Horn: "Neurologist-intensivists are fairly rare and now I am the first professor of Neuro-Intensive Care Medicine."
Difficult choices after CPR
Horn conducts research in comatose patients after CPR. As a professor she wants to extend this research to other comatose patient groups. “For example, people with a major brain hemorrhage or after a major accident. Those patients, who are often young, are located at the Intensive Care Unit (ICU) and sometimes do not wake up or do not wake up properly. Then the dilemma arises: do we continue the treatment of these comatose patients? If you stop, it is clear that someone will die. If you continue the treatment the future might be uncertain. Is someone recovering sufficiently, and is there an acceptable quality of life left? We don't know this in advance, which makes it difficult to make such decisions."
Now Horn is looking for tools which help to make such drastic decisions at the ICU." Tools that help to be able to estimate quality of life in advance." She wants to combine MRI scans, EEG and certain blood values. “We already have these measures for people who don't wake up immediately after CPR. With these measurements we determine whether it is worthwhile to continue treatment for that specific patient. I also want to develop such guidelines for other patient groups in the ICU.”
Another research topic of Horn is about ICU-acquired weakness. After ICU admission, many patients suffer from severe muscle weakness because they have been inactive for a long time. In addition, there are indications that muscle and nervous tissue is affected by the body's inflammatory response. “If you become very ill, immune response regularly derails, causing damage to muscle and nerve cells.”
All kinds of factors can influence ICU weakness, Horn explains, such as the body's inflammatory response, metabolism, nutrition, et cetera. That makes the research very broad. “It would help us enormously if we could determine in advance which patients will suffer from ICU weakness. And whether that is due to damage to the muscles or the nervous tissue. In the ideal situation you would like to coordinate the rehabilitation process according that information. However, we are not there yet.”
Horn is trained as a neurologist in Amsterdam and Enschede. She obtained her PhD at AMC and also followed the ICU training there. She now supervises several PhD students and is involved in the training of prospective intensivists. Horn previously chaired the guideline committee for the prognosis of postanoxic coma (coma after CPR). “And because I have a fairly rare specialty, I am often asked for a second opinion. For example, if a patient is in a coma in another hospital.”