Individualized targeted management in neurocritical care.

Neurocritical care has become a distinct discipline within the field of intensive care medicine with amajor focus on the treatment of patients with acute damage to the most complex organ of thehuman body, the brain. The main indications for acute neurocritical care concern aneurysmalSubarachnoid Hemorrhage (SAH) and severe Traumatic Brain Injury (TBI). These disease entitiesform a major health and socioeconomic problem as they afflict young patients and the rate of deathand disability is high. The pathology and treatment of these patients is heterogeneous andcomplex. Despite advances in basic neuroscience which have increased our understanding ofprocesses in the injured brain, approaches to management are largely unfocused and adhere to theconcept of a 'one pill for everybody' approach. Novel monitoring technology and new neuroimagingtechniques now offer opportunities for advancing the care for these patients to a moreindividualized targeted management.This proposal concerns a prospective translational study in patients with SAH or TBI requiringneurocritical care. The global aim is to develop recommendations for individualized targetedmanagement. We aim to enrol a total of 50 patients over a 2-year period. We will implementextensive monitoring in these patients, including electrocorticography, continuous monitoring ofcerebral blood flow and oxygenation and perform extensive neuroimaging studies. The variousmonitoring modalities will each provide a different and complementary perspective to the complexproblems in acutely brain damaged patients, as well as into the interaction between systemic andcerebral effects. Neuroimaging studies will provide accurate characterization of structural damageand serve as early endpoints for documentation of ischaemic damage and for differentiating thedegree of swelling from ischaemia. Extensive within– and between– patient analyses will beconducted to assess the sensitivity of monitored parameters for detecting impending deteriorationand to quantify the added benefits of extended monitoring and sensitivity of these parametersunder different disease conditions.The major novelty in this project is the concept of an integrated approach towards individualizedtargeted management in neurocritical care. This concept carries a high potential for improvingtreatment and outcome for these patients. Collaboration with international partners will beestablished for specific items of this project and this will additionally serve to establish the positionof neurocritical care in Flanders on an international level.

Keywords:MEDICAL MONITORING, NEUROSCIENCE

Disciplines:Anaesthesiology, Intensive care and emergency medicine, Orthopaedics, Surgery, Nursing