Neurocritical Care Program

Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are common and serious medical conditions. The development of modern neurointensive care has markedly reduced mortality and improved patient outcomes while clinical trials of neuroprotective drug candidates have to date been unsuccessful. Basic research has identified a number of secondary injury mechanisms following TBI and SAH.

The challenge ahead is to translate this knowledge into the clinical setting to find new treatment strategies to hinder secondary injuries and improve patient outcomes even further. The neurointensive care unit (Neuro-ICU) with highly standardised health care, a multitude of monitoring methods and powerful computerised data collection systems provides an excellent platform for this translational research.

Overall goal

To study secondary brain injury mechanisms in patients with TBI and SAH in the Neuro-ICU utilising the available multimodality monitoring and computerised data collection systems.
To specifically study secondary injury mechanisms caused by intracranial secondary insults/complications (e.g. intracranial hypertension owing to brain swelling) and secondary systemic insults (e.g. hypotension with a reduced cerebral blood perfusion).

Methods

Multimodality monitoring – The technical equipment available in our Neuro-ICU allows for continuous monitoring of intracranial pressure, systemic blood pressure, cerebral perfusion pressure, intracerebral neurochemistry changes (e.g. energy metabolic perturbations and biomarkers), neurophysiology (e.g. post traumatic seizure activity), brain temperature, brain tissue oxygen pressure, jugular venous oxygen saturation, cerebral blood flow velocity, intracranial compliance. Neuroimaging (CT, CT/PET and MRI) are important complimentary methods for monitoring the brain injury process.

Computerised data collection system – A computer system has been developed and implemented in the Neuro-ICU allowing for collection, analysis and illustration of clinical data (e.g. type of brain injury, CT findings), physiological data (e.g. intracranial pressure, brain tissue oxygen pressure), treatment data (e.g. ventricular CSF drainage to lower the intracranial pressure).

The Neuro-ICU as a “clinical laboratory” – A standardised clinical protocol corresponding to the concept of “good laboratory practice” has been developed and implemented in the Neuro-ICU. The clinical protocol, the multimodality monitoring system and the computer data collection system together allows for extensive control and monitoring of the clinical condition, resembling a basic science laboratory environment. The facilities thus create an excellent platform for neurointensive care and clinical research of top international quality.

Brain IT group – We have in collaboration with distinguished colleagues in the field established an international research network comprising over 20 centers in Europe with focus on neurointensive care of TBI patients (www.brainit.org). Information technology (IT) is used collect patient data to a common web-based database for TBI research. This will provide a powerful research tool for international multi-center trials on e.g. novel treatment strategies and neurosurgical methods.

Uppsala Brain Injury Center (UBIC) – This is a recently established translational research network with focus on TBI research. The basic objective of this multidisciplinary endeavour is to combat TBI with a broad spectrum of competencies ranging from molecule to man, i.e. from molecular genetics, cellculture systems, animals models, TBI patients in the Neuro-ICU to rehabilitation and follow-up (www.neuro.uu.se/ubic ). The Uppsala Neuro-ICU is of top international class providing one of the major research platforms within the UBIC. The UBIC concept received top marks regarding research quality, research environment and future potential by the external international review board in the recent evaluation “Quality and Reneval 2007” of the research at Uppsala University.

Another multidisciplinary project was lounged in 2007 in a collaborative effort between UBIC and the Uppsala Berzelii Technology Center for Neurodiagnostics (www.berzelii.uu.se) combining clinical microdialysis technology with modern proteomic methodology and Materials Science. The main goal is to find clinically useful diagnostic and prognostic biomarkers for point-of-care use in the Neuro-ICU. The basic working hypothesis is that harvesting of biomarkers directly in the injured brain by microdialysis will improve the spatial and temporal resolution leading to an improved enhanced value of the biomarkers. Modern proteomics methodology is a powerful tool to screen for entirely novel biomarkers of TBI. Materials Science technology is instrumental in optimising protein biomarker sampling performance and combined biosensor technology.

Significance

The organisation of neurointensive care into a ”laboratory-like” environment with powerful multimodality monitoring and computerised data collection provides a unique opportunity to monitor the acute brain injury process and the effect of treatment strategies, enabling the study of pathophysiological and neurochemical mechanisms of acute brain injury directly in the human brain. We hypothesise that this opportunity will be instrumental in the translation of promising basic science results to the Neuro-ICU setting improving outcome of patients with acute brain injury.