Direct CBF monitoring
Thermal diffusion (Hemedex / Bowman), laser Doppler, xenon CT, and perfusion CT/MR; the family of methods that report regional cerebral blood flow directly, mostly research-grade in pediatrics.
1. Bedside vignettes: why this matters
Vignette A. SAH day 8 with high TCD velocities but real DCI
A 14-year-old with aneurysmal SAH, day 8, post-coiling. Right MCA TCD MFV has risen to 180 cm/s with Lindegaard ratio 4.2; clinical exam shows subtle right-arm drift. A bedside thermal-diffusion probe was placed at admission in the right frontal white matter. TD-CBF reads 18 mL/100 g/min (down from baseline 42); the patient is at the electrical-failure threshold. DCI is confirmed by direct measurement; haemodynamic augmentation and (if needed) intra-arterial therapy follow. The TCD warned; the TD-CBF confirmed and quantified.
Vignette B. Severe TBI with PbtO₂ low, CPP normal
A 13-year-old severe TBI, day 2. PbtO₂ probe reads 14 mmHg (low), CPP 65 (adequate), ICP 18. The team adds a thermal-diffusion probe at the same trajectory. TD-CBF 22 mL/100 g/min in the pericontusional white matter, consistent with oligemia at the upper end of the Astrup cascade. The CBF deficit is the upstream cause of the low PbtO₂; raising MAP to lift CPP to 70 brings TD-CBF to 38 and PbtO₂ to 22. The combined measurement disambiguates flow vs O₂-delivery problems.
Vignette C. Xe-CT for moyamoya screening
A 9-year-old with confirmed moyamoya, considering bypass surgery. Pre-operative xenon-CT (a research / academic centre offering) shows reduced baseline CBF in both MCA territories (24 mL/100 g/min) with markedly reduced reserve to acetazolamide challenge (no increase). This documents the haemodynamic indication for bypass. The same patient post-bypass returns to a 30+ mL/100 g/min CBF with augmented reserve. Xe-CT here is a tomographic snapshot, not a continuous monitor; it bridges the gap between continuous bedside tools and tomographic imaging.
2. What direct CBF monitoring is, and what it is not
The bedside ICU question "what is the flow?" is answered indirectly by every other modality on this site: TCD measures velocity (proxy for flow if vessel diameter is constant), NIRS measures tissue oxygenation (proxy for the supply-demand ratio), PbtO₂ measures tissue O₂ tension (proxy for the same ratio at the tip), and SjvO₂ measures global O₂ extraction (proxy for whole-brain supply-demand). Direct CBF measures the flow itself, in absolute units, at one or more regions.
2.1 The Astrup cascade
The reason "absolute CBF" matters at all is that the bedside thresholds for neuronal viability are calibrated in absolute flow units:
| CBF (mL/100 g/min) | Bedside meaning |
|---|---|
| 50–75 | Normal adult cortex |
| 35–50 | Oligemia onset; CMRO₂ still met |
| 20–35 | Oligemia; functional deficit possible |
| 15–20 | Electrical failure (EEG flattening) |
| 10–15 | Membrane failure threshold |
| < 10 | Imminent infarction |
| < 6 | Established infarction |
These thresholds come from controlled adult-cortex data (Astrup, Heiss, Hossmann); pediatric thresholds are inferred. Direct CBF measurement is what turns these numbers from a foundational concept into a bedside threshold.
2.2 The four method families
Continuous bedside (research-grade):
- Thermal diffusion (TD-CBF): Hemedex Bowman QFlow probe. A small parenchymal probe with a heater and two temperature sensors; measures the rate of heat dispersion to compute absolute CBF at the probe tip (~17 mm³ tissue zone).
- Laser Doppler flowmetry (LDF): a fibreoptic probe; measures the Doppler shift of light reflected from moving red blood cells. Reports relative flux in arbitrary units (perfusion units), not absolute mL/100 g/min.
Intermittent tomographic:
- Xenon-CT (Xe-CT): inhaled stable xenon (a freely diffusible radioopaque tracer); serial CT scans during washin map absolute regional CBF.
- CT perfusion (CTP): bolus iodinated contrast; deconvolution analysis gives CBF, CBV, MTT maps. Widely available; the standard for acute stroke imaging.
- MR perfusion (MRP) and arterial spin labelling (ASL): bolus gadolinium (MRP) or magnetically tagged blood (ASL, no contrast); regional CBF maps. ASL is repeatable, non-contrast; ideal for pediatric serial use.
What direct CBF does well
- Absolute units: anchors the Astrup cascade at the bedside.
- Regional specificity: probe-tip resolution for continuous methods; whole-brain regional for tomographic methods.
- DCI surveillance: continuous TD-CBF in the at-risk SAH territory provides quantitative warning before clinical signs.
- Bridge to therapy: a measured CBF deficit can guide haemodynamic augmentation, transfusion, or intra-arterial intervention.
What direct CBF cannot do
- TD-CBF requires steady-state thermal conditions: shivering, fever spikes, body-temperature changes invalidate the measurement for the duration of the perturbation.
- LDF reports relative, not absolute: useful for trend, not for thresholding against Astrup.
- Xe-CT requires patient transport and is no longer routinely available in most centres.
- CT perfusion requires iodinated contrast and radiation: limits repeatability.
- MRP / ASL require MRI scanner time and patient stability for transport.
- Pediatric data are sparse: most evidence is adult; pediatric thresholds inferred.
- All methods are operator- and centre-dependent: routine clinical use is uncommon.
Direct CBF tells you the flow. Every other modality in the ICU tells you a proxy. The clinical question "is the brain ischaemic?" maps cleanly onto direct CBF values; the proxies require interpretation chains. Where the budget and expertise allow, direct CBF is the missing piece.
- Pediatric experience with direct CBF monitoring is limited: most published series are adult.
- TD-CBF probes in pediatric severe TBI have been used in academic centres; pediatric Astrup thresholds are inferred from adult data.
- ASL is the pediatric-friendly tomographic method: no contrast, repeatable, increasingly available on modern MRI scanners.
- Routine bedside direct CBF in pediatric SAH or TBI is uncommon; the modality is most relevant in research-active centres.
3. Anatomy and probe placement (TD-CBF)
3.1 TD-CBF probe placement
The thermal-diffusion probe is a 1.0 mm diameter parenchymal probe inserted via a cranial bolt:
| Step | Action |
|---|---|
| 1 | Pre-procedure imaging review; identify the at-risk territory |
| 2 | Cranial bolt placement under sterile technique; same trajectory as ICP / PbtO₂ |
| 3 | Advance the TD-CBF probe 2–3 cm into white matter; secure at the bolt |
| 4 | Confirm position with post-procedure CT |
| 5 | Allow 60–120 min equilibration for thermal stability |
| 6 | Begin recording; pair with core temperature and ICP / PbtO₂ |
The probe interrogates a small tissue zone (~17 mm³) at the tip. It does not survey the whole brain; placement must target the at-risk territory.
3.2 LDF probe placement
The laser Doppler probe is similar in size; placement is via the same bolt trajectory. The interrogation depth is shallower (~1 mm³ at the tip).
3.3 Tomographic methods
Xe-CT, CTP, MRP, and ASL require transport to the imaging scanner. Patient stability and scheduling drive the feasibility; the result is a single tomographic snapshot rather than a continuous trend.
Probe placement determines what you measure. A probe in normal-appearing brain remote from the at-risk territory may read normal flow while the lesion territory is ischaemic. Match probe placement to the question, just as with PbtO₂.
4. The signal: thermal diffusion physics
The TD-CBF method exploits the fact that flowing blood removes heat from tissue. A small heater on the probe tip delivers a controlled heat pulse; the probe's distal temperature sensor records the temperature rise and the subsequent decay back to baseline. The decay rate is converted, via a calibrated heat-transfer model, to local CBF in absolute units.
4.1 The measurement cycle
Each measurement cycle:
- Establish thermal equilibrium with surrounding tissue (~60 s).
- Deliver a controlled heat pulse (raise tip temperature ~ 2 °C).
- Record the temperature decay over ~ 90 s.
- Compute CBF from the decay constant.
A full measurement cycle takes approximately 2–3 minutes; continuous monitoring delivers a CBF value every 2–3 minutes.
4.2 Limitations
- Thermal stability required: the calculation assumes steady-state tissue temperature; shivering, fever spikes, body-temperature changes invalidate the measurement.
- Probe-tip CBF only: small interrogation zone (~17 mm³).
- Calibration drift: every probe requires periodic recalibration; long-term continuous use needs maintenance.
- Cost: the disposable probe and the dedicated cart limit availability.
4.3 LDF physics
Laser Doppler delivers near-infrared light into tissue; light backscattered from moving red blood cells is Doppler-shifted. The frequency distribution of the backscattered light yields a flux value (perfusion units). The relationship to absolute CBF is approximate; calibration to absolute units requires assumptions about haematocrit and tissue scattering properties.
5. The numbers to record: the direct-CBF six-pack
| Variable | Symbol | What to record |
|---|---|---|
| Regional CBF | TD-CBF (mL/100 g/min) | Primary; with probe location |
| Baseline CBF | TD-CBF baseline | Established in first 12 h |
| CBF trend | ΔCBF/h | A sustained 25% fall is a clinical event |
| Probe location | Documented on CT | At-risk territory vs normal control |
| Concurrent ICP / CPP / MAP | mmHg | The perfusion-pressure context |
| Patient temperature | T_core | Thermal stability is required for valid measurement |
Always pair direct-CBF readings with the time since insult, the most recent imaging, the multimodal context (PbtO₂, microdialysis, TCD, qEEG), and the clinical exam.
6. What is normal? Age-banded reference
Pediatric CBF is higher per gram than adult, peaks in the preschool window, and falls into adolescence and adulthood. The Astrup cascade thresholds are referenced to adult cortex; pediatric thresholds are inferred and may be different.
| Age band | Healthy CBF (mL/100 g/min) | Notes |
|---|---|---|
| Preterm < 32 wk | 10–30 | Low baseline; passive flow common |
| Term newborn | 20–40 | Lower than older child |
| 6 months | 50–80 | Rising rapidly |
| 1–3 years | 80–120 | Peak years |
| 4–6 years | 80–110 | Peak window |
| 7–12 years | 70–100 | Declining |
| Adolescent | 55–75 | Approaching adult |
| Adult | 50–75 | Reference |
Sources: . The Astrup cascade thresholds (electrical failure ~ 15, membrane failure ~ 10, infarction ~ 6) are adult-cortex values; pediatric thresholds are inferred and may be lower in absolute terms but proportionally similar.
Healthy pediatric MFV by TCD parallels pediatric CBF. The reference values above are derived from PET, Xe-CT, and ASL studies in healthy children. Use within-patient trend over absolute values where possible; the pediatric Astrup cascade should be informed by the patient's own baseline plus the proportional thresholds.
7. What is abnormal? Pattern library
| Pattern | Bedside meaning | What to do |
|---|---|---|
| TD-CBF < 20 mL/100 g/min | Oligemia at electrical-failure threshold | Treat: raise CPP, transfuse, escalate; pair with qEEG and PbtO₂ |
| TD-CBF < 15 | Electrical failure threshold | Urgent intervention; impending injury |
| TD-CBF < 10 | Membrane failure / impending infarction | Aggressive intervention; consider intra-arterial therapy in SAH |
| TD-CBF falling > 25% over hours | Evolving ischaemia | Treat the trend; do not wait for absolute threshold |
| TD-CBF normal with low PbtO₂ | Diffusion limitation, oedema, mitochondrial dysfunction | Microdialysis; targeted treatment of oedema |
| TD-CBF high with normal CMRO₂ | Luxury perfusion; hyperaemic phase of injury | Identify cause; consider seizure, fever |
| TD-CBF high with collapsed CMRO₂ | Luxury without demand; severe injury | Pair with cEEG, SSEP; poor prognostic signature |
| LDF flux change > 50% | Real perfusion event (LDF is relative) | Correlate with absolute CBF or other modalities |
| Xe-CT or ASL deficit in territory at risk | Confirmed regional ischaemia | Anatomical correlate; targeted intervention |
| Acetazolamide challenge non-responder (moyamoya) | Exhausted vasodilatory reserve | Surgical bypass indication |
Decision tree: TD-CBF in DCI surveillance
flowchart TD
Baseline[TD-CBF baseline 40 mL/100g/min] --> Trend{Trend over time}
Trend -->|Stable 35-45| Normal[Continue surveillance]
Trend -->|Falling 30-40| Watch[Recheck TCD, qEEG; tighter monitoring]
Trend -->|Falling 20-30| Treat[Augment haemodynamics; transfuse; angio if available]
Trend -->|Below 20| Urgent[Urgent intervention; intra-arterial therapy candidate]
Trend -->|Below 15| Critical[Imminent injury; aggressive escalation]
8. Try it: interactive widget
9. Management: CBF-anchored decision-making
9.1 DCI surveillance in SAH
The most evidence-supported application. In high-risk SAH patients (Hunt-Hess 4–5, modified Fisher 3–4), continuous TD-CBF in the at-risk territory provides quantitative early warning:
- Establish baseline TD-CBF in the at-risk territory within the first 12–24 h after admission.
- Continuous monitoring for the 14-day vasospasm window.
- A 25% fall from baseline over hours, or absolute TD-CBF < 20, triggers:
- Re-examine: clinical exam, TCD, qEEG.
- Haemodynamic augmentation: raise MAP within autoregulatory range.
- Transfusion if Hb low.
- Angiography / intra-arterial therapy if clinical or quantitative deterioration confirmed.
- Documentation: every event, every intervention, every quantitative response.
9.2 CPP titration in severe TBI
In centres with TD-CBF available, the probe complements PbtO₂ for CPP titration:
- Establish TD-CBF and PbtO₂ baseline at current CPP.
- Trial small CPP changes (5 mmHg).
- Observe TD-CBF and PbtO₂ response.
- Identify the CPP range that maintains TD-CBF in the normal-to-oligemia upper range (35–50 mL/100 g/min) without driving hyperaemia.
- Document the operational CPP window.
9.3 Moyamoya pre-operative assessment
Xe-CT or ASL with acetazolamide challenge documents baseline CBF and vasodilatory reserve:
- Baseline resting CBF map.
- Repeat after acetazolamide IV (1 g adult equivalent, weight-adjusted in pediatrics).
- Calculate the increase in CBF; the failure to increase (cerebrovascular reserve exhausted) is a surgical indication for bypass.
- Post-operative re-assessment confirms restored reserve.
Decision support, not a clinical protocol. Every threshold and workflow above is centre-, patient-, and protocol-dependent. Pair with the full multimodal stack and defer to your unit's protocols.
10. Clinical contexts
10.1 Aneurysmal SAH and DCI
The leading clinical use case. Continuous TD-CBF in the at-risk territory provides quantitative DCI early warning; absolute thresholds (TD-CBF < 20 mL/100 g/min) trigger intervention. The combined surveillance bundle (TCD + qEEG + TD-CBF) is the modern academic-centre approach. Pediatric SAH data are limited.
10.2 Severe TBI
TD-CBF in severe TBI complements PbtO₂ for CPP titration and identifies regional flow deficits that contribute to low PbtO₂. The 2019 BTF pediatric guidelines do not specifically recommend direct CBF monitoring but acknowledge it as a research modality.
10.3 Pediatric arterial ischaemic stroke
CT perfusion is the standard acute-stroke imaging modality. ASL is the pediatric-friendly serial alternative. Direct continuous CBF is rare in pediatric AIS.
10.4 HIE and post-cardiac-arrest
CBF in HIE evolves through hypoperfusion, reperfusion, and (in severe injury) luxury perfusion. Direct measurement is research-grade in this context; the bedside surrogates (TCD, NIRS) carry the routine clinical signal.
10.5 Moyamoya disease
Xe-CT and ASL with acetazolamide challenge are part of the pre-operative work-up for moyamoya bypass surgery. The CBF reserve is the haemodynamic indication.
10.6 Pediatric ECMO
Direct CBF in pediatric ECMO is research-grade; NIRS is the bedside non-invasive standard.
10.7 Bacterial meningitis / encephalitis
CT perfusion and ASL may document hypoperfusion in vasculitis or large infarct territories complicating severe meningitis. Continuous direct CBF monitoring is uncommon.
10.8 Brain-death determination (supportive)
In brain death, CBF is zero or near-zero by direct measurement; CTA and TCD are the preferred ancillary tests in the World Brain Death Project framework.
10.9 Refractory status epilepticus
Continuous seizure activity drives hyperaemic CBF. Direct CBF monitoring is uncommon; TCD MFV trends provide the bedside surrogate.
11. Multimodal integration: direct CBF in the MMM/MNM stack
| Pair with… | What you gain | Worked scenario |
|---|---|---|
| PbtO₂ | Flow + O₂ tension; localises supply vs delivery problem | PbtO₂-CPP titration |
| TCD | Velocity + absolute flow; calibrates the TCD trend in absolute units | TCD vs ICP vasospasm |
| NIRS | Tissue oxygenation + flow; cortical vs probe-tip cross-check | PRx vs COx discordance |
| Microdialysis | Flow + metabolism; the L/P ratio context | Multimodal discordance |
| qEEG | Electrophysiologic function at the CBF threshold; the Astrup correlate | SAH DCI surveillance |
| ICP / CPP / PRx | CBF response to CPP titration; autoregulation curve in absolute flow | CPPopt targeting |
12. Setup and technique
12.1 Equipment
- TD-CBF system: Hemedex Bowman QFlow 500; the cart-based monitor and the disposable probe.
- LDF system: research-grade fibreoptic probes; less commonly deployed clinically.
- Bolt and adapter: same cranial bolt as ICP / PbtO₂; multi-channel adapter.
- Tomographic modalities: Xe-CT (rare), CTP (widely available), MRP (MRI-dependent), ASL (modern MRI).
- Trained operator: probe placement and signal interpretation require dedicated training.
12.2 TD-CBF placement: 6-step protocol
- Pre-procedure imaging review to identify the at-risk territory (pericontusional in TBI; at-risk vascular territory in SAH).
- Cranial bolt placement under sterile technique; multi-channel adapter accommodates ICP, PbtO₂, and TD-CBF probes through a single bolt.
- Advance the TD-CBF probe 2–3 cm into white matter; secure at the bolt.
- Confirm probe position with post-procedure CT; document the territory.
- Allow 60–120 minutes equilibration: thermal stabilisation is required for valid measurement; CBF values during the first hour are unreliable.
- Begin continuous recording: 2–3 minute measurement cycles; pair with ICP, PbtO₂, MAP, core temperature.
12.3 Validity checks
- Thermal stability: shivering, fever spikes, body-temperature changes invalidate the measurement. Annotate every such event.
- Probe-tip position: a probe that has migrated into CSF or against bone gives unreliable values; daily check.
- Calibration drift: weekly recalibration is typical for long-term use.
- Concurrent ICP: a probe-tip CBF in the presence of unstable ICP needs cautious interpretation.
12.4 Reading routine
- Establish baseline in the first 12 h: the patient's own reference.
- Track trend: 25% fall over hours is more informative than a single absolute value.
- Annotate clinical events: suction, intubation, fever, sedation changes, transfusion.
- Correlate with the other channels: PbtO₂, microdialysis, TCD, qEEG.
12.5 Xenon-CT and tomographic methods
Xe-CT requires patient transport, inhalation of stable xenon, and serial CT scans; the resulting absolute CBF map is a single time-point. CTP and MRP / ASL are similar in workflow: scanner time, contrast (CTP, MRP) or no contrast (ASL), reconstruction, and interpretation. The result is a tomographic snapshot, not a continuous trend.
12.6 Removal
The TD-CBF probe is removed when monitoring is no longer required, typically at the same time as ICP and PbtO₂. Complications are similar (small haemorrhage, infection, malposition); the probe is small and removal is straightforward.
13. Pitfalls
- Thermal instability invalidates TD-CBF measurements; fever spikes, shivering, body-temperature changes pause the measurement for the duration.
- Single-region measurement: probe tip samples ~17 mm³; misses remote ischaemia.
- LDF is relative: useful for trend, not for thresholding against Astrup.
- Xe-CT availability is limited: most centres no longer offer the modality.
- CT perfusion radiation and contrast limit repeatability; not a continuous monitor.
- ASL motion sensitivity: pediatric patients may need sedation for high-quality ASL acquisitions.
- Pediatric Astrup thresholds are inferred: the cascade values are adult-cortex calibrated; pediatric application is approximate.
- Probe drift / dislodgement: same risks as ICP / PbtO₂ probes.
- Calibration drift: TD-CBF systems require periodic calibration; uncalibrated values drift.
- Interpretation requires training: not a plug-and-play modality; clinical use is centre- and operator-dependent.
14. Combine with…
- PbtO₂: tissue oxygen tension at the same trajectory.
- TCD: macrovascular velocity; calibration of trend.
- NIRS: cortical oxygenation; non-invasive cross-check.
- Microdialysis: tissue metabolism at the same trajectory.
- SjvO₂: global O₂ extraction; whole-brain context.
- Foundations: autoregulation: the Lassen plateau in absolute flow units.
- Foundations: Astrup cascade: the thresholds direct CBF anchors at the bedside.
- Integration: TCD vs ICP vasospasm: how TD-CBF confirms TCD findings.
- Integration: PbtO₂-CPP titration: the BOOST paradigm extended.
15. Evidence summary
| Topic | Source | Grade |
|---|---|---|
| Kety-Schmidt CBF measurement | foundational | |
| Lassen autoregulation | foundational | |
| Thermal diffusion CBF (Vajkoczy) | B | |
| Laser Doppler flowmetry | B | |
| AHA SAH guidelines | expert | |
| Modern DCI review | review | |
| Pediatric severe TBI (BTF 4th ed.) | expert | |
| BOOST-II (PbtO₂ feasibility) | A | |
| BOOST-III (PbtO₂ outcome) | A | |
| HIE NICHD cooling trial | A | |
| AHA pediatric post-arrest | expert | |
| Pediatric brain injury post-arrest | review | |
| Pediatric AIS / thrombectomy | expert | |
| Bacterial meningitis | expert | |
| ECMO neuro outcomes | C | |
| Brain-death determination | expert | |
| Pediatric MMM consensus | expert | |
| Pediatric neurocritical care review | review | |
| Autoregulation review | review | |
| TCD post-HIE prognosis (pediatric) | C |
16. Recent literature (2022–2025)
- BOOST-III (Bernard 2025): PbtO₂-guided care reduces brain hypoxia episodes; direct CBF complements PbtO₂ where available.
- Modern DCI surveillance in SAH continues to evolve toward multimodal bundles (TCD + qEEG + TD-CBF where available); pediatric data remain sparse.
- Tasker 2023 (pediatric neurocritical care review): direct CBF monitoring listed as tier-3 research modality in pediatric centres.
- Pediatric MMM consensus (Figaji 2025): direct CBF monitoring acknowledged as research-grade with potential bedside utility in academic centres.
- ASL adoption in pediatric MRI continues to expand; the non-contrast, repeatable nature makes it the pediatric-friendly tomographic CBF modality of choice.
- TD-CBF in adult TBI / SAH continues to be used in academic centres; the cost and complexity limit broader adoption.
17. Self-check
References
- Vajkoczy P, Roth H, Horn P, et al.. Continuous monitoring of regional cerebral blood flow: experimental and clinical validation of a novel thermal diffusion microprobe. J Neurosurg 2000;93(2):265–274.
- Hoh BL, Ko NU, Amin-Hanjani S, et al.. Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke 2023;54(7):e314-e370.
- Rass V, Helbok R. How to diagnose delayed cerebral ischaemia and symptomatic vasospasm and prevent cerebral infarction in patients with subarachnoid haemorrhage. Current Opinion in Critical Care 2021;27(2):103-114.
- Kirkpatrick PJ, Smielewski P, Czosnyka M, Pickard JD. Continuous monitoring of cortical perfusion by laser Doppler flowmetry in ventilated patients with head injury. J Neurol Neurosurg Psychiatry 1994;57(11):1382–1388.
- Kochanek PM, Tasker RC, Carney N, et al.. Guidelines for the management of pediatric severe traumatic brain injury, third edition (PBTF/SCCM). Pediatric Critical Care Medicine 2019;20(3S):S1-S82.
- Okonkwo DO, Shutter LA, Moore C, et al.. Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II (BOOST-II): a phase II RCT. Critical Care Medicine 2017;45(11):1907-1914.
- Kirkpatrick PJ, Smielewski P, Czosnyka M, Menon DK, Pickard JD. Near-infrared spectroscopy use in patients with head injury. Journal of Neurosurgery 1995;83(6):963–970. doi:10.3171/jns.1995.83.6.0963 link
- Kety SS, Schmidt CF. The effects of altered arterial tensions of carbon dioxide and oxygen on cerebral blood flow and cerebral oxygen consumption of normal young men. Journal of Clinical Investigation 1948;27(4):484–492. doi:10.1172/JCI101995 link
- Lassen NA. Cerebral blood flow and oxygen consumption in man. Physiological Reviews 1959;39(2):183–238. doi:10.1152/physrev.1959.39.2.183 link
- Bernard F, Barsan W, Diaz-Arrastia R, et al.. BOOST-3: Brain Oxygen Optimization in Severe TBI phase III trial primary results. NEJM 2024.
- Ferriero DM, Fullerton HJ, Bernard TJ, et al.. Management of stroke in neonates and children: a scientific statement from the AHA/ASA. Stroke 2019;50(3):e51-e96.
- Sun LR, Wilson JL, Waak M, et al.. Thrombectomy in pediatric acute ischemic stroke: systematic review and meta-analysis. Pediatric Neurology 2020;105:11-19.
- Shankaran S, Laptook AR, Ehrenkranz RA, et al.. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. NEJM 2005;353(15):1574-1584.
- Kirschen MP, Majmudar T, Beaulieu F, et al.. Transcranial Doppler in pediatric cardiac arrest survivors, association with neurologic outcome. Pediatric Critical Care Medicine 2020;21(5):e221-e229.
- Topjian AA, Scholefield BR, Pinto NP, et al.. Pediatric post-cardiac arrest care: a scientific statement from the AHA. Circulation 2021;144(13):e194-e233.
- Naim MY, Friess SH, Sutton RM, et al.. Multimodal neuromonitoring in pediatric post-cardiac-arrest care. Pediatric Critical Care Medicine 2023.
- Lorusso R, Taccone FS, Belliato M, et al.. Brain monitoring in adult and pediatric ECMO patients: the importance of early and late assessments. Minerva Anestesiologica 2017;83(10):1061-1074.
- Cho SM, Ziai W, Geocadin R, et al.. Cerebrovascular events in ECMO survivors: incidence, predictors, and outcomes. Critical Care Medicine 2024.
- Tunkel AR, Hartman BJ, Kaplan SL, et al.. Practice guidelines for the management of bacterial meningitis (IDSA). Clinical Infectious Diseases 2004;39(9):1267–1284.
- Tunkel AR, Glaser CA, Bloch KC, et al.. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases 2008;47(3):303-327.
- Greer DM, Shemie SD, Lewis A, et al.. Determination of brain death/death by neurologic criteria: the World Brain Death Project. JAMA 2020;324(11):1078-1097.
- Nakagawa TA, Ashwal S, Mathur M, et al.. Guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendations. Critical Care Medicine 2011;39(9):2139-2155.
- Glauser T, Shinnar S, Gloss D, et al.. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults. Epilepsy Currents 2016;16(1):48-61.
- Kapur J, Elm J, Chamberlain JM, et al.. Randomized trial of three anticonvulsant medications for status epilepticus (ESETT). NEJM 2019;381(22):2103-2113.
- Figaji AA, Tasker RC, Bell MJ, Kochanek PM. Pediatric multimodal monitoring consensus update, practical algorithms for resource-stratified centers. Intensive Care Medicine, Paediatric and Neonatal 2025.
- Helbok R, Tasker RC, Kochanek PM, Bell MJ. Pediatric multimodal monitoring: where are we and where do we go?. Pediatric Critical Care Medicine 2024.
- Tasker RC, LaRovere KL, Riviello JJ, et al.. Pediatric multimodal neuromonitoring: international Delphi consensus. Pediatric Critical Care Medicine 2023.
- van de Beek D, Cabellos C, Dzupova O, et al.. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clinical Microbiology and Infection 2016;22 Suppl 3:S37-S62.
- Tasker RC. Cerebrovascular reactivity in pediatric severe traumatic brain injury: a review. Pediatric Critical Care Medicine 2023.
- Rivera-Lara L, Zorrilla-Vaca A, Geocadin R, et al.. Cerebral autoregulation-oriented therapy at the bedside: a comprehensive review. Anesthesiology 2017;126(6):1187-1199.