Brain oxygen and microdialysis monitoring technology have been established in clinical practice to assist in the management of patients on an intention to treat basis. This has been facilitated by two major consensus conferences (Neuro Critical Care Consensus meeting; Philadelphia; Menon, Hutchinson, Czosnyka and the International Microdialysis Forum held in Cambridge; Hutchinson, Carpenter, Helmy, Menon). Experience in monitoring over 500 patients in Cambridge, with intracranial pressure, brain tissue oxygen and microdialysis monitoring (lactate/pyruvate ratio; glucose), has provided the data to define treatment targets based on derangements in oxygenation and metabolism. Current treatment is directed by an algorithm based on intracranial pressure.
Multimodality monitoring in children with acute brain injury
The Technicam cranial access device with combined intracranial pressure, brain tissue oxygenation and brain chemistry monitoring pioneered in adults has been applied to paediatric traumatic brain injury. Preliminary results show a relationship between monitored parameters and outcome and the data is being used to define treatment thresholds (Young 2016 J Neurosurg Pediatr Res).
Refining clinical protocols
We will develop protocols for both traumatic brain injury and subarachnoid haemorrhage with refinements in the ICM+ technology to capture and display all data parameters. This approach will be applied to both adults and children to address the challenge of different pathophysiology (e.g. increased tendency to hyperaemia in paedatric traumatic brain injury) and to address age-related thresholds.