Jonathan Elmer discusses limitations in current neuro-prognostication tools, post-arrest prognostication and precision medicine, and high resolution multimodal data for precision care after cardiac arrest – the PRECICECAP study.

Gregory Hawryluk discusses concerns with poor threshold compliance in neurocritical care, the rationale for improving physiologic threshold compliance, and appreciation of a tool developed to improve physiologic threshold compliance and evidence supporting its effectiveness.

Brian Appavu and Brandon Foreman explore recent work describing the interpretation and reporting of MMM (Multimodal Monitoring) data in the pediatric ICU and its impact on care, the value of interpreting and reporting MMM data to clinical teams, the practical aspects of reporting MMM data in clinical practice, and future directions to enhance the utility of MMM to improve patient care.

Christon Lazaridus covers conceptual approaches to intracranial hypertension, patient-specific intracranial pressure, and predicting secondary brain insults.

Dr. Luca Longhi talks on characteristics of traumatic brain injury and subarachnoid hemorrhage and preliminary data collected through the CNS Monitor.

Jed Hartings covers methods for recording spreading depolarizations, characteristics of spreading depolarizations, and using Moberg software to help identify spreading depolarizations.

Brandon Westover and Sahar Zafar discuss using Ictal-Interictal Continuum Abnormality (IICA) burden to predict patient outcome, automating detection of seizure and IICA, and areas of the model needing improvement.

Dr. Sarwal gives a case-based talk on emerging clinical application of neuroultrasound in the critical care setting. Clinical cases highlighting the use of cranial ultrasound and point of care applications of transcranial doppler monitoring in enhancing the understanding of patient’s cerebrovascular physiology are reviewed.

Dr. Heldt provides a review of some important concepts when monitoring ICP. He also gives an overview of research in recording this important cranial vital sign non-invasively. Learn about The Integrative Neuromonitoring and Critical Care Informatics Group. http://neuro.mit.edu/

This month’s webinar takes you to Zurich, Switzerland where you will hear about the Neuro ICU Cockpit developed by Dr. Emanuela Keller together with ETH Zurich and IBM Research Zurich. Their ICU Cockpit is a great example of how to use comprehensive data for predicting status and optimizing patient management.

Lawrence Chyall and Debra Hemmerle discuss recent findings from the CAMPER study which demonstrate that maintaining SCPP greater than 50mmHg is a strong predictor of recovery in spinal cord injury (SCI). They present a new protocol that operationalizes these findings into the clinical practice of a Smart Neuro ICU. Dr. Geoff Manley makes a guest appearance to introduce the topic.

Dr. Lina Chalak discusses the topic of neonatal asphyxia. The session includes challenges and updates for infants with so called “mild HIE”, new research involving physiological biomarkers to improve risk stratification of the disease severity within 6 hours, as well as new randomized trials of neuroprotection beyond hypothermia.

Clinical management of severe traumatic brain injury has traditionally been focused on control of intracranial pressure, which may be an insensitive and late indicator of secondary brain injury. The monitoring and treating of other physiologic variables, particularly brain tissue oxygenation (PbtO2), may enhance patient care. Insights regarding physiological changes in the brain may be determined through responses of PbtO2 to controlled changes in FiO2, CO2 and MAP. The methods to perform and interpret these dynamic “challenges” are the focus of this webinar.

Sharon Jewell discusses what Spreading Depolarizations (SD) are, how to record them, and why they are clinically relevant in the context of human brain injury. She covers the electrical characteristics of SDs, the blood flow response, and the complex interactions that SDs share with other, established secondary insults. She also touches upon their discovery and historical aspects of SDs important for our current and future understanding.

Dr. Ramon Diaz-Arrastia, MD, PhD, from the University of Pennsylvania, presents the scientific and clinical rationale for monitoring brain tissue oxygen pressure, summarizes the results of the BOOST Phase 2 study, and discusses the design of the BOOST Phase 3 study, which will be launched in the first quarter of 2019.

Dr. Brian Appavu, MD discusses electroencephalographic patterns in neurocritical care as epiphenomena or direct contributors of brain injury. He highlights the effect that seizures and other EEG patterns may have on other neurophysiologic variables (ABP, CPP, brain tissue oxygenation, etc).

Dr. Peter Smielewski of Cambridge Neuroscience presents the current state of the art in continuous assessment of cerebral autoregulation in patients undergoing neuro-monitoring. In particular, he illustrates a practical approach to the autoregulation-oriented management of TBI patients and discusses the clinical impact of such therapy and the road ahead.

Dr. Brandon Foreman, MD, FACNS demonstrates how he records multimodal data and uses this new “medical record for the brain” in the management of his patients.

Dr. Ramani Balu, MD, PhD discusses his recent publication and Olof Nord, discusses the present and future of cerebral microdialysis. Topics covered in this webinar are invasive neuromonitoring methods, candidates for invasive monitoring, and benefits of utilizing multiple monitors.

The first webinar of our Brain Matters Webinar series is on neonatal brain monitoring, featuring Kathi Salley Randall, RN, MSN, CNS, NNP-BC. Topics covered in this webinar are advantages and disadvantages of cEEG and aEEG, usage of therapeutic hypothermia in neonates, and benefits of multimodal monitoring in neonatal care.