Neurocritical care in Canada: evolving streams in a new discipline.

devoted to life-threatening diseases of the nervous system.1 The Table lists various disorders of the central and peripheral nervous systems that are encountered, either as primary neurological/neurosurgical disorders or as complications of systemic diseases or their therapy. Neurocritical care developed as a national discipline in Canada with the founding of the Canadian Neurocritical Care Group in 1992. Members were almost exclusively from the neurology and neurosurgery communities. The Group developed an annual course held concurrently with the Canadian Congress of Neurological Sciences and revised the guidelines for the determination of brain death in 1999.2 These have subsequently been revised by the Canadian Council for Donation and Transplantation in 2003. This development reflected the increasing interest of intensivists with special training in neurocritical care to be involved and lead to the founding of the Canadian Neurocritical Care Society in 2003. By-laws were drafted and annual meetings have been held in conjunction with the Critical Care Canada Forum. The founding and still present co-chairs are Drs. Draga Jichici and David Zygun. At present there are 49 members. The majority (61%) have fellowship training in critical care medicine. Of those with critical care medicine fellowship training, internal medicine (51%) is the most common base specialty followed by anaesthesia (19%), pediatrics (11%), neurology (7%), surgery (7%) and emergency medicine (4%). Of those who have not completed formal critical care medicine training, 11 are neurologists or neurologists in training, 4 are neurosurgeons and 2 are anesthetists. The Society exists to set practice guidelines and standards of care,3 develop standards of training and education for neurocritical care medicine, promote and perform research with the goal of improving outcome from life-threatening neurological illness and advocate for the profession.