Skip to main content Accessibility help
×
Hostname: page-component-848d4c4894-xm8r8 Total loading time: 0 Render date: 2024-06-25T07:10:43.837Z Has data issue: false hasContentIssue false

Chapter 8 - Intracranial Monitoring in the Neurocritical Care Unit

Published online by Cambridge University Press:  24 July 2019

Michel T. Torbey
Affiliation:
Ohio State University
Get access

Summary

Invasive neuromonitoring is fast becoming an integral part of neurocritical care due to its capability and role in identifying risk for secondary injury and patient deterioration. Care of the brain-injured patient that utilizes only systemic therapeutic parameters and generalized patient goals has been shown to result in unacceptable rates of delayed brain injury [1]. Traditional signs of injury, such as examination changes and hemodynamic variation, are important but insensitive and late markers of irreversible damage, and are preceded by subclinical edema, inflammation, ischemia, and free radical production by hours and sometimes days [2]. Current neuromonitoring devices are capable of assessing risks for deterioration by measurement of the uptake, delivery, or utilization of brain metabolites at a time when therapeutic intervention is possible.

Type
Chapter
Information
Neurocritical Care , pp. 78 - 85
Publisher: Cambridge University Press
Print publication year: 2019

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

Schmidt, JM, Wartenberg, KE, Fernandez, A, et al. Frequency and clinical impact of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage. J Neurosurg. 2008;109:1052–9.Google Scholar
Miller, CM. Update on multimodality monitoring. Curr Neurol Neurosci Rep. 2012;12:474–80.Google Scholar
Brain Trauma Foundation. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;34:S1-S106.Google Scholar
Sussman, ES, Kellner, CP, Nelson, E, et al. Hemorrhagic complications of ventriculostomy: incidence and predictors in patients with intracerebral hemorrhage. J Neurosurg 2014;120:931–6.Google Scholar
Lozier, AP, Sciacca, RR, Romagnoli, MF, et al. Ventriculostomy-related infections: A critical review of the literature. Neurosurgery 2002;51:170–82.Google Scholar
Holloway, KL, Barnes, T, Choi, S, et al. Ventriculostomy infections: the effect of monitoring duration and catheter exchange in 584 patients. J Neurosurg 1996;85:419–24.Google Scholar
Rebuck, JA, Murry, KR, Rhoney, DH, et al. Infection related to intracranial pressure monitors in adults: analysis of risk factors and antibiotic prophylaxis. J Neurol Neurosurg Psychiatry 2000;69:381–4.Google Scholar
Lazaridis, C, DeSantis, SM, Smielewski, P, et al. Patient-specific thresholds of intracranial pressure in severe traumatic brain injury. J Neurosurg 2014;120:893900.CrossRefGoogle ScholarPubMed
Pople, I, Poon, W, Assaker, R, et al. Comparison of infection rate with the use of antibiotic-impregnated vs standard extraventricular drainage devices: A prospective randomized controlled trial. Neurosurgery 2012;71:613.Google Scholar
Kubilay, Z, Amini, S, Fauerbach, LL, et al. Decreasing ventricular infections throughout the use of a ventriculostomy placement bundle: experience at a single institution. J Neurosurg 2013;118:514–20.CrossRefGoogle Scholar
Chesnut, RM, Temkin, N, Carney, N, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. NEJM 2012;367(26):2471–81.CrossRefGoogle ScholarPubMed
Nwachuku, EL, Puccio, AM, Fetzick, A, et al. Intermittent versus continuous cerebrospinal fluid drainage management in adult severe traumatic brain injury: assessment of intracranial pressure burden. Neurcrit Care 2014;20:4953.CrossRefGoogle ScholarPubMed
Hoelper, DM, Alessandri, B, Heimann, A, et al. Brain oxygen monitoring: in-vitro accuracy, long-term drift and response-time of Licox- and Neurotrend sensors. Acta Neurochir (Wien) 2005;147:767–74.Google Scholar
Rosenthal, G, Hemphill, JC III, Sorani, M, et al. Brain tissue oxygen tension is more indicative of oxygen diffusion than oxygen delivery and metabolism in patients with traumatic brain injury. Crit Care Med 2008;36:1917–24.Google Scholar
Maloney-Wilensky, E, Gracias, V, Itkin, A, et al. Brain tissue oxygen and outcome after severe traumatic brain injury: a systematic review. Crit Care Med. 2009;37:2057–63.Google Scholar
Dings, J, Miexensberger, J, Jager, A, Klaus, R. Clinical experience with 118 brain tissue oxygen partial pressure catheter probes. Neurosurgery 1998;43(5):1082–94.Google Scholar
Stewart, C, Haitsma, I, Zador, Z, et al. The new Licox combined brain tissue oxygen And brain temperature monitor: Assessment of in vitro accuracy and clinical experience in severe traumatic brain injury. Neurosurgery 2008;63:1159–65.CrossRefGoogle ScholarPubMed
Miller, CM, Palestrant, D. Distribution of delayed ischemic neurological deficits after aneurysmal subarachnoid hemorrhage and implications for regional neuromonitoring. Clinical Neurology and Neurosurgery 2012;114:545–9.Google Scholar
Ponce, LL, Pillai, S, Cruz, J, et al. Position of probe determines prognostic information of brain tissue PO2 in severe traumatic brain injury. Neurosurgery 2012;70:14921503.CrossRefGoogle ScholarPubMed
Stiefel, MF, Udoetuk, JD, Spiotta, AM, et al. Conventional neurocritical care and cerebral oxygenation after traumatic brain injury. J Neurosurg. 2006;105:568–75.CrossRefGoogle ScholarPubMed
Valadka, AB, Gopinath, SP, Contant, CF, Uzura, M, Robertson, CS. Relationship of brain tissue PO2 to outcome after severe head injury. Crit Care Med. 1998;26(9):1576–87.Google Scholar
Bohman, L, Heuer, GG, Macyszyn, L, et al. Medical management of compromised brain oxygen in patients with severe traumatic brain injury. Neurocrit Care. 2011;14:361–9.Google Scholar
Stieffel, MF, Spiotta, A, Gracias, VH, et al. Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg. 2005;103:805–11.Google Scholar
Narotam, PK, Morrison, JF, Nathoo, N. Brain tissue oxygen monitoring in traumatic brain injury and major trauma: outcome analysis of a brain tissue oxygen-directed therapy. J Neurosurg. 2009;111:672–82.CrossRefGoogle ScholarPubMed
Ramakrishna, R, Stieffel, M, Udoteuk, J, et al. Brain oxygen tension and outcome in patients with subarachnoid hemorrhage. J Neurosurg. 2008;109:1075–82.Google Scholar
Hemphill, JC III, Morabito, D, Farrant, M, Manley, GT. Brain tissue oxygen monitoring in intracerebral hemorrhage. Neurocrit Care. 2005;3:260–70.Google Scholar
Hemphill, JC III, Smith, WS, Sonne, C, Morabito, D, Manley, GT. Relationship between brain tissue oxygen tension and CT perfusion: feasibility and initial results. AJNR. 2005;26:10951100.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;100:815.Google Scholar
Maurer, MH, Haux, D, Sakowitz, OW, Unterberg, AW, Kuschinsky, W. Identification of early markers for symptomatic vasospasm in human cerebral microdialysate after subarachnoid hemorrhage: Preliminary results of a proteome-wide screening. Journal of Cerebral Blood Flow and Metabolism 2007;27:1675–83.Google Scholar
Stuart, RM, Helbok, R, Kurtz, , et al. High-dose intra-arterial verapamil for the treatment of cerebral vasospasm after subarachnoid hemorrhage: Prolonged effects on hemodynamic parameters and brain metabolism. Neurosurgery 2011;68:337–45.CrossRefGoogle ScholarPubMed
Schmidt, JM, Claassen, J, Ko, S, et al. Nutritional support and brain tissue glucose metabolism in poor-grade SAH: a retrospective observational study. Critical Care 2012;16:R15.Google Scholar
Timofeev, I, Carpenter, KLH, Nortje, J, et al. Cerebral extracellular chemistry and outcome following traumatic brain injury: a microdialysis study of 223 patients. Brain 2011;134:484–94.Google Scholar
Stein, NR, McArthur, DL, Etchepare, M, Vespa, PM. Early cerebral metabolic crisis after TBI influences outcome despite adequate hemodynamic resuscitation. Neurocrit Care 2012; 17:4957.Google Scholar
Marcoux, J, McArthur, DA, Miller, C, et al. Persistent metabolic crisis as measured by elevated cerebral microdialysis lactate-pyruvate ratio predicts chronic frontal lobe brain atrophy after traumatic brain injury. Crit Care Med 2008;36:2871–7.CrossRefGoogle ScholarPubMed
Timofeev, I, Czosnyka, M, Carpenter, KLH, et al. Interaction between brain chemistry and physiology after traumatic brain injury: Impact of autoregulation and microdialysis catheter location. Journal of Neurotrauma 2011;28:849–60.Google Scholar
Vespa, P, Boonyaputthikul, R, McArthur, DL, et al. Intensive insulin therapy reduces microdialysis glucose values without altering glucose utilization or improving the lactate/pyruvate ratio after traumatic brain injury. Crit Care Med 2006;34:850–6.Google Scholar
Schnewies, S, Grond, M, Staub, F, et al. Predictive value of neurochemical monitoring in large middle cerebral artery infarction. Stroke 2001;32:1863–7.Google Scholar
Helmy, A, Carpenter, KLH, Skeper, JN, Kirkpatrick, PJ, Picard, JD, Hutchinson, PJ. Microdialysis of cytokines: Methodological considerations, scanning electron microscopy, and determination of relative recovery. Journal of Neurotrauma 2009;26:549–61.Google Scholar
Portnow, J, Badie, B, Liu, X. et al. A pilot microdialysis study in brain tumor patients to assess changes in intracerebral cytokine levels after craniotomy and in response to treatment with a targeted anti-cancer agent. J Neurooncol 2013; E-pub before print.Google Scholar
Dahyot-Fizelier, C, Frasca, D, Gregoire, N, et al. Microdialysis study of cefotaxime cerebral distribution in patients with acute brain injury. Antimicrob. Agents Chemother. 2013;57(6):2738.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.Google Scholar
Klein, KU, Glaser, M, Reisch, R, Tresch, A, Werner, C, Englehard, K. The effects of arterial carbon dioxide partial pressure and sevoflurane on capillary venous cerebral blood flow and oxygen saturation during craniotomy. Anesth Analg 2009;109:199204.CrossRefGoogle ScholarPubMed
Miller, CM, Palestrant, D, Schievink, WI, Alexander, MJ. Prolonged transcranial Doppler monitoring after aneurysmal subarachnoid hemorrhage fails to adequately predict ischemic risk. Neurocrit Care 2011;15:387–92.Google Scholar
Vajkoczy, P, Horn, P, Bauhuf, C, et al. Effect of intra-arterial papaverine on regional cerebral blood flow in hemodynamically relevant cerebral vasospasm. Stroke. 2001;32:498505.Google Scholar
Thome, C, Vajkoczy, P, Horn, P, Bauhuf, C, Hubner, U, Schmeidek, P. Continuous monitoring of regional cerebral blood flow during temporary arterial occlusion in aneurysm surgery. J Neurosurg 2001;95:402–11.Google Scholar
Rosenthal, G, Sanchez-Mejia, RO, Phan, N, et al. Incorporating a parenchymal thermal diffusion cerebral blood flow probe in bedside assessment of cerebral autoregulation and vasoreactivity in patients with severe traumatic brain injury. J Neurosurg 2011;114(1):6270.Google Scholar
Sioutos, P, Orozco, JA, Carter, LP, Weinand, ME, Hamilton, AJ, Williams, FC. Continuous regional cerebral cortical blood flow monitoring in head-injured patients. Neurosurg 1995;36(5):943–9.Google Scholar
Chieregato, A, Calzolari, F, Trasfoini, G, et al. Normal jugular bulb oxygen saturation. J Neurol Neurosurg Psychiatry. 2003;74(6):784–6.Google Scholar
Metz, C, Holzschuh, M, Bein, T, et al. Monitoring of cerebral oxygen metabolism in the jugular bulb: reliability of unilateral measurements in severe head injury. J Cereb Blood Flow Metab. 1998;18:332–43.Google Scholar
Coplin, WM, O’Keefe, GE, Grady, MS, et al. Thrombotic, infectious, and procedural complications of the jugular bulb catheter in the intensive care unit. Neurosurgery. 1997;41(1):101–9.Google Scholar
Gopinath, SP, Robertson, CS, Contant, CF, et al. Jugular venous desaturation and outcome after head injury. Journal of Neurology, Neurosurgery, and Psychiatry. 1994;57:717–23.Google Scholar
Heran, NS, Hentschel, SJ, Toyota, BD. Jugular bulb oximetry for prediction of vasospasm following subarachnoid hemorrhage. Can J Neurol Sci. 2004;31:80–6.Google Scholar
Gopinath, SP, Valadka, AB, Uzura, M, Robertson, CS. Comparison of jugular venous oxygen saturation and brain tissue PO2 as monitors of cerebral ischemia after head injury. Crit Care Med. 1999;27(11):2337–45.Google Scholar
Huang, AP, Lee, CW, Hsieh, HJ, et al. Early parenchymal contrast extravasation predicts subsequent hemorrhage progression, clinical deterioration, and need for surgery in patients with traumatic cerebral contusion. J Trauma. 2011;71:1593–9.Google Scholar
Oertel, M, Kelly, DF, McArthur, D, et al. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg. 2002;96(1):109–16.Google Scholar
Kim, J, Smith, A, Hemphill, JC III, et al. Contrast extravasation on CT predicts mortality in primary intracerebral hemorrhage. AJNR. 2008;29:520–5.Google Scholar
Kidwell, CS, Chalela, JA, Saver, JL, et al. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA. 2009;292(15):1823–30.Google Scholar
Matsukawa, H, Shinoda, M, Fujii, M, et al. Genu of corpus callosum as a prognostic factor in diffuse axonal injury. J Neurosurg. 2011;115:1019–24.Google Scholar
Bruns, BR, Tesoriero, R, Kufera, J, et al. Blunt cerebrovascular injury screening guidelines: What are we willing to miss? J Trauma Acute Care Surg. 2014;76:691–5.CrossRefGoogle ScholarPubMed
Marshall, LF, Marshall, SB, Klauber, MR, et al. A new classification of head injury based on computerized tomography. J Neurosurg. 1991;75:S14-S20.Google Scholar
Maas, AIR, Hukkelhoven, CWPM, Marshall, LF, Steyerberg, EW. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery. 2005;57:1173–82.Google Scholar
Washington, CW, Grubb, RL. Are routine repeat imaging and intensive care unit admission necessary in mild traumatic brain injury? J Neurosurg. 2012;116:549–57.Google Scholar
Garrett, MC, Bilgin-Freiert, A, Bartels, C, Everson, R, Afsarmanesh, N, Pouratian, N. An evidence-based approach to the efficient use of computed tomography imaging in the neurosurgical patient. Neurosurgery. 2013;73:209–16.Google Scholar
Lang, EW, Chesnut, RM. Intracranial Pressure: monitoring and management. Neursurg Clin North Am. 1994;5:573–88.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
×