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Chapter 2 - Multimodal Neurological Monitoring

Published online by Cambridge University Press:  28 April 2020

Andrew B. Leibowitz
Affiliation:
Icahn School of Medicine at Mount Sinai
Suzan Uysal
Affiliation:
Icahn School of Medicine at Mount Sinai
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Summary

In this chapter the basic principles of neuromonitoring will be reviewed. Evidence-based applications, advantages, and disadvantages of various invasive and noninvasive techniques for monitoring intracranial pressure, brain tissue oxygenation, cerebral blood flow, brain metabolism, electroencephalography, and evoked potentials will be covered.

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Publisher: Cambridge University Press
Print publication year: 2020

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References

Jones, RF, Dorsch, NW, Silverberg, GD, Torda, TA. Pathophysiology and management of raised intracranial pressure. Anaesth Intensive Care 1981;9:336–51.CrossRefGoogle ScholarPubMed
Kirkman, MA, Smith, M. Intracranial pressure monitoring, cerebral perfusion pressure estimation, and ICP/CPP-guided therapy: a standard of care or optional extra after brain injury? Br J Anaesth 2014;112:3546.CrossRefGoogle ScholarPubMed
Treggiari, MM, Schutz, N, Yanez, ND, Romand, JA. Role of intracranial pressure values and patterns in predicting outcome in traumatic brain injury: a systematic review. Neurocrit Care 2007;6:104–12.CrossRefGoogle ScholarPubMed
Muizelaar, JP, Wei, EP, Kontos, HA, Becker, DP. Mannitol causes compensatory cerebral vasoconstriction and vasodilation in response to blood viscosity changes. J Neurosurg 1983;59:822–8.CrossRefGoogle ScholarPubMed
Akbik, OS, Carlson, AP, Krasberg, M, Yonas, H. The utility of cerebral blood flow assessment in TBI. Curr Neurol Neurosci Rep 2016;16:72.CrossRefGoogle ScholarPubMed
Brain Trauma, Foundation. Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma 2007;24 Suppl 1:S3744.Google Scholar
Carney, N, et al. Guidelines for the management of severe traumatic brain injury, Fourth Edition. Neurosurgery 2017;80:615.CrossRefGoogle ScholarPubMed
Bederson, JB, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the stroke council, American Heart Association. Stroke 2009;40:9941025.CrossRefGoogle ScholarPubMed
Steiner, T, Al-Shahi Salman, R, Christensen, H, et al. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke 2014;9:840–55.Google ScholarPubMed
Bathala, L, Mehndiratta, MM, Sharma, VK. Transcranial Doppler: technique and common findings (part 1). Ann Indian Acad Neurol 2013;16:174–9.Google Scholar
Cardim, D, Robba, C, Bohdanowicz, M, et al. Non-invasive monitoring of intracranial pressure using transcranial Doppler ultrasonography: is it possible? Neurocrit Care 2016;25:473–91.Google Scholar
Rajajee, V, Vanaman, M, Fletcher, JJ, Jacobs, TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care 2011;15:506–15.CrossRefGoogle ScholarPubMed
Robba, C, Santori, G, Czosnyka M, et al. Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis. Intensive Care Med 2018;44:1284–94.Google Scholar
Suarez, JI, Qureshi, AI, Yahia, AB, et al. Symptomatic vasospasm diagnosis after subarachnoid hemorrhage: evaluation of transcranial Doppler ultrasound and cerebral angiography as related to compromised vascular distribution. Crit Care Med 2002;30:1348–55.Google Scholar
Vajkoczy, P, Roth, H, Horn, P, et al. Continuous monitoring of regional cerebral blood flow: experimental and clinical validation of a novel thermal diffusion microprobe. J Neurosurg 2000;93: 265–74.CrossRefGoogle ScholarPubMed
Al-Mufti, F, Amuluru, K, Damodara, N, et al. Novel management strategies for medically-refractory vasospasm following aneurysmal subarachnoid hemorrhage. J Neurol Sci 2018;390:4451.CrossRefGoogle ScholarPubMed
Ko, SB, Choi, HA, Parikh, G, et al. Real time estimation of brain water content in comatose patients. Ann Neurol 2012;72:344–50.Google Scholar
Lindegaard, KF, Nornes, H, Bakke, SJ, Sorteberg, W, Nakstad, P. Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir (Wien) 1989;100:1224.CrossRefGoogle ScholarPubMed
Robertson, CS, Gopinath, SP, Goodman, JC, et al. SjvO2 monitoring in head-injured patients. J Neurotrauma 1995;12:891–6.Google Scholar
Schell, RM, Cole, DJ. Cerebral monitoring: jugular venous oximetry. Anesth Analg 2000;90:559–66.Google Scholar
Siegemund, M, van Bommel, J, Ince, C. Assessment of regional tissue oxygenation. Intensive Care Med 1999;25:1044–60.CrossRefGoogle ScholarPubMed
Francoeur, CL, Pain, M, Mayer, SA. Multimodality monitoring: illuminating the Comatose Human Brain. Semin Neurol 2016;36:560–9.Google Scholar
Bohman, LE, Pisapia, JM, Sanborn, MR, et al. Response of brain oxygen to therapy correlates with long-term outcome after subarachnoid hemorrhage. Neurocrit Care 2013;19:320–8.CrossRefGoogle ScholarPubMed
Hlatky, R, Valadka, AB, Gopinath, SP, Robertson, CS. Brain tissue oxygen tension response to induced hyperoxia reduced in hypoperfused brain. J Neurosurg 2008;108:53–8.CrossRefGoogle ScholarPubMed
Nangunoori, R, Maloney-Wilensky, E, Stiefel, M, et al. Brain tissue oxygen-based therapy and outcome after severe traumatic brain injury: a systematic literature review. Neurocrit Care 2012;17:131–8.Google Scholar
Johnston, AJ, Steiner, LA, Coles, JP, et al. Effect of cerebral perfusion pressure augmentation on regional oxygenation and metabolism after head injury. Crit Care Med 2005;33:189–95; discussion 255–187.CrossRefGoogle ScholarPubMed
Oddo, M, Levine, JM, Mackenzie, L, et al. Brain hypoxia is associated with short-term outcome after severe traumatic brain injury independently of intracranial hypertension and low cerebral perfusion pressure. Neurosurgery 2011;69:1037–45; discussion 1045.Google Scholar
Naidech, AM, Bendok, BR, Ault, ML, Bleck, TP. Monitoring with the somanetics INVOS 5100C after aneurysmal subarachnoid hemorrhage. Neurocrit Care 2008;9:326–31.Google Scholar
Rosenthal, G, Furmanov, A, Itshayek, E, Shoshan, Y, Singh, V. Assessment of a noninvasive cerebral oxygenation monitor in patients with severe traumatic brain injury. J Neurosurg 2014;120:901–7.Google Scholar
Jaeger, M, Dengl, M, Meixensberger, J, Schuhmann, MU. Effects of cerebrovascular pressure reactivity-guided optimization of cerebral perfusion pressure on brain tissue oxygenation after traumatic brain injury. Crit Care Med 2010;38:1343–7.Google Scholar
Jaeger, M, Schuhmann, MU, Soehle, M, Meixensberger, J. Continuous assessment of cerebrovascular autoregulation after traumatic brain injury using brain tissue oxygen pressure reactivity. Crit Care Med 2006;34:1783–8.Google Scholar
Czosnyka, M, Smielewski, P, Piechnik, S, Steiner, LA, Pickard, JD. Cerebral autoregulation following head injury. J Neurosurg 2001;95:756–63.Google Scholar
Zeiler, FA, Thelin, EP, Helmy, A, et al. A systematic review of cerebral microdialysis and outcomes in TBI: relationships to patient functional outcome, neurophysiologic measures, and tissue outcome. Acta Neurochir (Wien) 2017;159:2245–73.Google Scholar
Sahuquillo, J, Merino, MA, Sánchez-Guerrero, A, et al. Lactate and the lactate-to-pyruvate molar ratio cannot be used as independent biomarkers for monitoring brain energetic metabolism: a microdialysis study in patients with traumatic brain injuries. PLoS One 2014;9:e102540.Google Scholar
Hlatky, R, Valadka, AB, Goodman, JC, Contant, CF, Robertson, CS. Patterns of energy substrates during ischemia measured in the brain by microdialysis. J Neurotrauma 2004;21:894906.Google Scholar
Helbok, R, Schmidt, JM, Kurtz, P, et al. Systemic glucose and brain energy metabolism after subarachnoid hemorrhage. Neurocrit Care 2010;12:317–23.CrossRefGoogle ScholarPubMed
Hillered, L, Vespa, PM, Hovda, DA. Translational neurochemical research in acute human brain injury: the current status and potential future for cerebral microdialysis. J Neurotrauma 2005;22:341.Google Scholar
Vespa, P, Prins, M, Ronne-Engstrom, E, et al. Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study. J Neurosurg 1998;89:971–82.Google Scholar
Sarrafzadeh, AS, Sakowitz, OW, Kiening, KL, et al. Bedside microdialysis: a tool to monitor cerebral metabolism in subarachnoid hemorrhage patients? Crit Care Med 2002;30:1062–70.Google Scholar
Sarrafzadeh, A, Haux, D, Kuchler, I, Lanksch, WR, Unterberg, AW. Poor-grade aneurysmal subarachnoid hemorrhage: relationship of cerebral metabolism to outcome. J Neurosurg 2004;100: 400–6.Google Scholar
Skjoth-Rasmussen, J, Schulz, M, Kristensen, SR, Bjerre, P. Delayed neurological deficits detected by an ischemic pattern in the extracellular cerebral metabolites in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 2004;100:815.Google Scholar
Ferguson, M, Bianchi, MT, Sutter, R, et al. Calculating the risk benefit equation for aggressive treatment of non-convulsive status epilepticus. Neurocrit Care 2013;18:216–27.CrossRefGoogle ScholarPubMed
Caricato, A, Melchionda, I, Antonelli, M. Continuous electroencephalography monitoring in adults in the intensive care unit. Crit Care 2018;22:75.Google Scholar
Herman, ST, et al. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol 2015;32:8795.CrossRefGoogle ScholarPubMed
Claassen, J, Mayer, SA, Kowalski, RG, Emerson, RG, Hirsch, LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004;62:1743–8.Google Scholar
Farrokh, S, Tahsili-Fahadan, P, Ritzl, EK, Lewin, JJ 3rd, Mirski, MA. Antiepileptic drugs in critically ill patients. Crit Care 2018;22:153.CrossRefGoogle ScholarPubMed
Chang, SH, Park, YG, Kim, DH, Yoon, SY. Monitoring of motor and somatosensory evoked potentials during spine surgery: intraoperative changes and postoperative outcomes. Ann Rehabil Med 2016;40:470–80.Google Scholar
Rosenthal, ES. The utility of EEG, SSEP, and other neurophysiologic tools to guide neurocritical care. Neurotherapeutics 2012;9:2436.CrossRefGoogle ScholarPubMed
Sanchez-Pinto, LN, Luo, Y, Churpek, MM. Big data and data science in critical care. Chest 2018;154:1239–48.Google Scholar
Yang, S, Stansbury, LG, Rock, P, Scalea, T, Hu, PF. Linking big data and prediction strategies: tools, pitfalls, and lessons learned. Crit Care Med 2019;47(6):840–8.Google Scholar
Learning Health Systems | Agency for Healthcare Research & Quality www.ahrq.gov/professionals/systems/learning-health-systems/index.html (2019).Google Scholar
Li, P, Xie, C, Pollard, T, et al. Promoting secondary analysis of electronic medical records in China: summary of the PLAGH-MIT critical data conference and health Datathon. JMIR Med Inform 2017;5:e43.CrossRefGoogle Scholar
Flechet, M, Grandas, FG, Meyfroidt, G. Informatics in neurocritical care: new ideas for Big Data. Curr Opin Crit Care 2016;22:8793.Google ScholarPubMed
ICM+ Features | Cambridge Enterprise ICM+., https://icmplus.neurosurg.cam.ac.uk/home/icm-features/ (2018).Google Scholar
Johnson, AE, Pollard, TJ, Shen, L, et al. MIMIC-III, a freely accessible critical care database. Sci Data 2016;3:160035.Google Scholar
Saeed, M, Villarroel, M, Reisner, AT, et al. Multiparameter intelligent monitoring in intensive care II: a public access intensive care unit database. Crit Care Med 2011;39:952–60.Google Scholar
Maas, AI, Menon, DK, Steyerberg, EW, et al. Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study. Neurosurgery 2015;76:6780.CrossRefGoogle ScholarPubMed
Multimodal Data Integration – Moberg ICU Solutions: Transforming Neurocritical Care., www.moberg.com/solutions/multimodal-data-integration (2018).Google Scholar

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