PhD defence E.J.A. (Eveline) Wiegers

Diseases in neurocritical care, in particular traumatic brain injury (TBI) and stroke, are major public health concerns with an annual incidence in Europe of 2.1 million patients
with TBI and 1.1 million patients with stroke. Patients with TBI and stroke are often admitted to neurocritical care. Neurocritical care is crucial in providing meticulous neuroprotection, mainly by avoiding or minimizing secondary neurological injury, recognizing and treating systemic complications, ultimately to have the best possible recovery for patients. Several randomized controlled trials (RCTs) proved the benefit of endovascular thrombectomy (EVT) compared with best medical care for patients with acute ischemic stroke. For patients with TBI, there is no proven specific neuroprotective therapy that is highly effective. Guideline recommendations for TBI care are often weak, leaving opportunity for individual treatment preferences and resource availability, resulting in variation of care. Comparative Effectiveness Research (CER) has been proposed to optimize treatments and management strategies for TBI patients admitted to neurocritical care. CER is designed to account for the abundance of treatment options by comparisons that are clinically meaningful in a broader representation of the affected population. Improving outcomes in neurocritical patients can be approached in different ways. Treatments that intervene in the pathophysiological pathway of a disease are evident methods to improve outcomes. Over the past years, fluid management has gained attention in neurocritical care. Several studies in critical care have demonstrated that fluid overload can be detrimental, which might also be applicable for patients with TBI. Beta-blockers might have the potential to block some of the adverse effects of sympathetic activation after TBI. However, quality of care also plays an important role in daily clinical practice. Quality indicators are measurable aspects of quality of care
and have been developed in many clinical fields proving to benefit patients’ outcomes. The overall aim of this thesis was to improve some aspects of neurocritical care. In specific, the following questions were answered: 

1. To describe the contemporary landscape of neurocritical care in Europe and Australia
d. To describe patient populations and outcomes
e. To describe how neurocritical care is organized and implemented
f. To quantify the variability in management, organization and outcomes between centres, regions and countries regions and countries
2. To assess the effectiveness and quality of neuro-critical care
d. What is the effectiveness of different fluid management strategies?
e. What is the effectiveness of beta-blockers?
f. How may quality of neurocritical care for TBI patients be assessed and can it be investigated in the CENTER-TBI database?

The public defence will take place at the Prof. Andries Queridoroom, 3rd floor Education Center, Erasmus MC. The ceremony will begin exactly at 15.30 PM. In light of the solemn nature of the ceremony, we recommend that you do not take children under the age of 6 to the first part of the ceremony.