Clinical review: Neuromonitoring - an update

Abstract

Critically ill patients are frequently at risk of neurological dysfunction as a result of primary neurological conditions or secondary insults. Determining which aspects of brain function are affected and how best to manage the neurological dysfunction can often be difficult and is complicated by the limited information that can be gained from clinical examination in such patients and the effects of therapies, notably sedation, on neurological function. Methods to measure and monitor brain function have evolved considerably in recent years and now play an important role in the evaluation and management of patients with brain injury. Importantly, no single technique is ideal for all patients and different variables will need to be monitored in different patients; in many patients, a combination of monitoring techniques will be needed. Although clinical studies support the physiologic feasibility and biologic plausibility of management based on information from various monitors, data supporting this concept from randomized trials are still required.

Recommendations for the use of multimodal monitoring in the neurointensive care unit

“…Even if no single monitor will improve outcome per se, if the findings obtained from such devices are not associated with effective therapeutic interventions, a monitoring-based approach could still be essential to overall improve neurological outcome and quality of life in survivors of severe brain damage [1]. It should primarily guide clinicians to understand ABI mechanisms, eventually clinical deterioration, and tailor therapy to the individual patient [2 && ].…”

S100β in newborns after C‐section with general vs. epidural anesthesia: a prospective observational study

“…38,39 So the specificity of S100b for acute brain injury is generally low. 40 A combination of different biomarkers, such as neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP), and tau protein, will be needed to improve predictive ability of brain injury in further work. S100b in blood is regarded as extracellular S100B passing into the blood through a disrupted blood-brain barrier (BBB).…”

Neurocritical care

“…Increasingly, neurointensivists integrate ICP and cerebral perfusion pressure with other information, including neuroimaging, intracranial compliance, cerebral blood flow autoregulation and information derived from other modes of neurological monitoring before making treatment decisions [77][78][79][80]. Even within a particular diagnostic subgroup like TBI, it seems unlikely that targeting a single treatment threshold in all patients (e.g.…”