Neuroprotective ICU Care Bundle
Regardless of the specific neurological diagnosis, a standardised set of ICU interventions reduces secondary brain injury across all patient groups. These are sometimes referred to as the neuro-ICU care bundle:
| Bundle Element | Target | Rationale |
| Head positioning | 30° head elevation, head midline | Facilitates venous drainage; reduces ICP |
| Blood pressure | MAP ≥65–70 mmHg (or higher if raised ICP) | Maintains CPP; prevents secondary ischaemia |
| SpO2 / PaO2 | SpO2 94–98%; PaO2 10–13 kPa | Prevents hypoxic secondary injury |
| PaCO2 | 4.5–5.0 kPa (normocapnia) | Avoids hypercapnia (↑ICP) and chronic hypocapnia (ischaemia) |
| Blood glucose | 6–10 mmol/L | Both hypo- and hyperglycaemia worsen neurological outcomes |
| Temperature | 36–37°C; treat fever aggressively | Pyrexia increases CMRO2 and worsens oedema |
| Seizure management | Identify and treat promptly | Seizures dramatically increase CMRO2 and worsen injury |
| Nutrition | Enteral feeding within 24–48 hours | Maintains gut barrier; reduces infection; caloric support |
| DVT prophylaxis | Compression stockings; LMWH when safe | ICU patients are at very high VTE risk |