Neurointensive Care, TBI, SAH

Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are common and serious medical conditions. The development of modern neurointensive care (NIC) has markedly reduced mortality and improved patient outcomes.  The NIC unit with highly standardised care, a multitude of monitoring methods and powerful computerised data collection systems provides an excellent platform for explorative studies of pathophysiology in humans and development of new monitoring techniques and new management strategies. The research also covers other aspects of TBI and SAH beside the NIC research and also includes other acute conditions.

Goals

To study pathophysiology and management of acute brain injury in humans with the ultimate goal to develop the NIC and the clinical management in order to improve clinical outcome.

Methods

Multimodality monitoring – The technical equipment available in our NIC-unit 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 and intracranial compliance.

Neuroimaging – The NIC-unit is equipped with a mobile CT-scanner. The Xenon-CT technique is used for bed-side measurements of CBF.

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.

NIC quality registers – All clinical data and the clinical outcome are stored in quality registers, e.g. The Uppsala TBI register at Uppsala clinical research center (www.ucr.uu.se).

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.

Centre of Excellence Neurotrauma – The neurointensive care of neurotrauma has been identified as a prominent activity both at Uppsala university and Akademiska sjukhuset which has led to that the neurointensive care of neurotrauma is one out of four Centres of Excellence at Akademiska sjukhuset.(https://www.akademiska.se/forskning-och-utbildning/centre-of-excellence/neurotrauma/)

Specific study examples

• Intracranial pressure dynamics and compliance
• CBF pressure autoregulation (PRx)
• Xenon-CT CBF studies
• Brain tissue oxygenation
• HHH-therapy in SAH
• Neurochemical microdialysis studies
• Neuro inflammation
• NIC management of elderly
• Genetics in TBI
• Detailed follow-up studies

Senior investigators

Per Enblad, Professor (principal investigator)
Elisabeth Ronne-Engström, Adjunct Professor
Anders Lewén, Associate Professor 
Elham Rostami, Associate Professor 
Pelle Nilsson M.D, docent
Lena Nyholm, R.N., Ph.D.
Henrik Engquist, Ph.D.
Teodor Svedung-Wettervik, Ph.D.
Timothy Howells, Ph.D.
Anders Hånell, Ph.D.
Lars Hillered, Professor emeritus

Ph.D students

Philip Dyhrfort, M.D.
Samuel Lenell, M.D.
Fredrik Vedung, M.D.
Fartein Velle, M.D.
Pavlos Vlachogiannis, M.D.
Henrietta Gustavsson, R.N.
Peter Galos, M.D.