Neuroscience Monitor
August 2010 Vol. 1 No. 1


Welcome to the first edition of The Neuroscience Monitor. Actually this is the resurrection of a whimsical newsletter written by Dick Moberg in the mid-1990s about neuromonitoring. A lot has changed since then. The goal of this newsletter is to help you keep up with neuromonitoring with an emphasis on neurocritical care. We plan to keep the newsletter fun and informative. We will also use the newsletter to provide updates on our products and users. We encourage you to contribute and we hope you like it.
 
People & Places
 
University of New Mexico

As many of you know, Dr. Howard Yonas moved from Pittsburgh (a former "mecca" of neurosurgery) in 2005 to take over as Chairman of Neurosurgery at the University of New Mexico. In the past five years, Dr. Yonas has built UNM's neurosurgery department into one that is very active in research, training, and patient care. The hospital recently expanded into a new building that included a 24-bed Neuroscience Intensive Care Unit, and a particular focus of the Department is now on continuous physiological data collection for improved patient monitoring as well as research.

The team in the Neurosciences ICU at the University of New Mexico with the CNS Monitor


The team in the Neurosciences ICU at the University of New Mexico with the CNS Monitor. Left to right: Tracey Berlin RN, Cindy Martinez RN, Dr. Martina Stippler, Dr. Howard Yonas, and Arthur Stidfole RN.

Dr. Yonas' vision is for the ICU to become a state-of-the-art center for multimodality neuromonitoring where devices, analysis tools, imaging, and patient records are all seamlessly integrated. Thus, in 2006, and with subsequent support from the Army and the National Institutes of Health, we started developing the informatics infrastructure to help Dr. Yonas achieve his vision.

One part of this collaboration is that UNM is a partner with us in the Army's Hospital of the Future program. The goal is to develop a standards-based "open system" that can communicate with information "sources" (monitors, imaging, etc.) and store the information in a common format where it is usable by information "users" such as analysis tools (e.g., ICM+, ICUPilot, statistical programs, etc.), decision support tools, and the electronic patient record.

A recent addition and core component of UNM's ICU infrastructure is our CNS Multimodality Monitor that collects data from many of these vital signs monitors and other specialty neuromonitoring devices at the bedside. The data is time synchronized and can be displayed in a variety of formats to detect changes in the trends. Multiple CNS Monitors are now in place at UNM and are incorporated into the hospital network so that the data can be viewed remotely from each system. Multi-channel EEG can also be collected and processed at each bedside and can be viewed in the EEG lab using third-party software (the Persyst EEG Suite).

The goal of "seamless collection of data" from multiple diverse sources is a lofty one. However, several companies agreed to partner with us for device integration at UNM and elsewhere including Hemedex (Bowman Perfusion Monitor), Somanetics (INVOS monitor), Integra (Licox and Camino monitors), Philips (vital signs monitors), GE (vital signs monitors), Persyst Development (EEG review & analysis software), Neurologica (portable CT scanners), and Cincinnati Sub-Zero (Blanketrol cooling system).

We have learned a lot from working with UNM and the job has not always been easy. For example, because the serial data output from the GE vital signs monitors at UNM was being used by an electronic patient record system, we had to develop an alternate Ethernet interface to collect the vital signs data. Similarly, when we learned that UNM wanted to record ICP from two locations simultaneously, we needed to modify our measurement labeling paradigm to enable this collection. Throughout the process the team at UNM has been a pleasure to work with and their feedback has been invaluable.

According to Dr. Yonas, UNM's focus is on patients with head trauma as well as hemorrhagic and ischemic stroke. Over the past decades, Dr. Yonas has conducted pioneering work in the quantification of cerebral blood flow and now, with multimodality monitoring, his interest is on combining CBF with continuous physiological measurements. They have observed that high ICP is frequently due to high flow and that blood pressure elevation to "improve" CPP can paradoxically lower CBF.

As a collaborator, the University has some additional "resources" that make it a particularly attractive place for our work. The Mind Research Network (MRN) is an independent non-profit research organization focusing on mental illness and brain injury. Also in Albuquerque is Sandia National Laboratories. Sandia is a national laboratory involved in a variety of research and development programs for energy, security, and defense. One area of expertise that makes Sandia interesting for work in neuromonitoring is their ability to analyze large quantities of time series data with their super computers.

Dr. Yonas recently told us that one of the reasons he moved to Albuquerque was that his brother (also "Dr. Yonas") ran the Advanced Project Group at Sandia National Laboratories, where he was involved in much of their defense and weapons research. He said, to distinguish the two, he was called "Dr. Life" and, you guessed it, his brother was called "Dr. Death".

The University of New Mexico is sponsoring the upcoming meeting "Clinical Integration of Tomographic Physiological Imaging and Multimodal Monitoring: Present and Future", August 26-28. See the Events section for details.
 
Books
 
Book Cover Epilepsy and Intensive Care Monitoring: Principles and Practice

Bruce J. Fisch, MD, and Bruce Fisch

Published: September 15, 2009

 
Book Cover Case Studies in Neuroanesthesia and Neurocritical Care

George A. Mashour and Ehab Farag

Published: December 31, 2010

 
Book Cover The Practice of Emergency and Critical Care Neurology

Eelco F. M. Wijdicks

Published: June 22, 2010

 
Book Cover Intracranial Pressure and Brain Monitoring XII (Acta Neurochirurgica Supplementum) (v. 12)

Wai S. Poon, Cees J.J. Avezaat, Matthew Chan, and Marek Czosnyka

Published: April 4, 2006

 
Book Cover AACN-AANN Protocols for Practice: Monitoring Neuroscience Patients

American Association of Critical-Care Nurses (AACN), and American Association of Neuroscience Nurses (AANN)

Published: January 28, 2008

 
Book Cover Neurosurgical Emergencies

Christopher M. Loftus

Published: October 22, 2007

 
Book Cover Neurocritical Care (Cambridge Medicine)

Michel T. Torbey MD

Published: September 14, 2009

 
Book Cover Decision Making in Neurocritical Care

Jennifer Frontera

Published: April 24, 2009

 
Book Cover Neurocritical Care: A Guide to Practical Management (Competency-Based Critical Care)

John P. Adams, Dominic Bell, and Justin McKinlay

Published: February 18, 2010

 
Book Cover Handbook of Neurocritical Care (Current Clinical Neurology)

Anish Bhardwaj and Marek A. Mirski

Published: June 28, 2010

 
Book Cover Neurotrauma and Critical Care of the Brain

Jack Jallo and Christopher M Loftus

Published: May 28, 2009

 
Book Cover Neurosurgical Intensive Care

Javed Siddiqi

Published: June 30, 2008

 
Book Cover Seizures in Pediatric Neurocritical Care (Current Clinical Neurology)

James J. Riviello JR and Robert S. Rust

Published: September 1, 2010

 
Book Cover Essentials of Neurosurgical Anesthesia & Critical Care: Strategies for Prevention, Early Detection, and Successful Management of Perioperative Complications (Lecture Notes in Mathematics; 751)

Ansgar Brambrink and Jeffrey Kirsch

Published: July 1, 2010

 
Book Cover Handbook of Neurocritical Care

J. Ricardo Carhuapoma and Stephan Mayer

Published: March 1, 2008

 
Events


2010

August 26-28, 2010
Clinical Integration of Tomographic Physiological Imaging and Multimodal Monitoring - Present and Future
Buffalo Thunder Resort and Casino
Santa Fe, New Mexico
Contact: http://www.tpimm2010.org/default.aspx


September 15-18, 2010
Neurocritical Care Society
San Francisco Marriott Marquis
San Francisco, CA
Contact: http://www.neurocriticalcare.org/i4a/pages/index.cfm?pageid=3719


October 7-9, 2010
Neurocritical Care 2010
A Global Conference of Neurocritical Care and Music
Case Western Reserve University
Cleveland, OH
Contact: http://www.clevelandneurocriticalcare.com/accommodations


October 9, 2010
Third Annual Case Western Reserve University Critical Care Bioinformatics Workshop
Case Western Reserve University
Cleveland, OH
Contact: http://www.clevelandneurocriticalcare.com/3rd-annual-cwru-critical-care-bioinformatics-workshop


October 14-15, 2010
Society for Neuroscience in Anesthesiology and Critical Care, 38th Annual Meeting
Hilton San Diego Bayfront Hotel
San Diego, CA
Contact: http://snacc.org/annual-meeting.php


October 16-21, 2010
Congress of Neurological Surgeons
Moscone West Convention Center
San Francisco, CA
Contact: http://w3.cns.org/meetings/2010/index.asp

 
Publications


Elevated cerebral pressure passivity is associated with prematurity-related intracranial hemorrhage.
Pediatrics. 2009 Jul;124(1):302-9
O'Leary H, Gregas MC, Limperopoulos C, Zaretskaya I, Bassan H, Soul JS, Di Salvo DN, du Plessis AJ.

Intracranial multimodal monitoring for acute brain injury: a single institution review of current practices.
Neurocrit Care. 2010 Apr;12(2):188-98.
Stuart RM, Schmidt M, Kurtz P, Waziri A, Helbok R, Mayer SA, Lee K, Badjatia N, Hirsch LJ, Connolly ES, Claassen J.

Reactivity of brain tissue oxygen to change in cerebral perfusion pressure in head injured patients.
Neurocrit Care. 2009;10(3):274-9. Epub 2009 Jan 30.
Radolovich DK, Czosnyka M, Timofeev I, Lavinio A, Hutchinson P, Gupta A, Pickard JD, Smielewski P.

Monitoring of cerebrovascular autoregulation: facts, myths, and missing links.
Neurocrit Care. 2009;10(3):373-86. Epub 2009 Jan 6.
Czosnyka M, Brady K, Reinhard M, Smielewski P, Steiner LA.

Multimodal monitoring in traumatic brain injury: current status and future directions.
Tisdall MM, Smith M.
Br J Anaesth. 2007 Jul;99(1):61-7. Epub 2007 Jun 4.

 
Research Partners Program


We are pleased to announce our Research Partners program. As many of you know, the parent company of CNS Technology (Moberg Research, Inc.) and its predecessors have been actively involved in neuromonitoring research for three decades. These companies have been the recipient of numerous NIH and DoD grants related to neuromonitoring which have led to new monitoring technology including neonatal seizure detection and a neonatal brain wellness index as well as an advanced multimodality neuromonitoring system. Over the years we have developed some excellent research partnerships which have been beneficial to our company as well as to our academic and clinical partners. If you would like more information, contact Mr. Damon Lees at damon@moberg.com.

 
Product News


EEG, video, and all other physiological data recorded with the CNS Monitor can be viewed away from the bedside using Persyst EEG Suite software.

Compatibility with the CNS Monitor
  • Enables review of EEG, patient video, and all other physiological parameters recorded by the CNS Monitor.
  • The Persyst EEG Suite can be used to review completed recordings that have been archived to CD/DVD, USB drive, or a networked server.
  • The Persyst EEG Suite can also be used to review ongoing CNS Monitor recordings via network connection.
  • Persyst supports a variety of data formats from many EEG manufacturers, enabling you to use one review program for recordings from the CNS Monitor and from other EEG monitoring equipment at your hospital.


Review and Analysis Features of the Persyst EEG Suite
  • Synchronized and fast review of EEG, trends, and video using configurable displays
  • EEG spectral analysis and other computed EEG metrics
  • Automated seizure detection with expert-level performance
  • Automated graphical email notifications


Installation and Support of the Persyst EEG Suite
  • Full software package available for 30 day evaluation
  • Automated installation via CD or by activation of evaluation version
  • Purchase of software includes one year of updates and one year of live web-based training from expert clinical applications specialists
  • For more information, please visit www.persyst.com or contact CNS Technology.


Persyst

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This newsletter is brought to you by CNS Technology.  CNS Technology, LLC is an affiliate of Moberg Research, Inc.

The "Component Neuromonitoring System" and "The Neuroscience Monitor" are trademarks of Moberg Research, Inc. All other trademarks, service marks, company names, and publications that may be identified within this newsletter are the property of their respective owners.