Neurosurgical Intensive Care Unit Research Group
Incorporating the Brain Monitoring Research Group
Brain injury is a significant health burden because it causes death and severe disability, often in young people. Current techniques for monitoring the injured brain have disadvantages. We have developed and tested a comprehensive range of innovative, non-invasive optical monitors which measure regional changes in metabolic as well as oxygenation and haemodynamic variables as indicators of cerebral ischaemic damage following brain injury. In association with other components of the multi-modal array, these techniques offer the possibility to identify windows for targeted therapy after brain injury, thereby potentially reducing the risk of secondary brain damage. This might improve outcome in survivors and reduce the length of stay in neurointensive care, which is a costly and scarce resource in the UK.
The Neurosurgical Intensive Care Unit Research Group is a multidisciplinary group comprising neurointensivists, medical physicists, bioengineers and a mathematical modeller from the Departments of Neurosurgical Critical Care at the National Hospital for Neurology and Neurosurgery, UCLH and Medical Physics and Bioengineering, UCL.
Head of department
Dr Martin Smith, Consultant and Honorary Professor in Neurocritical Care
Clinical Research Fellows
Dr Arnab Ghosh, Clinical Research Associate
Dr David Highton, Academic Clinical Fellow in Anaesthesia and Critical Care
Professor Clare Elwell, Department of Medical Physics and Bioengineering, UCL
Dr Ilias Tachtsidis
Dr Murad Banjee
Dr Terence Leung
Investigation of cerebral oxygenation, haemodynamic and metabolic variables after brain injury
The Brain Monitoring Research Group continues to develop and test near infrared spectroscopic techniques for non-invasive bedside monitoring of cerebral oxygenation, haemodynamic and metabolic variables in real-time. We are:
· Measuring, for the first time in adults, changes in cerebral cytochrome c oxidase concentration (oxCCO) as part of a UKCRN portfolio registered study. oxCCO redox state reflects cellular energy status and may be a superior measure of cerebral oxygen delivery and utilization, and of impending ischaemia, than more conventional NIRS and other monitored variables.
· Developing and testing a novel hybrid optical spectrometer (HOS) that has been optimized to quantify sub-micromolar concentration changes of cerebral oxCCO in vivo. The HOS is a combination of a multi-distance frequency domain spectrometer, capable of decoupling scattering and absorption changes within tissue, in association with a multi-distance broadband spectrometer which provides an optimized spectral range and sensitivity and the ability to isolate oxCCO changes in the intracerebral layers of the adult head.
· Developing a mathematical model of cerebral physiology that has been used successfully to aid the interpretation of signals from multimodal monitors of systemic and cerebral physiology. Pilot data provide compelling evidence that measured data can be converted into relevant clinical information at the bedside.
Risk prediction models for traumatic brain injury
In association with colleagues from ICNARC and Cambridge, MS is one of the lead investigators of the UKCRN Portfolio registered Risk Adjustment in Neurocritical Care (RAIN) study. This prospective validation of risk prediction models for adult patients with acute traumatic brain injury is designed to evaluate the optimum location and comparative costs of neurocritical care in the NHS. The study began in 2009 and continues to recruit patients from many centres in the UK. In addition to being a lead investigator, MS is a member of the Study Steering Group.
Royal College courses, intercalated BSc students,
Neuroanaesthesia & neurocritical care module, Anaesthesia final year SSM, Intercalated BSc students
SOURCES OF FUNDING
Medical Research Council
UCL/UCLH Comprehensive Biomedical Centre
Central and East London CLRN
National Institute for Health Research