Techniques and strategies in neurocritical care originating from southern Scandinavia.

Abstract

OBJECTIVE: To describe innovations in neurocritical care originating from university hospitals in southern Scandinavia over a period of 50 years. DISCUSSION: Several techniques and strategies that are now included in clinical routine were initially developed in southern Scandinavia: continuous recording of intracranial pressure, monitoring of cerebral blood flow, analyses of cerebral energy metabolism under physiological and pathological conditions, and intracerebral microdialysis with bedside biochemical analysis and display of data. This background and, in particular, knowledge of the physiological prerequisites for water transport across the blood-brain barrier and the regulation of brain volume constituted the basis for the "Lund Concept" for treatment of increased intracranial pressure. The development of neurocritical care has resulted in a dramatic decrease in mortality for patients with severe traumatic brain injury. CONCLUSION: The focus in the future may be on improved biochemical supervision at the bedside to avoid secondary episodes of ischaemia and to identify and treat secondary non-ischaemic mitochondrial dysfunction. As mortality has decreased, demand for qualified post-traumatic rehabilitation has increased. Further improvements will necessitate close cooperation between critical care physicians, neurosurgeons and specialists in rehabilitation medicine.