Individualized targeted management in neurocritical care.

Neurocritical care has become a distinct discipline within the field of intensive care medicine with a major focus on the treatment of patients with acute damage to the most complex organ of the human body, the brain. The main indications for acute neurocritical care concern aneurysmal Subarachnoid 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 death and disability is high. The pathology and treatment of these patients is heterogeneous and complex. Despite advances in basic neuroscience which have increased our understanding of processes in the injured brain, approaches to management are largely unfocused and adhere to the concept of a 'one pill for everybody' approach. Novel monitoring technology and new neuroimaging techniques now offer opportunities for advancing the care for these patients to a more individualized targeted management. This proposal concerns a prospective translational study in patients with SAH or TBI requiring neurocritical care. The global aim is to develop recommendations for individualized targeted management. We aim to enrol a total of 50 patients over a 2-year period. We will implement extensive monitoring in these patients, including electrocorticography, continuous monitoring of cerebral blood flow and oxygenation and perform extensive neuroimaging studies. The various monitoring modalities will each provide a different and complementary perspective to the complex problems in acutely brain damaged patients, as well as into the interaction between systemic and cerebral effects. Neuroimaging studies will provide accurate characterization of structural damage and serve as early endpoints for documentation of ischaemic damage and for differentiating the degree of swelling from ischaemia. Extensive within– and between– patient analyses will be conducted to assess the sensitivity of monitored parameters for detecting impending deterioration and to quantify the added benefits of extended monitoring and sensitivity of these parameters under different disease conditions. The major novelty in this project is the concept of an integrated approach towards individualized targeted management in neurocritical care. This concept carries a high potential for improving treatment and outcome for these patients. Collaboration with international partners will be established for specific items of this project and this will additionally serve to establish the position of neurocritical care in Flanders on an international level.

Keywords:MEDICAL MONITORING, NEUROSCIENCE

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