Multimodal monitoring in traumatic brain injury: current status and future directions

Abstract

Traumatic brain injury (TBI) remains a major cause of morbidity and mortality, particularly in young people. Despite encouraging animal studies, human trials assessing the use of pharmacological agents after TBI have all failed to show efficacy. Current management strategies are therefore directed towards providing an optimal physiological environment in order to minimize secondary insults and maximize the body's own regenerative processes. Modern neurocritical care management utilizes a host of monitoring techniques to identify or predict the occurrence of secondary insults and guide subsequent therapeutic interventions in an attempt to minimize the resulting secondary injury. Recent data suggest that the use of protocolized management strategies, informed by multimodality monitoring, can improve patient outcome after TBI. Developments in multimodality monitoring have allowed a movement away from rigid physiological target setting towards an individually tailored, patient-specific, approach. The wealth of monitoring information available provides a challenge in terms of data integration and accessibility and modern software applications may aid this process.

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

“…24 Care of patients is increasingly being individualized using multi-modal monitoring to adjust physiological goals, including intracranial pressure (ICP), cerebral perfusion pressure, and PCO 2 or PO 2 targets. [25][26][27] Several observational studies have suggested that an organized, protocol-based approach with emphasis on the prevention of ''secondary'' neurological insults may be associated with improved recovery. [28][29][30][31][32][33][34] Consistent with these developments, the care of neurocritical care patients in our region of Canada has evolved considerably over the past decade.…”

Correlation of pulsatility index with intracranial pressure in traumatic brain injury

“…The use of TCD as a predictor of ICP was first described by Klingerhofer et al They have shown that Middle cerebral artery (MCA) flow velocities and PI may help to assess the progression of the injury, correlate well with ICP and guide the treatment protocols if invasive ICP measurements are not available at the NICU (2,11,12,19,30). Several studies have focused on the changes in MCA flow velocity measurements after head injuries and they reinforce the use of TCD together with multimodality monitoring to understand the patterns of perfusion, oxygenation and autoregulation (8,15,22,26). This study was designed to record the cerebral haemodynamic changes and to evaluate ICP indirectly by TCD, to determine whether the increased PI values recorded with T corresponds to ICP values in TBI patients who are under a dynamic treatment protocol.…”

Shedding light on the adult brain: a review of the clinical applications of near-infrared spectroscopy

“…A recent observational study prospectively investigated the effect on mortality and cardiopulmonary morbidity of pre-operative rScO 2 measured with an INVOS 4100 or a 5100 cerebral oximeter in 1178 patients undergoing cardiac surgery with cardiopulmonary bypass [22]. The lowest median (range) oxygen-supplemented pre-operative rScO 2 was 64 per cent (15-92%).…”

“…One study identified an association between the increasing length of time that rScO 2 (measured with an INVOS 4100 oximeter) was below 60 per cent and intracranial hypertension, low cerebral perfusion pressure and increased mortality in 18 patients with severe traumatic brain injury [40]. A more recent study found that brain tissue oxygen tension and rScO 2 (measured using an INVOS 5100) were directly and significantly related in 22 patients with severe traumatic brain injury [41].…”