Multimodal Neurocritical Care Monitoring: Conceptual Approach and Indications
Scott G. Glickman, DO, PhD, MPH and Axel J. Rosengart, MD, PhD
Neuroscience Critical Care Program, Departments of Neurology and Neurosurgery, New York Presbyterian Hospital-Weill Cornell Medical College New York, NY, USA
Multimodal Neurocritical Care Monitoring: Conceptual Approach and Indications
Scott G. Glickman, DO, PhD MPH and Axel J. Rosengart, MD, PhD
Neuroscience Critical Care Program, Departments of Neurology and Neurosurgery, New York Presbyterian Hospital-Weill Cornell Medical College New York, NY, USA
ABSTRACT
The neurologically critically ill patient requires a comprehensive approach to evaluation and management. Standard intensive care monitoring equipment may lead to incorrect assumptions of the underlying pathophysiology at any given time. With the advancement of neurocritical care comes the evolution of advanced neurological monitoring techniques, technologies, and concepts. Much initial knowledge of brain injury was gained via the study of head trauma. More recently, application of the same techniques to other conditions, such as stroke, hemorrhage, and metabolic brain disease has expanded the concepts, goals, and benefits of multimodal neuromonitoring. The current review attempts to summarize and update basic understanding of many of the advanced neuromonitoring tools employed in the neurocritical care unit, from basic assessments of intracranial and cerebral perfusion pressure, to advances in cerebral blood flow determination, cerebral oxygenation and temperature, and brain metabolism with microdialysis, as well as non-invasive assessments of blood flow and electrical activity. Not all neurocritical care illnesses can be approached the same, nor can all patients with similar brain injury be expected to follow the same disease course. Therefore, combination or multimodal neuromonitoring of patients becomes more important to trend different physiologic parameters in each patient as indicators of the underlying and ongoing pathophysiologic mechanisms that will enhance and guide decision making, intervention, and improve outcome.
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