Research Andrew Maas

Abstract

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 entities form 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.

Researcher(s)

• Promoter: Maas Andrew

Research team(s)

• Translational Neurosciences (TNW)

Project website

Project type(s)

• Research Project

Abstract

IMPACT: International Mission for Prognosis and Analysis of Clinical Trials in TBI. Traumatic Brain Injury (TBI) may afflict us all, but young adult males are particularly at risk. IMPACT is an international multidisciplinary effort to advance clinical research programmes in search of better treatment. Nearly 10 years of work has resulted in the development of a prognostic calculator for establishing prognosis in individual patients, proposals for standardization of data collection in TBI studies (common data elements) and recommendations for improving the design and analysis of TBI studies. It is hoped that these recommendations will substantially increase possibilities for proving efficacy of new treatments. We greatly welcome any feedback you may have Background Traumatic Brain Injury (TBI) is a dynamic and heterogeneous disease in which many mechanisms and pathways can lead to secondary damage. Many different kinds of therapy and neuroprotective agents with high potential for efficacy have been developed. Unfortunately in trials none of these have shown convincing evidence of benefit in the clinical situation with sufficient generalizibility. Some of these therapies may have been truly ineffective but the risk exists that some therapies may have been wrongly discarded due to the use of insensitive methodology in clinical trials. The TBI population poses several complicated methodological challenges, related to the heterogeneity of the population, outcome-assessment and design issues. IMPACT is focused on tackling these head-on with the aim of providing recommendations for more powerful trials in the future.

Researcher(s)

• Promoter: Maas Andrew
• Fellow: Roozenbeek Bob

Research team(s)

• Translational Neurosciences (TNW)

Project website

Project type(s)

• Research Project

Abstract

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 entities form 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.

Researcher(s)

• Promoter: Maas Andrew

Research team(s)

• Translational Neurosciences (TNW)

Project website

Project type(s)

• Research Project