(If you want the quick video version – check here but the reading bit isn’t that scary).
This PhD is all about shining new light on the injured brain. It’s a project that comes from the clinical experience gained by working at CareFlight, where teams including doctors and paramedics go to accidents where patients might benefit from advanced level care immediately after the accident. In Australia, traumatic brain injury (TBI) is a significant cause of long term deficit after traumatic injury (with estimates that it costs up to $8.5 billion per year). Thanks to the demographic profile of trauma, it also impacts particularly on the young.
When we get to the accident scene, we use the best available monitoring to try and guide our treatment. So we monitor the oxygen levels measured at the finger or toes, blood pressure and heart rate, and obviously look at the patient and make an assessment as to what injuries they might have. All of this is valuable, but we’re often frustrated that we can’t just directly measure what is happening to the brain – after all, we’re trying to provide treatment to make sure vital organs are getting what they need.
When we can’t actually shine a light on the brain tissue to guide our treatment, it feels a little like we’re trying to put the key in the door in the dark. However, there is now technology which might be able to provide information in real time about what is happening in the brain tissue itself. Referred to as cerebral oximetry, it relies on shining wavelengths of light in the near-infrared range through the brain tissue, and measuring some of what is reflected back to provide information about oxygen delivery and use, and the amount of blood in the area.
What we’re trying to figure out, is whether the values provided by this monitor might suggest what injuries a patient has, and how they’ll recover over the next year. To do this, accompanying our treating teams will be a trial observer, who will apply the sticky forehead probes for monitoring and then focus entirely on keeping that monitoring happening, while the treating team get on with what they need to do without seeing the monitor (as we don’t want them influenced by things we’re still researching). So the patient gets the same care, and we hopefully uncover new information.
If we find associations that mean something, we would look at proving the monitoring helps treatment in later research. A key feature is that we’re aiming to start the monitoring very soon after the injury, so we may be in a position to reveal what is happening in these earliest stages. Along the way, we anticipate that we’ll have to redesign monitor displays as well. There will be a large amount of information to try and interpret, so we’ll have to come up with a better way to display that (than just numbers or lines on a screen) so that clinicians can glance at it and figure out what needs to be done in a moment.
The study is called the “Pre-Hospital Assessment of Noninvasive Tissue Oximetry Monitoring” or The PHANTOM Study and we hope to get under way in earnest in 2014. If you want to check out a trial run of getting the monitoring on to get a little bit more of an idea as to what it is all about, you can check out this video which we produced to educate our crews.
The study forms the basis of my PhD (or as I refer to it, a “real doctor’s degree”). I never particularly thought I’d end up doing a PhD, having initially followed my medical degree with specialty training in anaesthesia and some additional work in prehospital and retrieval medicine. So in my day jobs, I spend most of my time working as an anaesthetist at The Children’s Hospital at Westmead, and the other part working at CareFlight (and the other part doing the job I feel less trained for, looking after my kids).
The idea for the research came out of my exposure both to NIRS technology and patients with brain injury before they get to the hospital and once they are in the hospital. Having started with the nagging question “what could we use to actually see what’s happening in the brain?” I ended up moving towards getting this research going, and before I knew it, I’d signed up to be a part-time PhD student (that’s more than 6 years, making it potentially a Pretty horrible Decade).
You can find me on twitter – @AndyDW_
Otherwise, my work e-mail is firstname.lastname@example.org
The aim of this site is to share some of the interesting, challenging and potentially boring bits of the PhD process. It detours into broader discussions on topics surrounding science, stuff, health and healthcare (because I just can’t help myself, and because quite a lot of the research bit takes ages so it’s not that easy to update regularly with news about that bit).