The Future of Medicine: Monitoring Brain Trauma Patients’ Brains in Real Time

Lori Shutter, Neurointensivist, UC Neuroscience Institute at University Hospital and mayfield clinic

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In my residency I originally wanted to do neurorehabilitation—the thought being, I’m a physical therapist, I know rehab. I now know neurology and I can put the two together. Some of that came from one of my patients that I worked with as a physical therapist, a young girl who was 16 and had been in a bad car wreck. Her dad was informed that she would never walk again. She and I worked really hard together. The day she was first able to walk, we set it up so that as her dad walked off the elevator, I had her up walking toward him. Needless to say, [that] got her dad all in tears. The down side is that a lot of things had been done—or not done—during her acute care that [had] a negative impact on her rehabilitation. I discovered that you make or break things in the ICU [intensive care unit]. If you don’t optimize care there it doesn’t matter what happens after that.

What we try to do in the Neuro-ICU is allow the brain the optimum environment to get better and be hyper-vigilant to the things that can do secondary harm. In order to monitor everything—to avoid those secondary injuries—you have to put in a tube that measures pressure, then you put in a separate little catheter wire that measures oxygen levels in the brain, another catheter that measures temperature on the brain, another catheter that measures blood flow in the brain, and they all need to go in about the same place. Which makes it difficult.

The Smart Catheter is a unique device that was actually first conceptualized by the former Chairman of Neurosurgery, Dr. Raj Narayan, working with Dr. Chong Ahn here at UC and one of Dr. Ahn’s post-doc grad students, Chunyan Li. They started saying: “Is there any way to put this all together?” Because if you can miniaturize these sensors, then you only have to drill one small hole in the skull, slide this in and have all of this information available to you. Being able to capture it all at the same time on the same device allows you to see the interplay between them.

[The Smart Catheter] is in the development stage. We put together a proposal that received funding from the Department of Defense to try to move this from benchtop to animal testing and then clinical testing. You are talking about a four- to five-year process to get to a clinically proven device, [but] the device would allow us to hopefully optimize the potential for recovery.

There are not that many neurointensivists around. So often people start talking about the Cleveland Clinic and Mayo Clinic, and about needing to go other places for care. The people we train in our neurocritical care program are sought by Cleveland and Mayo. It’s one of the strongest programs in the country. I’m not sure Cincinnati realizes how unique it is to have this level of expertise right in its back yard.

Originally published in the January 2011 issue.

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