Impact of Dedicated Neurocritical Care Team and Pharmacist on Nicardipine Use in the Neuro-ICU

Introduction: Effective blood pressure management is a critical component for patients with intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and ischemic stroke requiring thrombectomy (IST). Intravenous antihypertensives like nicardipine are commonly used in the intensive care unit (ICU) for rapid control of blood pressure. However, prolonged use contributes to increased healthcare costs, extended ICU stays, potential harm of fluid overload and hyperchloremia. We evaluated the impact of a dedicated neurocritical care (NCC) team and pharmacist on the use of nicardipine.


Methods: This retrospective cohort study included adult patients admitted to the ICU with a primary diagnosis of ICU, SAH or IST, who received intravenous nicardipine between January 1st, 2025 and July 6th, 2025. Electronic medical records were reviewed to determine the total duration of nicardipine infusion and the initiation of oral antihypertensive agents. Patients were stratified into two groups: those managed prior to a dedicated NCC team as primary service (pre-group) and those managed after implementation (post-group).


Results: Of 150 patients included, 106 were in the pre-NCC team group and 44 in the post-group. Mean ages were 64 and 66 years, respectively, with 50% male in both. Nicardipine infusion mean duration decreased from 41.5 to 24.2 hours overall. Subgroup analysis showed that among patients with ICH, nicardipine duration dropped from 55.0 to 33.5 hours; in SAH patients, from 52.0 to 38.2 hours; and in IST patients, from 17.0 to 9.8 hours. Oral antihypertensives were initiated in 46% of pre-NCC patients and 43% of post-group patients.


Conclusions: Implementation of a dedicated NCC team and pharmacist was associated with a 58% reduction in the average duration of nicardipine infusion over a two-month period compared to the prior five months. Translating to an approximate minimum savings of $2,140 per patient. This reduction has important clinical and economic implications, including decreased medication waste and reduced ICU length of stay, particularly in institutions where titratable infusions are restricted to the ICU setting. These findings support the value of specialized NCC management with a dedicated pharmacist in optimizing resource use and improving care efficiency.