Published online by Cambridge University Press: 24 July 2019
Invasive neuromonitoring is fast becoming an integral part of neurocritical care due to its capability and role in identifying risk for secondary injury and patient deterioration. Care of the brain-injured patient that utilizes only systemic therapeutic parameters and generalized patient goals has been shown to result in unacceptable rates of delayed brain injury . Traditional signs of injury, such as examination changes and hemodynamic variation, are important but insensitive and late markers of irreversible damage, and are preceded by subclinical edema, inflammation, ischemia, and free radical production by hours and sometimes days . Current neuromonitoring devices are capable of assessing risks for deterioration by measurement of the uptake, delivery, or utilization of brain metabolites at a time when therapeutic intervention is possible.