Article

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.

Langue : ANGLAIS