Unraveling the complexities of invasive multimodality neuromonitoring

Abstract

<jats:p>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.</jats:p><jats:p>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.</jats:p><jats:p>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.</jats:p>

Temperature Difference between Brain and Axilla according to Body Temperature in the Patient with Brain Injury

“…In this study, we measured the brain temperature with a thermal diffusion flow meter (TDF) and measured the axillary temperature with a standard mercury thermometer simultaneously every two hours after a brain operation. 4 21 25 29 36 39) We tried to assess the temperature difference in terms of the axillary temperature. Body temperature was divided three groups, according to the axillary temperature: hypothermia group (less than 36.4°C), normothermia group (between 36.5°C and 37.5°C), and hyperthermia group (more than 37.6°C).…”

“…The implanted thermal diffusion flowmeter sensor, the SABER 2000 (SABER 2000; Flowtornics, Phoenix, AZ, USA), 4 34) was used to measure the brain cortex surface temperature in 52 cases, between 1997 and 2002. The Bowman perfusion monitor (Hemedex, Waltham, MA, USA,) 21 29) was used to measure the brain cortex temperature at about 1–2 cm below the surface in 83 cases, between 2003 and 2009. Both devices were designed to check cerebral blood flow (CBF) by monitoring the thermal diffusion.…”

Clinical trials for pediatric traumatic brain injury: definition of insanity?

“…to CPP and ICP in adults with TBI, distinct physiological profiles could be identified among patients with TBI who died, contracted an infection, and suffered multiple organ failure. 49 Clearly, further work is necessary, but these early studies provide a window into the potential for improved understanding of the complex neurophysiology following severe TBI in children and opportunities for more aggressive and novel therapeutic approaches for clinical management.…”

Continuous non-invasive optical monitoring of cerebral blood flow and oxidative metabolism after acute brain injury

“…Ideally, bedside monitors will detect conditions that increase the likelihood of secondary injury. 6 – 11 Unfortunately, however, bedside monitoring techniques (including serial neurologic examinations) in current use are unable to provide real-time, continuous, non-invasive measurements of CBF and brain metabolism. 6 – 9 This leads to a situation wherein mismatches between perfusion and metabolism that commonly arise in the hospital are often not detected until after irreversible brain damage has developed.…”

“…Thus, we evaluated the capabilities of NNOM for detection of ischemia based on CBF and CMRO 2 data in combination. We further compared NNOM CBF and CMRO 2 to concurrent invasive PbtO 2 , ICP, TDF, and cerebral microdialysis measurements obtained during standard clinical care, 6,11,39 and we used NNOM to assess CA state.…”