Prise en charge médicale des victimes de traumatisme craniocérébral admises à l'unité des soins intensifs

 

François Lauzier

Centre hospitalier universitaire de Québec [CHUQ]

 

Domaine : services de santé

Programme Chercheurs-boursiers cliniciens - Senior

Concours 2018-2019

Despite the fact that they are younger and have fewer medical comorbidities, victims of moderate and severe traumatic brain injury (TBI) develop more complications than any other patients admitted to the intensive care unit (ICU). These complications, directly due to the trauma or indirectly due to life-sustaining treatments, may have major impact on patients' outcomes. Among those complications, damage to the pituitary gland is a frequently overlooked but potentially important condition that can cause dysfunction of other glands such as the adrenals, thyroid, ovaries and testes. Also, TBI victims are more likely to be underfed during their ICU stay and to have vitamin D deficiency, which could impair repair mechanisms following TBI. However, the association between these complications, the chances of survival and symptoms commonly experienced by TBI survivors remains unclear.

This research program aims to optimize the management of these medical problems in order to improve the outcome of TBI victims. We will first conduct a study on 168 patients to better understand the impact of pituitary disorders on disability, functional recovery, quality of life and depression of TBI survivors during the rehabilitation phase. We will also perform a clinical trial on 748 patients to determine if the use of corticosteroids in the ICU to treat adrenal insufficiency prevents long-term neurological sequelae. Finally, we will evaluate the impact of underfeeding and vitamin D deficiency using a database and a blood sample biobank that we have built over the past few years.

All these projects are mandatory steps before recommending the widespread use of corticosteroids and before conducting other large-scale clinical trials to determine if hormone therapy during the rehabilitation phase, and nutritional optimization and vitamin D supplementation during the ICU stay will improve clinically important outcomes for this vulnerable population.