Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-05T11:24:16.015Z Has data issue: false hasContentIssue false

Chapter 2 - Multimodal Neurological Monitoring

Published online by Cambridge University Press:  28 April 2020

By
Samson Zarbiv ,
Erica Fagleman  and
Neha S. Dangayach
Edited by
Andrew B. Leibowitz  and
Suzan Uysal
Andrew B. Leibowitz
Affiliation:
Icahn School of Medicine at Mount Sinai
Suzan Uysal
Affiliation:
Icahn School of Medicine at Mount Sinai
Get access

Summary

In this chapter the basic principles of neuromonitoring will be reviewed. Evidence-based applications, advantages, and disadvantages of various invasive and noninvasive techniques for monitoring intracranial pressure, brain tissue oxygenation, cerebral blood flow, brain metabolism, electroencephalography, and evoked potentials will be covered.

Keywords

Multimodality monitoringintracranial pressurecerebral autoregulationcerebral perfusion pressureelectroencephalogramevoked potentialsmicrodialysispressure reactivity indexpulsatile indexLundberg wavesthermal diffusion flowmetry
Type
Chapter
Information
Modern Monitoring in Anesthesiology and Perioperative Care , pp. 10 - 19
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Jones, RF, Dorsch, NW, Silverberg, GD, Torda, TA. Pathophysiology and management of raised intracranial pressure. Anaesth Intensive Care 1981;9:336–51.CrossRefGoogle ScholarPubMed
Kirkman, MA, Smith, M. Intracranial pressure monitoring, cerebral perfusion pressure estimation, and ICP/CPP-guided therapy: a standard of care or optional extra after brain injury? Br J Anaesth 2014;112:35–46.CrossRefGoogle ScholarPubMed
Treggiari, MM, Schutz, N, Yanez, ND, Romand, JA. Role of intracranial pressure values and patterns in predicting outcome in traumatic brain injury: a systematic review. Neurocrit Care 2007;6:104–12.CrossRefGoogle ScholarPubMed
Muizelaar, JP, Wei, EP, Kontos, HA, Becker, DP. Mannitol causes compensatory cerebral vasoconstriction and vasodilation in response to blood viscosity changes. J Neurosurg 1983;59:822–8.CrossRefGoogle ScholarPubMed
Akbik, OS, Carlson, AP, Krasberg, M, Yonas, H. The utility of cerebral blood flow assessment in TBI. Curr Neurol Neurosci Rep 2016;16:72.CrossRefGoogle ScholarPubMed
Brain Trauma, Foundation. Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma 2007;24 Suppl 1:S37–44.Google Scholar
Carney, N, et al. Guidelines for the management of severe traumatic brain injury, Fourth Edition. Neurosurgery 2017;80:6–15.CrossRefGoogle ScholarPubMed
Bederson, JB, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the stroke council, American Heart Association. Stroke 2009;40:994–1025.CrossRefGoogle ScholarPubMed
Steiner, T, Al-Shahi Salman, R, Christensen, H, et al. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke 2014;9:840–55.Google ScholarPubMed
Bathala, L, Mehndiratta, MM, Sharma, VK. Transcranial Doppler: technique and common findings (part 1). Ann Indian Acad Neurol 2013;16:174–9.Google Scholar
Cardim, D, Robba, C, Bohdanowicz, M, et al. Non-invasive monitoring of intracranial pressure using transcranial Doppler ultrasonography: is it possible? Neurocrit Care 2016;25:473–91.Google Scholar
Rajajee, V, Vanaman, M, Fletcher, JJ, Jacobs, TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care 2011;15:506–15.CrossRefGoogle ScholarPubMed
Robba, C, Santori, G, Czosnyka M, et al. Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis. Intensive Care Med 2018;44:1284–94.Google Scholar
Suarez, JI, Qureshi, AI, Yahia, AB, et al. Symptomatic vasospasm diagnosis after subarachnoid hemorrhage: evaluation of transcranial Doppler ultrasound and cerebral angiography as related to compromised vascular distribution. Crit Care Med 2002;30:1348–55.Google Scholar
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: 265–74.CrossRefGoogle ScholarPubMed
Al-Mufti, F, Amuluru, K, Damodara, N, et al. Novel management strategies for medically-refractory vasospasm following aneurysmal subarachnoid hemorrhage. J Neurol Sci 2018;390:44–51.CrossRefGoogle ScholarPubMed
Ko, SB, Choi, HA, Parikh, G, et al. Real time estimation of brain water content in comatose patients. Ann Neurol 2012;72:344–50.Google Scholar
Lindegaard, KF, Nornes, H, Bakke, SJ, Sorteberg, W, Nakstad, P. Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir (Wien) 1989;100:12–24.CrossRefGoogle ScholarPubMed
Robertson, CS, Gopinath, SP, Goodman, JC, et al. SjvO2 monitoring in head-injured patients. J Neurotrauma 1995;12:891–6.Google Scholar
Schell, RM, Cole, DJ. Cerebral monitoring: jugular venous oximetry. Anesth Analg 2000;90:559–66.Google Scholar
Siegemund, M, van Bommel, J, Ince, C. Assessment of regional tissue oxygenation. Intensive Care Med 1999;25:1044–60.CrossRefGoogle ScholarPubMed
Francoeur, CL, Pain, M, Mayer, SA. Multimodality monitoring: illuminating the Comatose Human Brain. Semin Neurol 2016;36:560–9.Google Scholar
Bohman, LE, Pisapia, JM, Sanborn, MR, et al. Response of brain oxygen to therapy correlates with long-term outcome after subarachnoid hemorrhage. Neurocrit Care 2013;19:320–8.CrossRefGoogle ScholarPubMed
Hlatky, R, Valadka, AB, Gopinath, SP, Robertson, CS. Brain tissue oxygen tension response to induced hyperoxia reduced in hypoperfused brain. J Neurosurg 2008;108:53–8.CrossRefGoogle ScholarPubMed
Nangunoori, R, Maloney-Wilensky, E, Stiefel, M, et al. Brain tissue oxygen-based therapy and outcome after severe traumatic brain injury: a systematic literature review. Neurocrit Care 2012;17:131–8.Google Scholar
Johnston, AJ, Steiner, LA, Coles, JP, et al. Effect of cerebral perfusion pressure augmentation on regional oxygenation and metabolism after head injury. Crit Care Med 2005;33:189–95; discussion 255–187.CrossRefGoogle ScholarPubMed
Oddo, M, Levine, JM, Mackenzie, L, et al. Brain hypoxia is associated with short-term outcome after severe traumatic brain injury independently of intracranial hypertension and low cerebral perfusion pressure. Neurosurgery 2011;69:1037–45; discussion 1045.Google Scholar
Naidech, AM, Bendok, BR, Ault, ML, Bleck, TP. Monitoring with the somanetics INVOS 5100C after aneurysmal subarachnoid hemorrhage. Neurocrit Care 2008;9:326–31.Google Scholar
Rosenthal, G, Furmanov, A, Itshayek, E, Shoshan, Y, Singh, V. Assessment of a noninvasive cerebral oxygenation monitor in patients with severe traumatic brain injury. J Neurosurg 2014;120:901–7.Google Scholar
Jaeger, M, Dengl, M, Meixensberger, J, Schuhmann, MU. Effects of cerebrovascular pressure reactivity-guided optimization of cerebral perfusion pressure on brain tissue oxygenation after traumatic brain injury. Crit Care Med 2010;38:1343–7.Google Scholar
Jaeger, M, Schuhmann, MU, Soehle, M, Meixensberger, J. Continuous assessment of cerebrovascular autoregulation after traumatic brain injury using brain tissue oxygen pressure reactivity. Crit Care Med 2006;34:1783–8.Google Scholar
Czosnyka, M, Smielewski, P, Piechnik, S, Steiner, LA, Pickard, JD. Cerebral autoregulation following head injury. J Neurosurg 2001;95:756–63.Google Scholar
Zeiler, FA, Thelin, EP, Helmy, A, et al. A systematic review of cerebral microdialysis and outcomes in TBI: relationships to patient functional outcome, neurophysiologic measures, and tissue outcome. Acta Neurochir (Wien) 2017;159:2245–73.Google Scholar
Sahuquillo, J, Merino, MA, Sánchez-Guerrero, A, et al. Lactate and the lactate-to-pyruvate molar ratio cannot be used as independent biomarkers for monitoring brain energetic metabolism: a microdialysis study in patients with traumatic brain injuries. PLoS One 2014;9:e102540.Google Scholar
Hlatky, R, Valadka, AB, Goodman, JC, Contant, CF, Robertson, CS. Patterns of energy substrates during ischemia measured in the brain by microdialysis. J Neurotrauma 2004;21:894–906.Google Scholar
Helbok, R, Schmidt, JM, Kurtz, P, et al. Systemic glucose and brain energy metabolism after subarachnoid hemorrhage. Neurocrit Care 2010;12:317–23.CrossRefGoogle ScholarPubMed
Hillered, L, Vespa, PM, Hovda, DA. Translational neurochemical research in acute human brain injury: the current status and potential future for cerebral microdialysis. J Neurotrauma 2005;22:3–41.Google Scholar
Vespa, P, Prins, M, Ronne-Engstrom, E, et al. Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study. J Neurosurg 1998;89:971–82.Google Scholar
Sarrafzadeh, AS, Sakowitz, OW, Kiening, KL, et al. Bedside microdialysis: a tool to monitor cerebral metabolism in subarachnoid hemorrhage patients? Crit Care Med 2002;30:1062–70.Google Scholar
Sarrafzadeh, A, Haux, D, Kuchler, I, Lanksch, WR, Unterberg, AW. Poor-grade aneurysmal subarachnoid hemorrhage: relationship of cerebral metabolism to outcome. J Neurosurg 2004;100: 400–6.Google Scholar
Skjoth-Rasmussen, J, Schulz, M, Kristensen, SR, Bjerre, P. Delayed neurological deficits detected by an ischemic pattern in the extracellular cerebral metabolites in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 2004;100:8–15.Google Scholar
Ferguson, M, Bianchi, MT, Sutter, R, et al. Calculating the risk benefit equation for aggressive treatment of non-convulsive status epilepticus. Neurocrit Care 2013;18:216–27.CrossRefGoogle ScholarPubMed
Caricato, A, Melchionda, I, Antonelli, M. Continuous electroencephalography monitoring in adults in the intensive care unit. Crit Care 2018;22:75.Google Scholar
Herman, ST, et al. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol 2015;32:87–95.CrossRefGoogle ScholarPubMed
Claassen, J, Mayer, SA, Kowalski, RG, Emerson, RG, Hirsch, LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004;62:1743–8.Google Scholar
Farrokh, S, Tahsili-Fahadan, P, Ritzl, EK, Lewin, JJ 3rd, Mirski, MA. Antiepileptic drugs in critically ill patients. Crit Care 2018;22:153.CrossRefGoogle ScholarPubMed
Chang, SH, Park, YG, Kim, DH, Yoon, SY. Monitoring of motor and somatosensory evoked potentials during spine surgery: intraoperative changes and postoperative outcomes. Ann Rehabil Med 2016;40:470–80.Google Scholar
Rosenthal, ES. The utility of EEG, SSEP, and other neurophysiologic tools to guide neurocritical care. Neurotherapeutics 2012;9:24–36.CrossRefGoogle ScholarPubMed
Sanchez-Pinto, LN, Luo, Y, Churpek, MM. Big data and data science in critical care. Chest 2018;154:1239–48.Google Scholar
Yang, S, Stansbury, LG, Rock, P, Scalea, T, Hu, PF. Linking big data and prediction strategies: tools, pitfalls, and lessons learned. Crit Care Med 2019;47(6):840–8.Google Scholar
Learning Health Systems | Agency for Healthcare Research & Quality www.ahrq.gov/professionals/systems/learning-health-systems/index.html (2019).Google Scholar
Li, P, Xie, C, Pollard, T, et al. Promoting secondary analysis of electronic medical records in China: summary of the PLAGH-MIT critical data conference and health Datathon. JMIR Med Inform 2017;5:e43.CrossRefGoogle Scholar
Flechet, M, Grandas, FG, Meyfroidt, G. Informatics in neurocritical care: new ideas for Big Data. Curr Opin Crit Care 2016;22:87–93.Google ScholarPubMed
ICM+ Features | Cambridge Enterprise ICM+., https://icmplus.neurosurg.cam.ac.uk/home/icm-features/ (2018).Google Scholar
Johnson, AE, Pollard, TJ, Shen, L, et al. MIMIC-III, a freely accessible critical care database. Sci Data 2016;3:160035.Google Scholar
Saeed, M, Villarroel, M, Reisner, AT, et al. Multiparameter intelligent monitoring in intensive care II: a public access intensive care unit database. Crit Care Med 2011;39:952–60.Google Scholar
Maas, AI, Menon, DK, Steyerberg, EW, et al. Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study. Neurosurgery 2015;76:67–80.CrossRefGoogle ScholarPubMed
Multimodal Data Integration – Moberg ICU Solutions: Transforming Neurocritical Care., www.moberg.com/solutions/multimodal-data-integration (2018).Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×