Recent developments suggest that improved physiologic monitoring may improve neurocritical care management of neurologically compromised patients. Studies have also demonstrated that laser Doppler flowmetry (LDF) is a very useful technique in the continuous, real-time measuring and monitoring of local cerebral blood flow (lCBF). The NeuroSensor is a US FDA-approved combined ICBF/intracranial pressure (ICP) monitoring device that is placed into the brain parenchyma and secured to the skull by a standard-sized bolt. NeuroSensor allows measurement of lCBF in cc/100 g/min, ICP (mm Hg), calculated CPP, mean arterial pressure (MAP), and cerebral vascular resistance and allows provocative testing to determine the presence or absence of CO2 reactivity and cerebral autoregulation. The Neurosystems is a US FDA-approved, novel multimodality monitoring device that combines lCBF and ICP with other monitored systemic physiologic parameters, such as MAP, heart rate, CVP/PAP, EtCO2, and the partial pressure brain tissue oxygen (PbtO2), and others. This provides output data to be viewed as live parametric plots using tunable algorithms and allows these various parameters to be viewed in relational comparison rather than as single data points. The purpose of this study is to measure the parameters mentioned above using the NeuroSensor and Neurosystems in an effort to ultimately gain more accurate measurements and to more effectively treat patients with a variety of pathologies; patients with aneurysmal subarachnoid hemorrhages, strokes, and traumatic brain injuries will be primarily targeted. As clinical trials began in August 2005, preliminary data from these patients may be presented. Additionally, a description of the combined devices and clinical protocols will also be presented. In conclusion, it is anticipated that the continuous, real-time monitoring and heightened accuracy of cerebral blood flow monitoring using the NeuroSensor and the multimodality monitoring using Neurosystems may prove to be an advantage in clinical decision making and ultimately improve clinical outcomes for these patients.
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