Since that time, medical and surgical options have continued to progress for conditions that had previously not been survivable. The catch was that patients who formerly would not have survived were in fact alive and they were sicker than ever. This new population of very sick people with very unique and complex illnesses drove the need for dedicated specialty ICU’s. For example, a person who had brain surgery yesterday had very different needs than someone who had had a heart attack. Today, most large medical centers have separate ICU’s for general and cardiac surgery, general and cardiac medicine, trauma, burn patients, neurology and neurosurgery, and others depending on institutional need.

Dr. Walter Dandy a neurosurgeon at Johns Hopkins Hospital can be credited with championing the neurocritical care movement at Johns Hopkins Hospital in the 1930s [6, 7]. He recognized that neurosurgical patients needed vigilant monitoring during the immediate postoperative period to quickly identify, and treat any complications. At first it was the surgeons who saw their patients in the ICU, but eventually they realized that they could not be present both in the ICU and in the operating room simultaneously and couldn’t keep up with the day-to-day demands of patient care in the operating room and neurosurgical ICU [8]. The result was the development of specialty providers to provide this service [9]. These specialists were often anesthesiologists and neurologists with interest and special training in critical care. In time, they brought their respective skills together and formed a uniquely talented team to provide comprehensive care for patients recovering from brain surgery [10] (Table 4.1).