Monitoring and modelling cerebral haemodynamics and metabolism
Research type
Research Study
Full title
Integrating brain monitoring and modelling for real-time prediction of the cerebral circulation and metabolism
IRAS ID
79350
Contact name
Martin Smith
Contact email
Sponsor organisation
University College London
Research summary
Acute brain injury remains a significant cause of morbidity and mortality across a wide range of pathologies. Primary injury describes the initial insult, this in turn leads to disordered metabolism and reduced cerebral blood flow which starves tissue of adequate energy and potentiates secondary cerebral hypoxic-ischaemic injury . Multimodal monitoring aims to detect conditions which may be deleterious to brain recovery so they may be treated within short windows for intervention.
Technological advances mean that multiple cerebral physiological variables can be measured, encoding information on important pathophysiological events. However the information of clinical interest relates to these measured signals in complex ways:
i)Diverse events can cause the same change: for example a change in measured cerebral oxygen saturation might reflect a change in supplied oxygen, blood flow, cerebral metabolism or cellular failure.
ii) Pathophysiological changes may exhibit regional and temporal variations.
iii) Compensatory changes (regulatory responses), occur at different time-scales and are affected by pathology.
In order to best interpret the signals, and deliver information which might be used to guide patient care, it is crucial to combine prior knowledge of the physiological and pathophysiological context with a wide range of measured data. We have developed a mathematical model of cerebral oxygenation, haemodynamics and metabolism which could form the basis of a novel model-enriched, patient-specific bedside monitoring system. The aim of this research is to assess the performance of this model to predict cerebral hypoxic-ischaemic injury.
We hypothesise that model based analysis of multimodal neuromonitoring can predict secondary cerebral injury. This research will compare model-defined predictions of ischaemia based on routine multimodal neuromonitoring in comparison with imaging, biomarkers of injury and functional outcome. By integrating multiple data sources, information reflecting novel treatment targets or identifying critical treatment windows may be possible and overcome many pitfalls of current approaches.
REC name
London - Queen Square Research Ethics Committee
REC reference
13/LO/0764
Date of REC Opinion
22 Jul 2013
REC opinion
Further Information Favourable Opinion