Niklas Marklund

Severe traumatic brain injury (TBI) is associated with high mortality and long-term disability. Inflammation is central to TBI pathophysiology, yet early dynamics of inflammatory mediators in blood and cerebrospinal fluid (CSF) remain incompletely understood, and commonly used assay platforms have rarely been directly compared. We aimed to characterize the inflammatory response in blood and CSF during the first week after severe TBI and to assess agreement between electrochemiluminescence (ECL) and proximity extension assay (PEA). In this prospective observational study, adults with severe TBI ( n = 21) were recruited. Plasma and CSF samples were collected at two time points: days 1–3 and days 4–8. Orthopedic patients with minor extremity fractures ( n = 11) served as controls. Inflammatory mediator levels were quantified using ECL (11 mediators) and PEA (45 mediators). Group differences, temporal changes, and inter-platform agreement were analyzed. In plasma, 13 mediators were increased and 3 decreased, while in CSF, 19 were increased and 3 decreased during the first week post-injury. Key mediators (IL-6, IL-8, IL-10) were consistently elevated in both compartments. When comparing analytic methods, ECL and PEA showed strong cross-platform correlations for IL-8 and IL-10 in both plasma and CSF, whereas IL-13 showed weak, non-significant correlation. However, limited interchangeability between platforms and platform-related differences across compartments and time points were also observed. Severe TBI is associated with marked, temporal and compartmentalized inflammatory response during first post-injury, particularly in CSF. Comparison of ECL and PEA showed limited interchangeability, underscoring the importance of platform awareness and interpretation in TBI biomarker studies. Clinical trial number: Not applicable.

Purpose: Secondary brain injury is a common cause of poor outcome after trauma, subarachnoid hemorrhage, and intracerebral hemorrhage, and optimizing treatment requires real-time insight into cerebral metabolism. Cerebral microdialysis (CMD) uniquely provides key related information, yet consensus on its use has not been updated since publication of the consensus statement from the 2014 International Microdialysis Forum. We aimed to assess expert consensus on the use of CMD in critical care and provide contemporary guidance to standardize practice and advance clinical implementation. Methods: We conducted a 3-round modified Delphi study with international experts in CMD and neurocritical care. Consensus was defined as ≥ 75% agreement among non-abstaining respondents, with a minimum of 30 non-abstaining respondents required per statement. Statements not reaching consensus were iteratively revised based on panelist feedback. Results: Forty of 67 invited experts (60%) from 9 countries participated. Sixty of 62 individual items achieved consensus (97%) across 9 domains: indications and patient selection, technical and procedural considerations, detecting deterioration and secondary injury, metabolic interpretation, treatment algorithms, glucose management, sampling frequency, core reporting items, and barriers to clinical implementation. Conclusion: This consensus statement provides updated, evidence-informed recommendations for the use of CMD in critical care. The panel reaffirmed many core recommendations from the 2014 consensus while making targeted advances: cautious extension of guidance to intracerebral hemorrhage, comprehensive reporting guidance addressing frequently omitted elements (19 items vs. 6 in 2014), and identification of 10 key barriers to routine clinical adoption.

Background: Neurointensive care is moving toward more automated patient management. This study aimed to evaluate a novel external ventricular drainage (EVD) system, the VGuard® system, as a tool for intracranial pressure (ICP) monitoring and automating ventricular drainage of cerebrospinal fluid (CSF), focusing on its safety and potential to reduce complications associated with manual EVD management. Methods: This prospective, randomized clinical study was conducted in the Department of Neurosurgery at Skåne University Hospital, Lund, Sweden. Patients (aged > 18 years) with different acute brain pathologies requiring an EVD were enrolled and randomized (1:1) to receive the VGuard® system or a manual EVD. Both systems employed a ventricular probe for simultaneous intraventricular and intraparenchymal ICP monitoring. Measurement accuracy was determined by comparing the median of absolute difference in ICP, using the Mann–Whitney U test. To further investigate the accuracy of ICP measuring, a post hoc Spearman correlation test was applied. In addition, as part of a post hoc analysis, we evaluated patient outcomes. Results: A total of 30 patients were included in the study. The VGuard® system demonstrated significantly better accuracy in ICP measurements compared with the manual EVD; median absolute difference: 1.07 versus 2.88, p < 0.001; median Spearman correlation coefficients: 0.81 versus 0.48, p < 0.05. There were no statistically significant differences in patient outcomes [mortality, Glasgow Outcome Scale-Extended (GOSE), modified Rankin Scale (mRS), median time with the EVD, and length of intensive care unit (ICU) stay], or adverse events (AE). No serious adverse events were noted. Conclusions: This is the first study to evaluate the VGuard® system, showing results of increased accuracy in measured ICP compared with the manual EVD. The VGuard® system offers an automated EVD solution, representing a step toward increased neurointensive care automation.