Multimodality Monitoring in Neurocritical Care

Abstract

Traditional monitoring in the NICU relegates physicians and nurses to treating patients reactively, only after the patients have declined neurologically and a physiologic process has become abnormal. Real-time monitoring of brain oxygen tension, brain temperature, ICP, CPP, CBF, and cerebral metabolismdin addition to TCD ultrasonography, cEEG, and cardiovascular parametersdgives the neurointensivist immediate insight in the physiologic and metabolic state of brain regions at risk for ischemia and injury and enhances the potential of early effective interventions to reverse pathologic states on an individual basis. Specifically, the combination of ICP/CPP monitoring, complemented by brain oxygen tension and lactate/pyruvate ratio monitoring, may distinguish areas of the brain at risk that might respond to manipulations of MAP or CPP. Initial research using this information at the bedside has enabled proactive treatment of patients in the form of patient-specific physiologic targets. Ideally, multimodal analysis of physiologic data will enable neurointensivists to  Summary 99 optimize a patient’s physiology, minimizing the impact of neurologic derangement, and ultimately transforming the NICU treatment model. More research and actual application of these techniques is needed to confirm reference values for brain health and to standardize clinical management. Optimization of CPP and ICP, hyperventilation, hyperosmolar therapy, hypothermia, weaning from liberation from ventilation, diagnosis and treatment of vasospasm, and temporary occlusion of arteries during radiologic or surgical interventions can be guided by these novel technologies. Clinical informatics tools and decision support research will be needed to reduce the quantity and increase the quality of information neurointensivists must sift through when managing their patients. Multi-modal monitoring should become the standard of every NICU and offers tremendous potential.  References 100