Unraveling the complexities of invasive multimodality neuromonitoring

Neurosurg Focus. 2017 Nov;43(5):E4. doi: 10.3171/2017.8.FOCUS17449.

Abstract

Acute brain injuries are a major cause of death and disability worldwide. Survivors of life-threatening brain injury often face a lifetime of dependent care, and novel approaches that improve outcome are sorely needed. A delayed cascade of brain damage, termed secondary injury, occurs hours to days and even weeks after the initial insult. This delayed phase of injury provides a crucial window for therapeutic interventions that could limit brain damage and improve outcome. A major barrier in the ability to prevent and treat secondary injury is that physicians are often unable to target therapies to patients' unique cerebral physiological disruptions. Invasive neuromonitoring with multiple complementary physiological monitors can provide useful information to enable this tailored, precision approach to care. However, integrating the multiple streams of time-varying data is challenging and often not possible during routine bedside assessment. The authors review and discuss the principles and evidence underlying several widely used invasive neuromonitors. They also provide a framework for integrating data for clinical decision making and discuss future developments in informatics that may allow new treatment paradigms to be developed.

Keywords: AJVDO2 = arterial to jugular venous difference in oxygen content; BP = blood pressure; CBF = cerebral blood flow; CMRO2 = cerebral metabolic rate of oxygen; CPP = cerebral perfusion pressure; EEG = electroencephalography; ICP = intracranial pressure; PRx = pressure reactivity index; PbtO2 = partial pressure of brain tissue oxygen; SAH = subarachnoid hemorrhage; SjvO2 = jugular venous oxygen saturation; TBI = traumatic brain injury; TDF = thermal diffusion flowmetry; brain oxygen; cerebral blood flow; informatics; intracranial pressure; multimodality monitoring; precision medicine; traumatic brain injury.

Publication types

  • Review

MeSH terms

  • Brain / diagnostic imaging*
  • Brain Injuries / complications
  • Brain Injuries / diagnostic imaging*
  • Cerebrovascular Circulation / physiology
  • Humans
  • Intracranial Pressure / physiology*
  • Monitoring, Physiologic*
  • Multimodal Imaging*