The major neuromonitoring techniques employed in ICU are the recording of neurophysiological parameters. From this information it is difficult to assess the neurochemical and metabolic status of the brain, the real-time knowledge of which would be extremely useful for patient care. Recent technological developments have opened up the possibility of monitoring neurochemical and metabolic changes in the brain in a clinical setting. In particular, microdialysis allows the analysis of extracellular neurotransmitters and metabolites, and jugular venous oximetry and near-infrared spectroscopy are beginning to provide valuable information on cerebral oxygen metabolism. This work contains the proceedings of the First International Symposium of Neurochemical Monitoring in ICU and thus represents a state-of-the-art review of the clinical application of real-time neurochemical monitoring.