Multimodality Monitoring in the Neurocritical Care Unit

Lucia Rivera Lara, MD, MPH; Hans Adrian Püttgen, MD p. 1776-1788 December 2018, Vol.24, No.6 doi: 10.1212/CON.0000000000000671
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PURPOSE OF REVIEW: This article focuses on the multiple neuromonitoring devices that can be used to collect bedside data in the neurocritical care unit and the methodology to integrate them into a multimodality monitoring system. The article describes how to apply the collected data to appreciate the physiologic changes and develop therapeutic approaches to prevent secondary injury.

RECENT FINDINGS: The neurologic examination has served as the primary monitor for secondary brain injury in patients admitted to the neurocritical care unit. However, the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care concluded that frequent bedside examinations are not sufficient to detect and prevent secondary brain injury and that integration of multimodality monitoring with advanced informatics tools will most likely enhance our assessments compared to the clinical examinations alone. This article reviews the invasive and noninvasive technologies used to monitor focal and global neurophysiologic cerebral alterations.

SUMMARY: Multimodal monitoring is still in the early stages of development. Research is still needed to establish more advanced monitors with the bioinformatics to identify useful trends from data gathered to predict clinical outcome or prevent secondary brain injury.

Address correspondence to Dr Lucia Rivera Lara, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD 21224, lriver14@jhmi.edu.

RELATIONSHIP DISCLOSURE: Dr Rivera Lara has received research/grant support from Covidien Ltd/Medtronic; the Johns Hopkins Anesthesiology and Critical Care Medicine (ACCM) Stimulating and Advancing ACCM Research (StAAR) award; and Ornim, Inc. Dr Püttgen reports no disclosure.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Rivera Lara and Püttgen discuss the unlabeled/investigational use of near-infrared spectroscopy as a surrogate of cerebral blood flow to measure cerebral autoregulation.

CONTINUUM AUDIO INTERVIEW AVAILABLE ONLINE

© 2018 American Academy of Neurology