Neurological Intensive Care Unit Multimodal Monitoring Project

Stephan Mayer, M.D.

New York - Presbyterian Hospital

Funded in September, 2005: $200000 for 2 years
LAY SUMMARY . ABSTRACT . BIOGRAPHY .

LAY SUMMARY

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Neurological Intensive Care Unit Multimodal Monitoring Project

The investigators plan to develop this integrated computerized monitoring software for use in the ICU.  Working with ICU physicians, about sixty stroke patients seen in the ICU will be assessed initially and monitored.  The clinical researchers will determine whether manipulating blood pressure, temperature, glucose and other factors prevents changes in the relationship between oxygen and metabolism when the monitoring system indicates that changes are beginning to occur in any of the patients.  After measuring the extent and duration of brain tissue damage that occurs, researchers would assess patients at 14 days, and then again at three months and one year following the ICU stroke care.  Through these assessments, the investigators would determine whether patients with a shorter and less severe period of brain tissue damage following stroke had better outcomes compared to those with longer and more severe tissue injury.

 

ABSTRACT

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Nuerological Intensive Care Unit Multimodal Monitoring Project

Neurocritical care is a specialty that focuses on the critical care management of patients with catastrophic neurologic diseases such as traumatic brain injury, subarachnoid hemorrhage and intracerebral hemorrhage. Traditionally, neuromonitoring is based on a “reactive” model, in which abnormal physiology or neurological deterioration is detectedm, which then triggers corrective actions to reverse this process. Multimodality monitoring refers to the tracking of multiple parameters of brain physiology and function that can be affected by direct medical or surgical intervention. We propose a novel paradigm to assess the pathophysiological events that accompany acute hemorrhagic stroke by combining the use of emerging neuromonitoring modalities in a Neuro-ICU. This overall vision of this project is to establish a new therapeutic paradigm in which multimodality neuromonitoring is used to provide real-time feedback, allowing the clinician to optimize systemic physiology, thus creating an optimal cellular environment that will both preserve neurologic function and allow the best chance for recovery to occur. The specific goals of this project are: 1) To create software tools for the bedside that enable physicians to evaluate relationships between systemic physiological variables and indicators of neuronal health in real time. 2) Determine if two brain tissue measures of neuronal oxidative stress - oxygen tension and lactate/pyruvate ratio - can be optimized by the manipulation of systemic physiological variables such as blood pressure, osmolality, and temperature in patients with hemorrhagic stroke. 3) Determine whether the extent and duration of neuronal oxidative stress and physiological derangement is predictive of long term clinical and functional outcome after hemorrhagic stroke.

 

INVESTIGATOR BIOGRAPHIES

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Stephan Mayer, M.D.

Stephan A. Mayer, MD, is Associate Professor of Clinical Neurology and Neurosurgery at Columbia University and Director of the Neurological Intensive Care Unit at NewYork-Presbyterian Hospital/Columbia. He earned his bachelor's degree at Brown University and earned his medical degree at Cornell University Medical College. He then went on to do his postdoctoral clinical training in neurology and neurological intensive care at at the Neurological Institute of New York and Columbia University Medical Center. Dr Mayer’s research interests include subarachnoid and intracerebral hemorrhage, therapeutic hypothermia, status epiliepticus, and neurological outcomes assessment. He is Principal investigator of the Factor VIIa in Acute Hemorrhagic Stroke Trial (FAST) and Director of the Columbia University Subarachnoid Hemorrhage Outcomes Project. Dr Mayer is Treasurer of the Neurocritical Care Society, co-founder and associate editor of the journal Neurocritical Care, and is a co-author of Ropper’s textbook on Neurological and Neurosurgical Intensive Care.