Neuro-ARC is a key prospective observational study dedicated to improving care for patients with life-threatening neurological illnesses. Globally, the most common life-threatening neurological conditions are stroke, severe traumatic brain injury (TBI), uncontrolled seizures, and brain infections. Treating this patient population is particularly complex due to the common and serious complications that follow acute neurological illness, such as seizures and infections. These are dangerous conditions that pose a high-risk to the patient, contributing significantly to poor outcomes. Successfully treating these complications requires prompt and appropriately dosed anti-seizure drugs and antibiotics, respectively.

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Many of the vital medications used in these treatments are renally eliminated drugs, which means they are removed from the body by the kidneys. However, there is a common, though often unrecognized, condition in critically ill patients known as Augmented Renal Clearance (ARC). ARC refers to an enhanced state of kidney function. This phenomenon can significantly accelerate how the body clears these renally eliminated drugs, potentially resulting in insufficient drug levels, treatment failure, poor patient outcomes, and increased healthcare costs. While clinicians routinely adjust doses for reduced kidney function, ARC is largely undetected by standard assessment methods. Critically, despite its high prevalence in the neurocritical care population, the full impact and critical consequences of ARC on critically ill patients have not yet been sufficiently characterized.

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Our Neuro-ARC study is designed to bridge this critical gap in knowledge. We aim to precisely characterize the phenomenon of ARC in patients admitted to the Neuro ICU, specifically by determining its prevalence, time course, and associated risk factors. To achieve this, consenting participants in the Neuro-ICU will undergo enhanced monitoring, including the collection of 8-hour urine samples and blood collections to measure kidney function along with the drug concentrations of five commonly used ICU medications. These sampling procedures use catheters and lines already in place as part of standard Neuro-ICU care, ensuring no additional invasive techniques or inconvenience to the patient. This allows us to keep participant health and safety as our highest priority throughout the duration of the study.

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The ultimate goal of this research is to translate our findings into clinical practice by developing and validating an ARC prediction tool and proposing individualized dosing recommendations for these critical medications. By facilitating the timely identification and medication optimization for patients with ARC, the Neuro-ARC trial seeks to improve the efficacy and safety of drug therapy, ultimately leading to better recovery and long-term well-being for patients with life-threatening neurological conditions.