David is an academic neurointensivist at Cambridge, with research interests in the acute management and long term outcomes of traumatic brain injury, and neuroanatomical substrates of consciousness and disorders of consciousness. He is an incurable clinical rationalist, who has a guilty scepticism of evidence based medicine, and seeks rational (and probably wrong!) answers from clinical physiology and medicine-based evidence. His research aim is to make the important measurable, rather than the measurable important, but he has the insight to realise that he often fails in this endeavour. He co-Chairs the Acute Brain Injury program in Cambridge, which has a large experimental medicine portfolio including clinical studies with positron emission tomography, advanced MR, and brain microdialysis. He is one of two coordinators for the €30 million CENTER-TBI study.
Not all Brains are the Same
Traumatic brain injury represents a substantial global problem, which takes many (often young) lives, is responsible for the greatest burden of neurodisability globally, and costs the global economy half a trillion dollars a year. Attempts at pharmacological neuroprotection in TBI have, thus far, failed, and clinical care of TBI relies on conventional approaches to optimising systemic physiology and controlling intracranial hypertension, none of which are risk free. Prognostication of both clinical course and outcome are difficult, and it remains a challenge to be able to efficiently match patients to choices and intensities of therapies while limiting iatrogenic harm. Conventional protocol-driven management aims at targets derived from population physiology averages, and provides little opportunity for individualising therapy. This talk will explore how we might use differences in pathophysiology to choose therapies, and multimodality monitoring to titrate their intensity, with the aim of maximising outcome in individual patients.