, either in-house or on-call. “NA” not available. ICU: intensive care unit; CT: computed tomography; DSA: digital subtraction angiography; MRI: magnetic resonance imaging

Fig. 4

Point of care (POC) area across Lombardia’s acute care hospitals with neurosurgical capabilities. Centers are identified progressively according to patient admission and the medical staff involved as follows: adult neuro-dedicated ICU with common admissions > 18 years old (neuro-ICU); adult general ICU with common admissions > 18 years old (gen-ICU). The presence of radiological specialties is defined as follows: “24/7 in-house” availability, meaning services were available every day of the week around the clock. “24/7 on-call” availability, meaning services were available on call every day of the week around the clock. “12/5” availability, meaning services were available from Monday to Friday around the clock, either in-house or on-call. “NA” not available. ICU: intensive care unit; EEG: electroencephalography; qEEG: quantitative electroencephalography